Log-Transformed TSH–Thyroglobulin Product as a Predictor of Placenta Previa and Placental Abruption

Maja Avramovska 1, Petar Jovan Avramovski 2 * , Liljana Todorovska 3, Zorica Nikleski 4, Kosta Sotiroski 5, Dejan Zdraveski 6, Biljana Ilkovska 7, Biljana Taleva 8
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1 Department of Obstetrics and Gynecology Clinical Hospital D-r Trifun Panovski, North Macedonia
2 Department of Internal Medicine, Clinical Hospital D-r Trifun Panovski, Bitola, North Macedonia
3 Department of Nuclear Medicine, Clinical Hospital “D-r Trifun Panovski” – Bitola, Bitola, North Macedonia
4 Medico-Legal Department, MedAssess, Sydney, New South Wales, Australia
5 Department of Statistics, University St. Clement of Ohrid, Bitola, Faculty of Economics – Prilep, North Macedonia
6 Head of the Second Cycle of Studies, University St. Clement of Ohrid, Bitola, Faculty of Economics – Prilep, North Macedonia
7 Head of department of medical biochemistry, Clinical Hospital "D-r Trifun Panovski", Bitola, North Macedonia
8 Department of Children Surgery, “Mother Teresa Clinical Center – Skopje”, Skopje, North Macedonia
* Corresponding Author
J CLIN MED KAZ, In press. https://doi.org/10.23950/jcmk/17940
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Author Contributions: 
M. A., the lead physician, oversaw participant selection, study implementation, and medical history analysis. She identified pathophysiological links between bone health and arterial stiffness, supported findings with references, ensured data analysis aligned with results, and critically reviewed the manuscript for scientific rigor. She also conducted a comprehensive literature review and played a key role in the study’s conception, data analysis, and discussion. 
P. A. contributed to data organization, statistical validation, and ensuring methodological accuracy. He assisted in refining the discussion by integrating relevant findings and enhancing the manuscript's clarity and coherence. 
L. T., contributed by analyzing diagnostic imaging, interpreting data, and ensuring accurate result interpretation. She also managed data organization in Excel, enhancing the clarity and reliability of the findings. 
B. T. contributed by sourcing relevant literature, refining the discussion, enhancing tables, and improving language, spelling, and grammar. 
K. S. applied statistical methods, interpreted results, and provided key insights, ensuring a strong data-driven foundation for the study. 
D. Z., an informatics and cloud expert, managed data collection, storage, and processing. He supervised statistical methods and contributed to result interpretation in the discussion. All authors collaborated actively in writing, reviewing, and finalizing the manuscript. All authors collaborated in writing, reviewing, and reaching a unanimous consensus on the final manuscript.

Data availability statement: The data supporting the findings of this clinical study are included within the manuscript. Due to the sensitive nature of patient’s information, additional data will not be made publicly available to maintain patient confidentiality. Specific data requests will be evaluated on a case-by-case basis, with consideration of ethical and privacy requirements.

Patient Informed Consent Statement: Written informed consent was obtained from all participants involved in the study, ensuring they understood the study’s purpose, procedures, and their right to confidentiality.

Artificial Intelligence (AI) Disclosure Statement: AI-Unassisted Work.

ABSTRACT

Introduction: Thyroid hormones are essential for placental development, and subtle disruptions may contribute to placenta previa (PP) and placental abruption (PA). This study evaluated thyroid hormone levels and derived log ratios to identify associations with delivery outcomes and predictors of PP/PA.
Methods: In this prospective study, 347 singleton pregnancies at a tertiary obstetric center were included, excluding women with thyroid or chronic disease, smoking, thyroid-affecting medications, or fetal anomalies. Maternal demographic and obstetric data were collected from medical records. Dried blood spot samples were analyzed for thyroid-stimulating hormone (TSH), total thyroxine (TT4), and thyroglobulin (Tg), and urinary iodine concentration (UIC) was measured. Derived thyroid hormone log ratios—including TSH/TT4, TT4/Tg, TSH∙Tg, UIC/TT4 were calculated.
Results: Correlations with PP/PA were: TSH (0.50 mU/L; r = –0.123, p = 0.022), Tg (9.42 µg/L; r = –0.119, p = 0.027), log(TSH/TT4) (–2.359 ± 0.283; r = –0.168, p = 0.002), log(TT4/Tg) (1.063±0.366; r = 0.187, p = 0.0005), log(TSH·Tg) (0.574±0.511; r = –0.216, p < 0.001). Logistic regression: log(TSH·Tg) [OR (odds ratio) = 0.16, p = 0.016; log(UIC/TT4) OR = 0.01, p = 0.055. Receiver operating characteristic analysis showed area under the curve 0.857, sensitivity/specificity pair = 100%/61.2% at cutoff < 0.4958, criterion = 0.4958.
Conclusions: Log(TSH·Tg) is a strong independent predictor of PP/PA with high sensitivity and moderate specificity. It outperforms individual thyroid measures and may support early risk stratification by reflecting subtle maternal thyroid dysregulation affecting placental development.
Keywords: Logarithm of thyroid hormones, adjusted predictor for Placenta Previa, Placental Abruption, Thyroid derived ratios, Thyroid-Stimulating Hormone.

CITATION

Avramovska M, Avramovski PJ, Todorovska L, Nikleski Z, Sotiroski K, Zdraveski D, et al. Log-Transformed TSH–Thyroglobulin Product as a Predictor of Placenta Previa and Placental Abruption. J Clin Med Kaz. 2026. https://doi.org/10.23950/jcmk/17940

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