<?xml version="1.0" encoding="UTF-8" standalone="no"?>
<!DOCTYPE article PUBLIC "-//NLM//DTD Journal Publishing DTD v2.3 20070202//EN" "journalpublishing.dtd">
<article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" article-type="review-article" dtd-version="2.3" xml:lang="EN">
<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Cell. Infect. Microbiol.</journal-id>
<journal-title>Frontiers in Cellular and Infection Microbiology</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Cell. Infect. Microbiol.</abbrev-journal-title>
<issn pub-type="epub">2235-2988</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3389/fcimb.2024.1361660</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Cellular and Infection Microbiology</subject>
<subj-group>
<subject>Review</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>The impact of gut microbiota on autoimmune thyroiditis and relationship with pregnancy outcomes: a review</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Song</surname>
<given-names>Yu</given-names>
</name>
<uri xlink:href="https://loop.frontiersin.org/people/2304865"/>
<role content-type="https://credit.niso.org/contributor-roles/writing-original-draft/"/>
<role content-type="https://credit.niso.org/contributor-roles/writing-review-editing/"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Bai</surname>
<given-names>Yu</given-names>
</name>
<role content-type="https://credit.niso.org/contributor-roles/writing-review-editing/"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Liu</surname>
<given-names>Cong</given-names>
</name>
<role content-type="https://credit.niso.org/contributor-roles/writing-review-editing/"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Zhai</surname>
<given-names>Xiaodan</given-names>
</name>
<role content-type="https://credit.niso.org/contributor-roles/writing-review-editing/"/>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name>
<surname>Zhang</surname>
<given-names>Le</given-names>
</name>
<xref ref-type="author-notes" rid="fn001">
<sup>*</sup>
</xref>
<role content-type="https://credit.niso.org/contributor-roles/writing-review-editing/"/>
</contrib>
</contrib-group>
<aff id="aff1">
<institution>Department of Endocrinology, Shengjing Hospital of China Medical University</institution>, <addr-line>Shenyang, Liaoning</addr-line>, <country>China</country>
</aff>
<author-notes>
<fn fn-type="edited-by">
<p>Edited by: Xiangtian Yu, Shanghai Jiao Tong University, China</p>
</fn>
<fn fn-type="edited-by">
<p>Reviewed by: Shigefumi Okamoto, Osaka University, Japan</p>
<p>Xin Sun, The First Affiliated Hospital of Soochow University, China</p>
</fn>
<fn fn-type="corresp" id="fn001">
<p>*Correspondence: Le Zhang, <email xlink:href="mailto:zhangle198626@163.com">zhangle198626@163.com</email>
</p>
</fn>
</author-notes>
<pub-date pub-type="epub">
<day>05</day>
<month>03</month>
<year>2024</year>
</pub-date>
<pub-date pub-type="collection">
<year>2024</year>
</pub-date>
<volume>14</volume>
<elocation-id>1361660</elocation-id>
<history>
<date date-type="received">
<day>26</day>
<month>12</month>
<year>2023</year>
</date>
<date date-type="accepted">
<day>19</day>
<month>02</month>
<year>2024</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#xa9; 2024 Song, Bai, Liu, Zhai and Zhang</copyright-statement>
<copyright-year>2024</copyright-year>
<copyright-holder>Song, Bai, Liu, Zhai and Zhang</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/">
<p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</p>
</license>
</permissions>
<abstract>
<p>Autoimmune thyroiditis (AITD) is a T-cell-mediated, organ- specific autoimmune disease caused by interactions between genetic and environmental factors. Patients with AITD show thyroid lymphocyte infiltration and an increase in the titer of thyroid autoimmune antibodies, thereby altering the integrity of thyroid follicle epithelial cells and dysregulating their metabolism and immune function, leading to a decrease in multi-tissue metabolic activity. Research has shown that patients with AITD have a significantly higher risk of adverse pregnancy outcomes, such as infertility and miscarriage. Levothyroxine(LT<sub>4</sub>) treatment can improve the pregnancy outcomes of normal pregnant women with thyroid peroxidase antibodies(TPOAb) positivity, but it is not effective for invitro fertilization embryo transfer (IVF-ET) in women with normal thyroid function and positive TPOAb. Other factors may also influence pregnancy outcomes of patients with AITD. Recent studies have revealed that the gut microbiota participates in the occurrence and development of AITD by influencing the gut-thyroid axis. The bacterial abundance and diversity of patients with Hashimoto thyroiditis (HT) were significantly reduced, and the relative abundances of <italic>Bacteroides</italic>, <italic>fecal Bacillus</italic>, <italic>Prevotella</italic>, and <italic>Lactobacillus</italic> also decreased. The confirmation of whether adjusting the composition of the gut microbiota can improve pregnancy outcomes in patients with AITD is still pending. This article reviews the characteristics of the gut microbiota in patients with AITD and the current research on its impact in pregnancy.</p>
</abstract>
<kwd-group>
<kwd>autoimmune thyroiditis</kwd>
<kwd>AITD</kwd>
<kwd>TPOAb</kwd>
<kwd>gut microbiota</kwd>
<kwd>pregnancy outcomes</kwd>
</kwd-group>
<counts>
<fig-count count="1"/>
<table-count count="2"/>
<equation-count count="0"/>
<ref-count count="79"/>
<page-count count="9"/>
<word-count count="4036"/>
</counts>
<custom-meta-wrap>
<custom-meta>
<meta-name>section-in-acceptance</meta-name>
<meta-value>Intestinal Microbiome</meta-value>
</custom-meta>
</custom-meta-wrap>
</article-meta>
</front>
<body>
<sec id="s1">
<label>1</label>
<title>Background</title>
<p>Autoimmune thyroiditis (AITD) is a T-cell-mediated, organ-specific autoimmune disease that mainly manifests as Hashimoto&#x2019;s thyroiditis (HT) and Graves&#x2019; disease (GD) (<xref ref-type="bibr" rid="B4">Antonelli et&#xa0;al., 2015</xref>). The incidence rate of AITD is approximately 5%, and is more common in women of childbearing age (<xref ref-type="bibr" rid="B36">Lee et&#xa0;al., 2015</xref>). It is accompanied by lymphocyte infiltration and elevated titers of thyroid autoimmune antibodies, such as thyroid peroxidase antibodies (TPOAb) and thyroid globulin antibodies (TgAb) (<xref ref-type="bibr" rid="B18">Fr&#xf6;hlich and Wahl, 2017</xref>), which are associated with varying degrees of hypothyroidism (<xref ref-type="bibr" rid="B8">Caturegli et&#xa0;al., 2014</xref>). Infiltrating lymphocytes can directly produce cytotoxicity in thyroid follicular cells or may indirectly affect their vitality and function through cytokines; this alters cell integrity and dysregulates their metabolism and immune function, leading to thyroid gland enlargement, gland fibrosis, decreased thyroid hormone (TH) levels, and ultimately reduced metabolic activity in multiple tissues (<xref ref-type="bibr" rid="B2">Ajjan and Weetman, 2015</xref>; <xref ref-type="bibr" rid="B47">Mori et&#xa0;al., 2012</xref>). It can cause a decrease in cardiovascular contractility and intestinal activity, coronary artery disease, hyperlipidemia, infertility, and neurosensory and musculoskeletal changes (<xref ref-type="bibr" rid="B10">Chaker et&#xa0;al., 2017</xref>).Therefore, it is crucial to reduce the incidence of AITD.</p>
<p>The etiology of AITD remains unclear. Epidemiological studies have shown that AITD is caused by interactions between genetic and environmental factors (<xref ref-type="bibr" rid="B66">Taylor et&#xa0;al., 2018</xref>). Genetic susceptibility plays a crucial role in autoimmune disorders, and immune modification genes (such as human leukocyte antigen classes I and II) and sites related to cytotoxic T lymphocyte-associated protein 4 (CTLA-4) may be involved in the autoimmune process. The interactions between these gene loci and environmental factors may affect the phenotype and severity of HT (<xref ref-type="bibr" rid="B2">Ajjan and Weetman, 2015</xref>). Environmental factors that may trigger the development of AITD include excessive iodine intake; deficiencies in selenium, iron, zinc, and vitamin D; intake of gluten (<xref ref-type="bibr" rid="B39">Liontiris and Mazokopakis, 2017</xref>), and alcohol; excessive stress; pregnancy; and the use of interferon, key immune modulators, such as iprimumab and alenzumab (<xref ref-type="bibr" rid="B68">Topliss, 2016</xref>).However, a study has found that smoking can reduce the risk of AITD (<xref ref-type="bibr" rid="B16">Effraimidis and Wiersinga, 2014</xref>). Recently, extensive research has indicated that the gut microbiota may play an important role in triggering AITD (<xref ref-type="bibr" rid="B31">K&#xf6;hling et&#xa0;al., 2017</xref>), thus providing new ideas for treating AITD.</p>
</sec>
<sec id="s2">
<label>2</label>
<title>The correlation between AITD and gut microbiota</title>
<sec id="s2_1">
<label>2.1</label>
<title>Gut microbiota</title>
<p>Gut microbiota is a general term for the microorganisms that parasitize the human intestine. It comprises bacteria, fungi, viruses, and archaea, with bacteria accounting for the majority. There are approximately 2000 species of gut microbiota, and more than 100 species have been identified by phylum classification. The main phylum categories include Firmicutes, Bacteroidetes, Proteobacteria, Actinobacteria, and Verrucomycetes (<xref ref-type="bibr" rid="B22">Hardin et&#xa0;al., 2019</xref>). Among them, Firmicutes and Bacteroidetes account for &gt; 90% of gut microbiota. The Firmicutes phylum has the highest number of bacteria, consisting of over 200 genera, including Lactobacillus, Mycoplasma, Bacillus, and Clostridium. The phylum Bacteroidetes includes more than 20 genera (<xref ref-type="bibr" rid="B6">Benson et&#xa0;al., 2010</xref>).</p>
<p>The gut microbiota undergoes corresponding changes owing to factors such as host genetics, diet, and environment, which can promote the growth of pathogenic bacteria (<xref ref-type="bibr" rid="B26">Kashtanova et&#xa0;al., 2016</xref>). Dysfunction of the gut microbiota not only causes a variety of gastrointestinal diseases, such as diarrhea, constipation, and enteritis, but can also induce chronic diseases, such as obesity, cardiovascular disease, diabetes, and metabolic syndrome (<xref ref-type="bibr" rid="B45">Marchesi et&#xa0;al., 2016</xref>; <xref ref-type="bibr" rid="B11">Cho and Blaser, 2012</xref>). Recent research has also shown that the intestinal flora and its metabolites may play a key role in the regulation of the immune system response and the development of autoimmune diseases, such as rheumatoid arthritis (RA) (<xref ref-type="bibr" rid="B64">Sun et&#xa0;al., 2019</xref>),multiple sclerosis (MS) (<xref ref-type="bibr" rid="B7">Cantoni et&#xa0;al., 2022</xref>), systemic lupus erythematosus(SLE) (<xref ref-type="bibr" rid="B43">Luo et&#xa0;al., 2018</xref>), type 1 diabetes(T1D) (<xref ref-type="bibr" rid="B30">Knip and Honkanen, 2017</xref>), and HT (<xref ref-type="bibr" rid="B5">Belvoncikova et&#xa0;al., 2022</xref>). The abundance of <italic>Prevotella</italic> in the feces of RA patients is higher (<xref ref-type="bibr" rid="B3">Alpizar-Rodriguez et&#xa0;al., 2019</xref>), and the genera <italic>Faecalibacterium</italic> and <italic>Bacteroides</italic> are reduced (<xref ref-type="bibr" rid="B44">Maeda and Takeda, 2019</xref>). <italic>Prevotella</italic> and <italic>Pseudomonas</italic> typically shows a decrease in the feces of patients with MS (<xref ref-type="bibr" rid="B46">Miyake et&#xa0;al., 2015</xref>), while the <italic>Akkermansia muciniphila</italic> typically increase (<xref ref-type="bibr" rid="B73">Ventura et&#xa0;al., 2019</xref>). Gut microbial diversity is significantly lower in patients with SLE with active disease than in non-SLE controls (<xref ref-type="bibr" rid="B43">Luo et&#xa0;al., 2018</xref>). In SLE patients, the relative abundance of <italic>Firmicutes</italic> decreased compared to the non-SLE controls, while <italic>Bacteroidetes</italic> increased (<xref ref-type="bibr" rid="B23">Hevia et&#xa0;al., 2014</xref>). A study conducted by Knip et&#xa0;al., to explore the relationship between gut microbiota and T1D, showed that children with positive islet-autoantibodies had a higher Bacteroidetes/Firmicutes ratio and lower Shannon diversity in the gut microbiota (<xref ref-type="bibr" rid="B30">Knip and Honkanen, 2017</xref>).</p>
</sec>
<sec id="s2_2">
<label>2.2</label>
<title>Characteristics of gut microbiota in patients with AITD</title>
<p>As shown in <xref ref-type="table" rid="T1">
<bold>Table&#xa0;1</bold>
</xref>, some studies have proposed compositional modifications and bacterial ecological imbalances arise in the gut microbiota of patients with AITD, indicating that specific bacterial overgrowth and its impact on the gut-thyroid axis may play key roles in the occurrence and progression of AITD (<xref ref-type="bibr" rid="B29">Knezevic et&#xa0;al., 2020</xref>). This cross-sectional study compared 45 patients with HT of normal thyroid function (HTN), 18 patients with HT of hypothyroid status (HTH), and 34 healthy controls (CON). The bacterial abundance and diversity in patients with HTN and HTH were significantly lower than those in the healthy group, and patients with HTH showed the lowest intestinal microbial abundance (<xref ref-type="bibr" rid="B41">Liu et&#xa0;al., 2020a</xref>).</p>
<table-wrap id="T1" position="float">
<label>Table&#xa0;1</label>
<caption>
<p>Characteristics of gut microbiota in patients with autoimmune thyroid disease.</p>
</caption>
<table frame="hsides">
<thead>
<tr>
<th valign="middle" rowspan="2" align="center">Number</th>
<th valign="middle" rowspan="2" align="center">Country</th>
<th valign="middle" rowspan="2" align="center">Reference</th>
<th valign="middle" rowspan="2" align="center">Period</th>
<th valign="middle" colspan="4" align="center">Size</th>
<th valign="middle" colspan="2" align="center">Result</th>
</tr>
<tr>
<th valign="middle" align="center">GD</th>
<th valign="middle" align="center">HTN</th>
<th valign="middle" align="center">HTH</th>
<th valign="middle" align="center">CON</th>
<th valign="middle" align="center">Bacterial abundance</th>
<th valign="middle" align="center">Specific differences in the microbiota</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="middle" align="left">1</td>
<td valign="middle" align="left">China</td>
<td valign="middle" align="left">
<xref ref-type="bibr" rid="B41">Liu et&#xa0;al., 2020a</xref>
</td>
<td valign="middle" align="left">2020</td>
<td valign="middle" align="left">&#x2013;</td>
<td valign="middle" align="left">45</td>
<td valign="middle" align="left">18</td>
<td valign="middle" align="left">34</td>
<td valign="middle" align="left">The microbial richness of gut microbiota in HT patients was significantly lower than in the control group. HT patients with hypothyroidism exhibited the least gut microbial abundance.</td>
<td valign="middle" align="left">HT patients with euthyroidism have more Lachnospiraceae_incertae_sedis, Lactonifactor, Alistipes, and Subdoligranulum, while HT with hypothyroidism have more Phascolarctobacterium.Phascolarctobacterium may be involved in the progression of HT in humans.</td>
</tr>
<tr>
<td valign="middle" align="left">2</td>
<td valign="middle" align="left">China</td>
<td valign="middle" align="left">
<xref ref-type="bibr" rid="B77">Zhao et&#xa0;al., 2018</xref>
</td>
<td valign="middle" align="left">2018</td>
<td valign="middle" align="left">&#x2013;</td>
<td valign="middle" align="left">28</td>
<td valign="middle" align="left">&#x2013;</td>
<td valign="middle" align="left">16</td>
<td valign="middle" align="left">Similar levels of bacterial richness and diversity were found in the gut microbiota of HT patients and healthy controls.</td>
<td valign="middle" align="left">The abundance levels of Blautia, Roseburia, Ruminococcus_torques_group, Romboutsia, Dorea, Fusicatenibacter, and Eubacterium_hallii_group genera were increased in HT patients, whereas the abundance levels of Fecalibacterium, Bacteroides, Prevotella_9, and Lachnoclostridium genera were decreased.</td>
</tr>
<tr>
<td valign="middle" align="left">3</td>
<td valign="middle" align="left">China</td>
<td valign="middle" align="left">
<xref ref-type="bibr" rid="B78">Zhao et&#xa0;al., 2022</xref>
</td>
<td valign="middle" align="left">2022</td>
<td valign="middle" align="left">27</td>
<td valign="middle" align="left">&#x2013;</td>
<td valign="middle" align="left">16</td>
<td valign="middle" align="left">3</td>
<td valign="middle" align="left">The gut microbiota abundance and diversity in the GD and HT groups were similar to those in the healthy groups, but the overall structure was different.</td>
<td valign="middle" align="left">Compared to Graves&#x2019; disease patients, HT patients are more abundant in Firmicutes, and have less Bacteroides, more Proteobacteria and Actinobacteria than the normal control group.Bacillus, Blautia, and Ornithinimicrobium can be used as potential markers to distinguish GD and HT patients from the healthy people.</td>
</tr>
<tr>
<td valign="middle" align="left">4</td>
<td valign="middle" align="left">China</td>
<td valign="middle" align="left">
<xref ref-type="bibr" rid="B25">Ishaq et&#xa0;al., 2017</xref>
</td>
<td valign="middle" align="left">2017</td>
<td valign="middle" align="left">&#x2013;</td>
<td valign="middle" align="left">&#x2013;</td>
<td valign="middle" align="left">29</td>
<td valign="middle" align="left">12</td>
<td valign="middle" align="left">The richness and diversity of bacterial community were calculated at the 97% similarity level.The diversity elevation indicates a clear gut microbial overgrowth in patients group in contrast to healthy control.</td>
<td valign="middle" align="left">The abundance of Prevotella_9 and Dialister declines in HT group,while Escherichia-Shigella and Parasutterella elevate.At the species leve,it also showed an increased abundance of E. coli in HT.</td>
</tr>
</tbody>
</table>
</table-wrap>
<p>Sequencing analysis by Zhao et&#xa0;al. identified specific differences in the microbiota. The feces of patients with HT showed an increase in Firmicutes and Actinobacteria levels, whereas Bacteroides and Proteobacteria decreased. The ratio of Firmicutes to Bacteroides was significantly increased, and patients with HTN had a higher abundance and diversity of gut microbiota than the CON group (<xref ref-type="bibr" rid="B77">Zhao et&#xa0;al., 2018</xref>). A recent study found that compared to patients with Graves&#x2019; disease, patients with HT had more abundant Firmicutes, fewer Bacteroidetes, and more Proteobacteria and Actinobacteria levels than the normal control group (<xref ref-type="bibr" rid="B78">Zhao et&#xa0;al., 2022</xref>). Ishaq et&#xa0;al. also proposed that the relative abundance of Proteobacteria in the feces of patients with HT was significantly increased, whereas the relative abundance of Firmicutes and Bacteroidetes was decreased (<xref ref-type="bibr" rid="B25">Ishaq et&#xa0;al., 2017</xref>). These three studies found that the HT group had high levels of Spirochaetaceae, Enterobacteriaceae, Alcaligenaceae, Trichocomaceae, Erythrobacteraceae, and Bacteroidaceae. In contrast, the levels of <italic>Prevotella</italic>, <italic>Ruminococcus</italic>, and <italic>Vibrio</italic> were decreased in the HT group (<xref ref-type="bibr" rid="B77">Zhao et&#xa0;al., 2018</xref>; <xref ref-type="bibr" rid="B78">Zhao et&#xa0;al., 2022</xref>; <xref ref-type="bibr" rid="B25">Ishaq et&#xa0;al., 2017</xref>).</p>
<p>At the genus level, the relative abundances of <italic>Bacteroides</italic>, fecal <italic>Bacillus</italic>, <italic>Prevotella</italic>, and <italic>Lactobacillus</italic> in the fecal samples of patients with HT decreased, while the relative abundances of <italic>Blautia</italic>, <italic>Ruminococcus</italic>, <italic>Rose</italic>, <italic>Clostridium</italic>, <italic>Longbuti</italic>, <italic>Dorea</italic>, and <italic>Eubacterium</italic> increased significantly (<xref ref-type="bibr" rid="B77">Zhao et&#xa0;al., 2018</xref>). Studies have also suggested a decrease in Prevotella levels in the feces of patients with HT (<xref ref-type="bibr" rid="B25">Ishaq et&#xa0;al., 2017</xref>). A meta-analysis showed that the abundance of Firmicutes, Bifidobacteria, and Lactobacillus in patients with AITD was lower than that in healthy controls; patients with HT having slightly higher levels of Bacteroides than in other bacteria. These taxa are associated with clinical indicators, such as an altered host metabolism or TPOAb and TgAb positivity in the host (<xref ref-type="bibr" rid="B20">Gong et&#xa0;al., 2021</xref>). A cross-sectional study of 22 patients with HT and 11 healthy individuals conducted by Zhao et&#xa0;al. showed that 18 genera in the microbiota of patients with HT were positively correlated with TPOAb or TgAb, whereas six genera were negatively correlated. In addition, the Heterobacteria genus is positively correlated with free thyroxine, Clostridium genus is negatively correlated with free thyroxine, and Pleurotus genus is negatively correlated with serum thyrotropin (TSH) (<xref ref-type="bibr" rid="B77">Zhao et&#xa0;al., 2018</xref>).</p>
</sec>
<sec id="s2_3">
<label>2.3</label>
<title>The mechanism of gut microbiota affecting the development of AITD</title>
<p>As shown in <xref ref-type="fig" rid="f1">
<bold>Figure&#xa0;1</bold>
</xref>, extensive research has been conducted on the mechanism by which the gut microbiota affects AITD development. Minerals such as selenium, iron, and zinc have a significant impact on the interactions between the host and gut microbiota (<xref ref-type="bibr" rid="B29">Knezevic et&#xa0;al., 2020</xref>), which affect TH levels by regulating iodine uptake, degradation, and hepatic-intestinal circulation (<xref ref-type="bibr" rid="B19">Fr&#xf6;hlich and Wahl, 2019</xref>). The gut microbiota produces its own antigens through protein post-translational modifications, activates Toll-like receptor 4 induced by lipopolysaccharide (LPS), induces T helper cell translocation from type 1 (Th1) to type 2 (Th2), reduces the integrity of intercellular connections, and promotes AITD development through intestinal leakage (<xref ref-type="bibr" rid="B38">Lerner et&#xa0;al., 2017</xref>). Some scholars also believe that changes in gut microbiota occur through post-translational modifications of luminal proteins, the transition of the intestinal mucosa to a pro-inflammatory environment, intestinal ecological imbalances leading to damage of the intestinal barrier, antigen entry into the circulation, activation of the immune system antibodies in the circulation, which react with bacterial antigens to enhance inflammatory body activations in the thyroid gland, and excessive bacterial growth that participates in the development of autoimmune thyroiditis (<xref ref-type="bibr" rid="B48">Mu et&#xa0;al., 2017</xref>; <xref ref-type="bibr" rid="B9">Cayres et&#xa0;al., 2021</xref>; <xref ref-type="bibr" rid="B67">Tomasello et&#xa0;al., 2015</xref>). Another theory suggests that a decreased population of beneficial bacteria such as Lactobacillus and Bifidobacterium is related to the development of AITD. Lactobacillus has been proven to protect TH17 cells and support their barrier integrity by secreting IL-22 and IL-17. The Th17/Treg imbalance may cause inflammatory disorders, indicating that Lactobacillus participates in the immune system balance. Bifidobacterium and Lactobacillus exhibit anti-inflammatory effects and protect the body from pathogens. Moreover, increased Bacteroides fragilis may account for the upregulation of IL-18, IL-1&#x3b2;, and caspase-1, promoting an inflammatory response (<xref ref-type="bibr" rid="B28">Kiseleva et&#xa0;al., 2011</xref>). It has been proposed that bacterial strains participate in the development of HT by influencing glutathione and arachidonic acid metabolism, and purine and pyrimidine metabolism pathways; however, further validation is still needed (<xref ref-type="bibr" rid="B78">Zhao et&#xa0;al., 2022</xref>).</p>
<fig id="f1" position="float">
<label>Figure&#xa0;1</label>
<caption>
<p>The possible mechanism of gut microbiota affecting the development of AITD.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fcimb-14-1361660-g001.tif"/>
</fig>
</sec>
</sec>
<sec id="s3">
<label>3</label>
<title>The impact of AITD on pregnancy</title>
<p>Numerous studies have shown that AITD increases the risk of adverse pregnancy outcomes. Women may experience changes in hormone levels and metabolic needs during pregnancy, such as an increase demand for THs to meet the needs of fetal growth and brain development. Therefore, thyroid diseases are frequently observed during pregnancy (<xref ref-type="bibr" rid="B35">Krassas et&#xa0;al., 2010</xref>). Thyroid dysfunction during pregnancy can include overt hypothyroidism (OH) and subclinical hypothyroidism (SCH). The relative incidence rates of OH and SCH are approximately 0.3&#x2013;1.0% and 4.0&#x2013;17.8%, respectively (<xref ref-type="bibr" rid="B59">Shan and Wang, 2022</xref>). AITD is the main cause of hypothyroidism in pregnant women, with an average incidence of 7.8% (<xref ref-type="bibr" rid="B34">Krassas et&#xa0;al., 2015</xref>).</p>
<sec id="s3_1">
<label>3.1</label>
<title>AITD and infertility</title>
<p>The incidence of infertility in women with AITD is high, with a prevalence of 52.3% in patients with GD and 47.0% in patients with HT (<xref ref-type="bibr" rid="B55">Quintino-Moro et&#xa0;al., 2014</xref>). In a prospective study, 438 women with infertility and 100 healthy women in postpartum were compared, and it was found that the prevalence of TPOAb positivity was significantly higher among women with infertility factors than those of the healthy group (<xref ref-type="bibr" rid="B53">Poppe et&#xa0;al., 2002</xref>).</p>
</sec>
<sec id="s3_2">
<label>3.2</label>
<title>AITD and miscarriage</title>
<p>AITD is associated with recurrent miscarriage (RM). Some scholars believe that autoimmunity in women with AITD affects embryo implantation by inducing endometrial receptive defects (<xref ref-type="bibr" rid="B27">Kim et&#xa0;al., 2011</xref>; <xref ref-type="bibr" rid="B42">Liu et&#xa0;al., 2020b</xref>; <xref ref-type="bibr" rid="B75">Wu et&#xa0;al., 2019</xref>), leading to an increase in fetal miscarriages. Some scholars also believe that, in women affected by thyroid autoimmunity, the thyroid may have insufficient TH release in the early stages of pregnancy, and their increased miscarriage rate may be due to TH deficiency rather than a systemic overreaction of the immune system (<xref ref-type="bibr" rid="B1">Abalovich et&#xa0;al., 2007</xref>). The local effects of TH on female reproductive organs and embryos during embryo implantation are crucial for successful pregnancies (<xref ref-type="bibr" rid="B63">Stavreus Evers, 2012</xref>).</p>
<p>A prospective cohort study conducted in women with infertility found that the median serum TSH levels were significantly higher in TPOAb- and TgAb-positive women than in women without AITD (<xref ref-type="bibr" rid="B71">Unuane et&#xa0;al., 2013</xref>). The TSH level is a sensitive indicator of thyroid function during pregnancy (<xref ref-type="bibr" rid="B69">Tortosa, 2011</xref>). The upper limit of the normal value of TSH in early pregnancy should be 4.0 mU/L, and 2.5 mU/L&#x2264; TSH&lt; 4.0 mU/L is called the normal high value of TSH. Women with positive thyroid antibodies or those undergoing assisted reproduction require levothyroxine (LT<sub>4</sub>) (<xref ref-type="bibr" rid="B59">Shan and Wang, 2022</xref>). Therefore, some scholars used LT<sub>4</sub> intervention as adjuvant therapy in 227 women with AITD who suffered from RM and it was found that low-dose LT<sub>4</sub> treatment can, to some extent, prevent miscarriage (<xref ref-type="bibr" rid="B15">Dal Lago et&#xa0;al., 2021</xref>). Another study also showed that administering LT<sub>4</sub> treatment to pregnant women with a history of hypothyroidism and TPOAb-positivity can improve their live birth rates and reduce miscarriages (<xref ref-type="bibr" rid="B37">Leng et&#xa0;al., 2022</xref>). However, some studies have found that LT<sub>4</sub> treatment did not increase live birth rates in women with RM, normal thyroid function, and positive TPOAb (<xref ref-type="bibr" rid="B72">van Dijk et&#xa0;al., 2022</xref>). Hong et&#xa0;al. also confirmed that LT<sub>4</sub> treatment did not reduce miscarriage rates or increase live birth rates in women undergoing <italic>in vitro</italic> fertilization embryo transfer (IVF-ET) with intact thyroid function and positive TPOAb (<xref ref-type="bibr" rid="B74">Wang et&#xa0;al., 2017</xref>). The use of glucocorticoids and aspirin as adjunctive therapies in euthyroid women with AITD undergoing IVF-ET may not improve pregnancy or live birth rates either (<xref ref-type="bibr" rid="B79">Zhou et&#xa0;al., 2022</xref>).</p>
</sec>
<sec id="s3_3">
<label>3.3</label>
<title>AITD and other adverse pregnancy outcomes</title>
<p>After analyzing 35 studies, we found that TPOAb-positive women had a higher risk of premature birth than TPOAb-negative women. The relationship between TPOAb positivity and premature birth appears to be related to TSH concentration. TPOAb-positive women with TSH concentrations higher than 4.0 mU/L have a higher risk of premature birth (<xref ref-type="bibr" rid="B33">Korevaar et&#xa0;al., 2019</xref>). Tang et&#xa0;al. found that with an increase in TPOAb and TgAb (in early and mid-pregnancy), the maternal risk of gestational diabetes mellitus (GDM) significantly increased. Therefore, the presence of thyroid antibodies can predict postpartum glucose abnormalities in individuals with GDM (<xref ref-type="bibr" rid="B65">Tang et&#xa0;al., 2021</xref>). Some studies have evaluated the impact of LT<sub>4</sub> on the risk of miscarriage, premature birth, preeclampsia, placental abruption, birth weight, gestational age at delivery, and neonatal admission rate in TPOAb-positive pregnant women with normal thyroid function; nevertheless, no significant differences between the LT<sub>4</sub> administrated and control groups were found. However, there has been a downward trend in premature births and miscarriages.</p>
</sec>
</sec>
<sec id="s4">
<label>4</label>
<title>Gut microbiota and pregnancy</title>
<p>In recent years, increasing evidence has shown that sex hormones can affect the structure of gut microbiota, and sex hormones act through steroid receptors directly regulate the metabolism of bacteria (<xref ref-type="bibr" rid="B76">Yoon and Kim, 2021</xref>). Autonomous diseases are typically more prevalent in women than in men (<xref ref-type="bibr" rid="B54">Quintero et&#xa0;al., 2012</xref>). A role for gut microbiota in the sex bias in autoimmunity has been revealed by different studies in animal models. This bias is at least partially mediated by the microbial metabolism of sex hormones (<xref ref-type="bibr" rid="B51">Ortona et&#xa0;al., 2016</xref>). Pregnancy is a special period for women, as the body undergoes various physiological changes, which provides the fetus with the best growth and development conditions (<xref ref-type="bibr" rid="B14">Costantine, 2014</xref>).Changes of hormones in pregnancy can alter the gut microbiota structure of pregnant women (<xref ref-type="bibr" rid="B32">Koren et&#xa0;al., 2012</xref>). As pregnancy progresses, there is a significant enrichment of <italic>Neisseria, Brautia, Collins</italic>, and <italic>Bifidobacterium</italic> genera. The increase in relative abundance of <italic>Bifidobacterium</italic> is highly likely mediated by progesterone (<xref ref-type="bibr" rid="B50">Nuriel-Ohayon et&#xa0;al., 2019</xref>). Throughout pregnancy, significant changes occur in the gut microbiota of mothers, which subsequently affect the gut microbiota of infants. Changes in microbiome composition occur between the first and third trimesters of pregnancy (<xref ref-type="bibr" rid="B21">Gorczyca et&#xa0;al., 2022</xref>). Scholars transplanted fecal microbiota from the first and third trimesters of pregnancy into sterile mice. Compared with mice transplanted with the first trimester of pregnancy microbiota, mice transplanted with the third trimester of microbiota showed significant weight gain, insulin resistance, and greater inflammatory response (<xref ref-type="bibr" rid="B32">Koren et&#xa0;al., 2012</xref>). Akkermansia, Bifidobacteria, and Firmicutes populations increase, which is related to an increase in energy storage requirements. Proteobacteria and Actinobacteria levels increase, owing to their pro-inflammatory properties, and have protective effects on both mothers and fetuses (<xref ref-type="bibr" rid="B56">Rodr&#xed;guez et&#xa0;al., 2015</xref>). The mechanism of these changes involves the regulation of the brain and intestinal axes by production of maternal estrogen and progesterone, as well as immune activation of the intestinal mucosa (<xref ref-type="bibr" rid="B49">Mulak et&#xa0;al., 2014</xref>; <xref ref-type="bibr" rid="B62">Stanislawski et&#xa0;al., 2017</xref>).</p>
<p>As shown in <xref ref-type="table" rid="T2">
<bold>Table&#xa0;2</bold>
</xref>, many studies have demonstrated that the gut microbiota is associated with many diseases during pregnancy. A study conducted among 100 women showed that 26 pregnant women with preeclampsia had a significantly lower abundance of <italic>Prevotella</italic>, <italic>Porphyromonas</italic>, <italic>Varibaculum</italic>, and <italic>Lactobacillus</italic> than pregnant women without this complication (<xref ref-type="bibr" rid="B24">Huang et&#xa0;al., 2021</xref>). Liu also reported significant structural changes in the gut microbiota of patients with preeclampsia. In these patients, there was an overall increase in the pathogenic bacteria <italic>Clostridium perfringens</italic> and <italic>Bulleidia moorei</italic>, but a reduction in the probiotic bacteria <italic>Coprococcus catus</italic> (<xref ref-type="bibr" rid="B40">Liu et&#xa0;al., 2017</xref>). Fetal growth restriction (FGR) is a common obstetric complication and also known as intrauterine growth restriction (IUGR) (<xref ref-type="bibr" rid="B60">Sharma et&#xa0;al., 2016</xref>). By 16S rDNA amplicon sequencing of samples, collected from pregnant women in the FGR and control groups, it was revealed that the genera <italic>Bacteroides</italic>, <italic>Faecalibacterium</italic>, and <italic>Lachnospira</italic> were highly abundant in the FGR group (<xref ref-type="bibr" rid="B70">Tu et&#xa0;al., 2022</xref>). GDM is one of the most common metabolic complications of pregnancy and its prevalence has significantly increased over the last few years (<xref ref-type="bibr" rid="B17">Filardi et&#xa0;al., 2019</xref>). Cortez et&#xa0;al. found an increase in Firmicutes and a decrease in Bacteroides levels in patients with GDM, as well as an increase in <italic>Firmicutes</italic>/<italic>Bacteroides</italic> (F/B) ratio in late pregnancy (<xref ref-type="bibr" rid="B13">Cortez et&#xa0;al., 2019</xref>). The increase in the F/B ratio is associated with low-grade inflammation, insulin resistance, and obesity (<xref ref-type="bibr" rid="B52">Pascale et&#xa0;al., 2019</xref>). Sililas et&#xa0;al. also found that the F/B ratio in the third trimester of pregnancy was higher in patients with GDM than in those of the control group (<xref ref-type="bibr" rid="B61">Sililas et&#xa0;al., 2021</xref>). Specific shifts in microbial composition were also associated with maternal factors such as BMI, weight, and weight gain during pregnancy. A higher number of <italic>Bifidobacterium</italic> organisms and lower levels of <italic>Staphylococcus</italic> may protect the mother from developing excess weight (<xref ref-type="bibr" rid="B12">Collado et&#xa0;al., 2008</xref>; <xref ref-type="bibr" rid="B57">Santacruz et&#xa0;al., 2010</xref>). A study found that overweight participants had significantly higher fecal concentrations of the genus <italic>Bacteroides</italic> and a lower F/B ratio (<xref ref-type="bibr" rid="B58">Schwiertz et&#xa0;al., 2010</xref>).</p>
<table-wrap id="T2" position="float">
<label>Table&#xa0;2</label>
<caption>
<p>Characteristics of gut microbiota in pregnant women with other diseases.</p>
</caption>
<table frame="hsides">
<thead>
<tr>
<th valign="middle" rowspan="2" align="center">Number</th>
<th valign="middle" rowspan="2" align="center">Country</th>
<th valign="middle" rowspan="2" align="center">Reference</th>
<th valign="middle" rowspan="2" align="center">Period</th>
<th valign="middle" colspan="2" align="center">Size</th>
<th valign="middle" rowspan="2" align="center">Result</th>
</tr>
<tr>
<th valign="middle" align="center">Case group</th>
<th valign="middle" align="center">Control group</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="middle" align="center">1</td>
<td valign="middle" align="center">Norway</td>
<td valign="middle" align="center">
<xref ref-type="bibr" rid="B62">Stanislawski et&#xa0;al., 2017</xref>
</td>
<td valign="middle" align="center">2017</td>
<td valign="middle" align="center">116</td>
<td valign="middle" align="center">&#x2013;</td>
<td valign="top" align="left">The most important taxa among women with excess gestational weight gain (GWG) included <italic>Methanobrevibacter, Bifidobacterium</italic>, and <italic>Bacteroides</italic>, as well as seven OTUs of the order Clostridiales. There were three OTUs,include Blautia, SMB53, Methanobrevibacter, that were significantly higher among women with excess GWG.</td>
</tr>
<tr>
<td valign="middle" align="center">2</td>
<td valign="middle" align="center">China</td>
<td valign="middle" align="center">
<xref ref-type="bibr" rid="B24">Huang et&#xa0;al., 2021</xref>
</td>
<td valign="middle" align="center">2021</td>
<td valign="middle" align="center">51</td>
<td valign="middle" align="center">49</td>
<td valign="top" align="left">Pregnant women with preeclampsia had significantly lower abundance of Prevotella, Porphyromonas, Varibaculum, and Lactobacillus compared to those without this complication. The abundance of <italic>Prevotella</italic>, <italic>Porphyromonas, Lactobacillus, Mobiluncus, Campylobacter</italic> and <italic>Peptostreptococcus</italic> were decreased significantly in the pregnant women with abnormal placental growth</td>
</tr>
<tr>
<td valign="middle" align="center">3</td>
<td valign="middle" align="center">China</td>
<td valign="middle" align="center">
<xref ref-type="bibr" rid="B40">Liu et&#xa0;al., 2017</xref>
</td>
<td valign="middle" align="center">2016</td>
<td valign="middle" align="center">26</td>
<td valign="middle" align="center">74</td>
<td valign="top" align="left">In preeclampsia patients, there was an overall increase in pathogenic bacteria, Clostridium perfringens and Bulleidia moorei,but a reduction in probiotic bacteria Coprococcus catus</td>
</tr>
<tr>
<td valign="middle" align="center">4</td>
<td valign="middle" align="center">China</td>
<td valign="middle" align="center">
<xref ref-type="bibr" rid="B70">Tu et&#xa0;al., 2022</xref>
</td>
<td valign="middle" align="center">2022</td>
<td valign="middle" align="center">14</td>
<td valign="middle" align="center">18</td>
<td valign="top" align="left">At phylum level, <italic>Firmicutes</italic> was more abundant in the Fetal growth restriction(FGR) group than in the control group. At genus level, <italic>Bacteroides, Faecalibacterium, Lachnospira</italic> (all belong to <italic>Lachnospiraceae</italic> family) were highly abundant in the FGR group as compared to the control group.</td>
</tr>
<tr>
<td valign="middle" align="center">5</td>
<td valign="middle" align="center">Brazil</td>
<td valign="middle" align="center">
<xref ref-type="bibr" rid="B13">Cortez et&#xa0;al., 2019</xref>
</td>
<td valign="middle" align="center">2019</td>
<td valign="middle" align="center">26</td>
<td valign="middle" align="center">42</td>
<td valign="top" align="left">The GDM patients presented a significantly higher abundance of the genera Bacteroides, Veillonella, Klebsiella, Escherichia-Shigella, Enterococcus, and Enterobacter.There is an increase in Firmicutes and a decrease in Bacteroides in GDM patients, as well as an increase in Firmicutes/Bacteroides (F/B ratio) in late pregnancy.</td>
</tr>
<tr>
<td valign="middle" align="center">6</td>
<td valign="middle" align="center">Thailand</td>
<td valign="middle" align="center">
<xref ref-type="bibr" rid="B61">Sililas et&#xa0;al., 2021</xref>
</td>
<td valign="middle" align="center">2021</td>
<td valign="middle" align="center">49</td>
<td valign="middle" align="center">39</td>
<td valign="top" align="left">There is a reduction in <italic>Lactobacillales</italic> from the time of GDM diagnosis to the time before delivery (&#x2265;37 weeks gestation). F/B ratio was found higher in GDM mother, when compared to their non-GDM counterparts, at the time before delivery. However, these alterations were not observed in meconium and the first feces of their newborn.</td>
</tr>
<tr>
<td valign="middle" align="center">7</td>
<td valign="middle" align="center">Finland</td>
<td valign="middle" align="center">
<xref ref-type="bibr" rid="B12">Collado et&#xa0;al., 2008</xref>
</td>
<td valign="middle" align="center">2008</td>
<td valign="middle" align="center">18</td>
<td valign="middle" align="center">36</td>
<td valign="top" align="left">Bacteroides and Staphylococcus were significantly higher in the overweight state than in normal-weight women. Mother&#x2019;s weight and BMI before pregnancy correlated with higher concentrations of Bacteroides, Clostridium, and Staphylococcus. Microbial counts increased from the first to third trimester of pregnancy. High Bacteroides concentrations were associated with excessive weight gain over pregnancy.</td>
</tr>
<tr>
<td valign="middle" align="center">8</td>
<td valign="middle" align="center">Spain</td>
<td valign="middle" align="center">
<xref ref-type="bibr" rid="B57">Santacruz et&#xa0;al., 2010</xref>
</td>
<td valign="middle" align="center">2010</td>
<td valign="middle" align="center">16</td>
<td valign="middle" align="center">34</td>
<td valign="top" align="left">Reduced numbers of Bifidobacterium and Bacteroides and increased numbers of Staphylococcus, Enterobacteriaceae and Escherichia coli were detected in overweight compared with normal-weight pregnant women. E. coli numbers were higher in women with excessive weight gain than in women with normal weight gain during pregnancy, while Bifidobacterium and Akkermansia muciniphila showed an opposite trend.</td>
</tr>
</tbody>
</table>
</table-wrap>
</sec>
<sec id="s5">
<label>5</label>
<title>Summary</title>
<p>AITD increases the risk of infertility, miscarriage, and other adverse pregnancy and neonatal outcomes. The use of LT<sub>4</sub> intervention can reduce adverse outcomes in patients with normally high TSH levels. However, it is not effective in euthyroid patients with AITD who undergo IVF-ET assisted pregnancy. It is not clear whether other factors affect adverse pregnancy outcomes in patients with AITD (<xref ref-type="bibr" rid="B72">van Dijk et&#xa0;al., 2022</xref>). Therefore, a new interventional approach is required to reduce adverse outcomes. Some researchers have found differences in the composition of the gut microbiota between patients with AITD and the normal population. Specific bacterial overgrowth and its impact on the gut-thyroid axis may promote thyroid antibody production. Currently, little research has explored the relationship between specific differences in gut microbiota composition in patients with AITD, and especially of those who are pregnant. It is unclear how the gut microbiota contributes to adverse pregnancy outcomes in TPOAb-positive women. Whether it is possible to improve the pregnancy outcomes of patients with AITD by regulating the composition of the gut microbiota still needs to be confirmed.</p>
</sec>
<sec id="s6" sec-type="author-contributions">
<title>Author contributions</title>
<p>YS: Writing &#x2013; original draft, Writing &#x2013; review &amp; editing. YB: Writing &#x2013; review &amp; editing. CL: Writing &#x2013; review &amp; editing. XZ: Writing &#x2013; review &amp; editing. LZ: Writing &#x2013; review &amp; editing.</p>
</sec>
</body>
<back>
<sec id="s7" sec-type="funding-information">
<title>Funding</title>
<p>The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This article was supported by &#x201c;345 talent project plan&#x201d; of Shengjing Hospital of China Medical University.</p>
</sec>
<ack>
<title>Acknowledgments</title>
<p>Thanks Shengjing Hospital of China Medical University for giving financial support for this article.</p>
</ack>
<sec id="s8" sec-type="COI-statement">
<title>Conflict of interest</title>
<p>The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
</sec>
<sec id="s9" sec-type="disclaimer">
<title>Publisher&#x2019;s note</title>
<p>All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.</p>
</sec>
<ref-list>
<title>References</title>
<ref id="B1">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Abalovich</surname> <given-names>M.</given-names>
</name>
<name>
<surname>Amino</surname> <given-names>N.</given-names>
</name>
<name>
<surname>Barbour</surname> <given-names>L. A.</given-names>
</name>
<name>
<surname>Cobin</surname> <given-names>R. H.</given-names>
</name>
<name>
<surname>De Groot</surname> <given-names>L. J.</given-names>
</name>
<name>
<surname>Glinoer</surname> <given-names>D.</given-names>
</name>
<etal/>
</person-group>. (<year>2007</year>). <article-title>Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society Clinical Practice Guideline</article-title>. <source>J. Clin. Endocrinol. Metab.</source> <volume>92</volume>, <fpage>S1</fpage>&#x2013;<lpage>47</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1210/jc.2007-0141</pub-id>
</citation>
</ref>
<ref id="B2">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Ajjan</surname> <given-names>R. A.</given-names>
</name>
<name>
<surname>Weetman</surname> <given-names>A. P.</given-names>
</name>
</person-group> (<year>2015</year>). <article-title>The pathogenesis of hashimoto&#x2019;s thyroiditis: further developments in our understanding</article-title>. <source>Horm. Metab. Res.</source> <volume>47</volume>, <fpage>702</fpage>&#x2013;<lpage>710</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1055/s-0035-1548832</pub-id>
</citation>
</ref>
<ref id="B3">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Alpizar-Rodriguez</surname> <given-names>D.</given-names>
</name>
<name>
<surname>Lesker</surname> <given-names>T. R.</given-names>
</name>
<name>
<surname>Gronow</surname> <given-names>A.</given-names>
</name>
<name>
<surname>Gilbert</surname> <given-names>B.</given-names>
</name>
<name>
<surname>Raemy</surname> <given-names>E.</given-names>
</name>
<name>
<surname>Lamacchia</surname> <given-names>C.</given-names>
</name>
<etal/>
</person-group>. (<year>2019</year>). <article-title>Prevotella copri in individuals at risk for rheumatoid arthritis</article-title>. <source>Ann. Rheum Dis.</source> <volume>78</volume>, <fpage>590</fpage>&#x2013;<lpage>593</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1136/annrheumdis-2018-214514</pub-id>
</citation>
</ref>
<ref id="B4">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Antonelli</surname> <given-names>A.</given-names>
</name>
<etal/>
</person-group>. (<year>2015</year>). <article-title>Autoimmune thyroid disorders</article-title>. <source>Autoimmun Rev.</source> <volume>14</volume>, <fpage>174</fpage>&#x2013;<lpage>180</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.autrev.2014.10.016</pub-id>
</citation>
</ref>
<ref id="B5">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Belvoncikova</surname> <given-names>P.</given-names>
</name>
<name>
<surname>Maronek</surname> <given-names>M.</given-names>
</name>
<name>
<surname>Gardlik</surname> <given-names>R.</given-names>
</name>
</person-group> (<year>2022</year>). <article-title>Gut dysbiosis and fecal microbiota transplantation in autoimmune diseases</article-title>. <source>Int. J. Mol. Sci.</source> <volume>23</volume> (<issue>18</issue>), <fpage>10729</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.3390/ijms231810729</pub-id>
</citation>
</ref>
<ref id="B6">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Benson</surname> <given-names>A. K.</given-names>
</name>
<name>
<surname>Kelly</surname> <given-names>S. A.</given-names>
</name>
<name>
<surname>Legge</surname> <given-names>R.</given-names>
</name>
<name>
<surname>Ma</surname> <given-names>F.</given-names>
</name>
<name>
<surname>Low</surname> <given-names>S. J.</given-names>
</name>
<name>
<surname>Kim</surname> <given-names>J.</given-names>
</name>
<etal/>
</person-group>. (<year>2010</year>). <article-title>Individuality in gut microbiota composition is a complex polygenic trait shaped by multiple environmental and host genetic factors</article-title>. <source>Proc. Natl. Acad. Sci. U.S.A.</source> <volume>107</volume>, <fpage>18933</fpage>&#x2013;<lpage>18938</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1073/pnas.1007028107</pub-id>
</citation>
</ref>
<ref id="B7">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Cantoni</surname> <given-names>C.</given-names>
</name>
<name>
<surname>Lin</surname> <given-names>Q.</given-names>
</name>
<name>
<surname>Dorsett</surname> <given-names>Y.</given-names>
</name>
<name>
<surname>Ghezzi</surname> <given-names>L.</given-names>
</name>
<name>
<surname>Liu</surname> <given-names>Z.</given-names>
</name>
<name>
<surname>Pan</surname> <given-names>Y.</given-names>
</name>
<etal/>
</person-group>. (<year>2022</year>). <article-title>Alterations of host-gut microbiome interactions in multiple sclerosis</article-title>. <source>EBioMedicine</source> <volume>76</volume>, <fpage>103798</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.ebiom.2021.103798</pub-id>
</citation>
</ref>
<ref id="B8">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Caturegli</surname> <given-names>P.</given-names>
</name>
<name>
<surname>De Remigis</surname> <given-names>A.</given-names>
</name>
<name>
<surname>Rose</surname> <given-names>N. R.</given-names>
</name>
</person-group> (<year>2014</year>). <article-title>Hashimoto thyroiditis: clinical and diagnostic criteria</article-title>. <source>Autoimmun Rev.</source> <volume>13</volume>, <fpage>391</fpage>&#x2013;<lpage>397</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.autrev.2014.01.007</pub-id>
</citation>
</ref>
<ref id="B9">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Cayres</surname> <given-names>L. C. F.</given-names>
</name>
<name>
<surname>de Salis</surname> <given-names>L. V. V.</given-names>
</name>
<name>
<surname>Rodrigues</surname> <given-names>G. S. P.</given-names>
</name>
<name>
<surname>Lengert</surname> <given-names>A. V. H.</given-names>
</name>
<name>
<surname>Biondi</surname> <given-names>A. P. C.</given-names>
</name>
<name>
<surname>Sargentini</surname> <given-names>L. D. B.</given-names>
</name>
<etal/>
</person-group>. (<year>2021</year>). <article-title>Detection of alterations in the gut microbiota and intestinal permeability in patients with hashimoto thyroiditis</article-title>. <source>Front. Immunol.</source> <volume>12</volume>, <elocation-id>579140</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.3389/fimmu.2021.579140</pub-id>
</citation>
</ref>
<ref id="B10">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Chaker</surname> <given-names>L.</given-names>
</name>
<name>
<surname>Bianco</surname> <given-names>A. C.</given-names>
</name>
<name>
<surname>Jonklaas</surname> <given-names>J.</given-names>
</name>
<name>
<surname>Peeters</surname> <given-names>R. P.</given-names>
</name>
</person-group> (<year>2017</year>). <article-title>Hypothyroidism</article-title>. <source>Lancet</source> <volume>390</volume>, <fpage>1550</fpage>&#x2013;<lpage>1562</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/S0140-6736(17)30703-1</pub-id>
</citation>
</ref>
<ref id="B11">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Cho</surname> <given-names>I.</given-names>
</name>
<name>
<surname>Blaser</surname> <given-names>M. J.</given-names>
</name>
</person-group> (<year>2012</year>). <article-title>The human microbiome: at the interface of health and disease</article-title>. <source>Nat. Rev. Genet.</source> <volume>13</volume>, <fpage>260</fpage>&#x2013;<lpage>270</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1038/nrg3182</pub-id>
</citation>
</ref>
<ref id="B12">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Collado</surname> <given-names>M. C.</given-names>
</name>
<name>
<surname>Isolauri</surname> <given-names>E.</given-names>
</name>
<name>
<surname>Laitinen</surname> <given-names>K.</given-names>
</name>
<name>
<surname>Salminen</surname> <given-names>S.</given-names>
</name>
</person-group> (<year>2008</year>). <article-title>Distinct composition of gut microbiota during pregnancy in overweight and normal-weight women</article-title>. <source>Am. J. Clin. Nutr.</source> <volume>88</volume>, <fpage>894</fpage>&#x2013;<lpage>899</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1093/ajcn/88.4.894</pub-id>
</citation>
</ref>
<ref id="B13">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Cortez</surname> <given-names>R. V.</given-names>
</name>
<name>
<surname>Taddei</surname> <given-names>C. R.</given-names>
</name>
<name>
<surname>Sparvoli</surname> <given-names>L. G.</given-names>
</name>
<name>
<surname>&#xc2;ngelo</surname> <given-names>A. G. S.</given-names>
</name>
<name>
<surname>Padilha</surname> <given-names>M.</given-names>
</name>
<etal/>
</person-group>. (<year>2019</year>). <article-title>Microbiome and its relation to gestational diabetes</article-title>. <source>Endocrine</source> <volume>64</volume>, <fpage>254</fpage>&#x2013;<lpage>264</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1007/s12020-018-1813-z</pub-id>
</citation>
</ref>
<ref id="B14">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Costantine</surname> <given-names>M. M.</given-names>
</name>
</person-group> (<year>2014</year>). <article-title>Physiologic and pharmacokinetic changes in pregnancy</article-title>. <source>Front. Pharmacol.</source> <volume>5</volume>, <elocation-id>65</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.3389/fphar.2014.00065</pub-id>
</citation>
</ref>
<ref id="B15">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Dal Lago</surname> <given-names>A.</given-names>
</name>
<name>
<surname>Galanti</surname> <given-names>F.</given-names>
</name>
<name>
<surname>Miriello</surname> <given-names>D.</given-names>
</name>
<name>
<surname>Marcoccia</surname> <given-names>A.</given-names>
</name>
<name>
<surname>Massimiani</surname> <given-names>M.</given-names>
</name>
<name>
<surname>Campagnolo</surname> <given-names>L.</given-names>
</name>
<etal/>
</person-group>. (<year>2021</year>). <article-title>Positive impact of levothyroxine treatment on pregnancy outcome in euthyroid women with thyroid autoimmunity affected by recurrent miscarriage</article-title>. <source>J. Clin. Med.</source> <volume>10</volume>, <fpage>10 2105</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.3390/jcm10102105</pub-id>
</citation>
</ref>
<ref id="B16">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Effraimidis</surname> <given-names>G.</given-names>
</name>
<name>
<surname>Wiersinga</surname> <given-names>W. M.</given-names>
</name>
</person-group> (<year>2014</year>). <article-title>Mechanisms in endocrinology: autoimmune thyroid disease: old and new players</article-title>. <source>Eur. J. Endocrinol.</source> <volume>170</volume>, <fpage>R241</fpage>&#x2013;<lpage>R252</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1530/EJE-14-0047</pub-id>
</citation>
</ref>
<ref id="B17">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Filardi</surname> <given-names>T.</given-names>
</name>
<name>
<surname>Panimolle</surname> <given-names>F.</given-names>
</name>
<name>
<surname>Crescioli</surname> <given-names>C.</given-names>
</name>
<name>
<surname>Lenzi</surname> <given-names>A.</given-names>
</name>
<name>
<surname>Morano</surname> <given-names>S.</given-names>
</name>
</person-group> (<year>2019</year>). <article-title>Gestational diabetes mellitus: the impact of carbohydrate quality in diet</article-title>. <source>Nutrients</source> <volume>11</volume> (<issue>7</issue>), <fpage>1549</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.3390/nu11071549</pub-id>
</citation>
</ref>
<ref id="B18">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Fr&#xf6;hlich</surname> <given-names>E.</given-names>
</name>
<name>
<surname>Wahl</surname> <given-names>R.</given-names>
</name>
</person-group> (<year>2017</year>). <article-title>Thyroid autoimmunity: role of anti-thyroid antibodies in thyroid and extra-thyroidal diseases</article-title>. <source>Front. Immunol.</source> <volume>8</volume>, <elocation-id>521</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.3389/fimmu.2017.00521</pub-id>
</citation>
</ref>
<ref id="B19">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Fr&#xf6;hlich</surname> <given-names>E.</given-names>
</name>
<name>
<surname>Wahl</surname> <given-names>R.</given-names>
</name>
</person-group> (<year>2019</year>). <article-title>Microbiota and thyroid interaction in health and disease</article-title>. <source>Trends Endocrinol. Metab.</source> <volume>30</volume>, <fpage>479</fpage>&#x2013;<lpage>490</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.tem.2019.05.008</pub-id>
</citation>
</ref>
<ref id="B20">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Gong</surname> <given-names>B.</given-names>
</name>
<name>
<surname>Wang</surname> <given-names>C.</given-names>
</name>
<name>
<surname>Meng</surname> <given-names>F.</given-names>
</name>
<name>
<surname>Wang</surname> <given-names>H.</given-names>
</name>
<name>
<surname>Song</surname> <given-names>B.</given-names>
</name>
<name>
<surname>Yang</surname> <given-names>Y.</given-names>
</name>
<etal/>
</person-group>. (<year>2021</year>). <article-title>Association between gut microbiota and autoimmune thyroid disease: A systematic review and meta-analysis</article-title>. <source>Front. Endocrinol. (Lausanne)</source> <volume>12</volume>, <fpage>774362</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.37766/inplasy2021.4.0135</pub-id>
</citation>
</ref>
<ref id="B21">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Gorczyca</surname> <given-names>K.</given-names>
</name>
<name>
<surname>Obuchowska</surname> <given-names>A.</given-names>
</name>
<name>
<surname>Kimber-Trojnar</surname> <given-names>&#x17b;.</given-names>
</name>
<name>
<surname>Wierzchowska-Opoka</surname> <given-names>M.</given-names>
</name>
<name>
<surname>Leszczy&#x144;ska-Gorzelak</surname> <given-names>B.</given-names>
</name>
</person-group> (<year>2022</year>). <article-title>Changes in the gut microbiome and pathologies in pregnancy</article-title>. <source>Int. J. Environ. Res. Public Health</source> <volume>19</volume>. doi:&#xa0;<pub-id pub-id-type="doi">10.3390/ijerph19169961</pub-id>
</citation>
</ref>
<ref id="B22">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Hardin</surname> <given-names>S. J.</given-names>
</name>
<name>
<surname>Singh</surname> <given-names>M.</given-names>
</name>
<name>
<surname>Eyob</surname> <given-names>W.</given-names>
</name>
<name>
<surname>Molnar</surname> <given-names>J. C.</given-names>
</name>
<name>
<surname>Homme</surname> <given-names>R. P.</given-names>
</name>
<name>
<surname>George</surname> <given-names>A. K.</given-names>
</name>
<etal/>
</person-group>. (<year>2019</year>). <article-title>Diet-induced chronic syndrome, metabolically transformed trimethylamine-N-oxide, and the cardiovascular functions</article-title>. <source>Rev. Cardiovasc. Med.</source> <volume>20</volume>, <fpage>121</fpage>&#x2013;<lpage>128</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.31083/j.rcm.2019.03.518</pub-id>
</citation>
</ref>
<ref id="B23">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Hevia</surname> <given-names>A.</given-names>
</name>
<name>
<surname>Milani</surname> <given-names>C.</given-names>
</name>
<name>
<surname>L&#xf3;pez</surname> <given-names>P.</given-names>
</name>
<name>
<surname>Cuervo</surname> <given-names>A.</given-names>
</name>
<name>
<surname>Arboleya</surname> <given-names>S.</given-names>
</name>
<name>
<surname>Duranti</surname> <given-names>S.</given-names>
</name>
<etal/>
</person-group>. (<year>2014</year>). <article-title>Intestinal dysbiosis associated with systemic lupus erythematosus</article-title>. <source>mBio</source> <volume>5</volume>, <fpage>e01548</fpage>&#x2013;<lpage>e01514</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1128/mBio.01548-14</pub-id>
</citation>
</ref>
<ref id="B24">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Huang</surname> <given-names>L.</given-names>
</name>
<name>
<surname>Cai</surname> <given-names>M.</given-names>
</name>
<name>
<surname>Li</surname> <given-names>L.</given-names>
</name>
<name>
<surname>Zhang</surname> <given-names>X.</given-names>
</name>
<name>
<surname>Xu</surname> <given-names>Y.</given-names>
</name>
<name>
<surname>Xiao</surname> <given-names>J.</given-names>
</name>
<etal/>
</person-group>. (<year>2021</year>). <article-title>Gut microbiota changes in preeclampsia, abnormal placental growth and healthy pregnant women</article-title>. <source>BMC Microbiol.</source> <volume>21</volume>, <fpage>265</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1186/s12866-021-02327-7</pub-id>
</citation>
</ref>
<ref id="B25">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Ishaq</surname> <given-names>H. M.</given-names>
</name>
<name>
<surname>Mohammad</surname> <given-names>I. S.</given-names>
</name>
<name>
<surname>Guo</surname> <given-names>H.</given-names>
</name>
<name>
<surname>Shahzad</surname> <given-names>M.</given-names>
</name>
<name>
<surname>Hou</surname> <given-names>Y. J.</given-names>
</name>
<name>
<surname>Ma</surname> <given-names>C.</given-names>
</name>
<etal/>
</person-group>. (<year>2017</year>). <article-title>Molecular estimation of alteration in intestinal microbial composition in Hashimoto&#x2019;s thyroiditis patients</article-title>. <source>BioMed. Pharmacother.</source> <volume>95</volume>, <fpage>865</fpage>&#x2013;<lpage>874</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.biopha.2017.08.101</pub-id>
</citation>
</ref>
<ref id="B26">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Kashtanova</surname> <given-names>D. A.</given-names>
</name>
<name>
<surname>Popenko</surname> <given-names>A. S.</given-names>
</name>
<name>
<surname>Tkacheva</surname> <given-names>O. N.</given-names>
</name>
<name>
<surname>Tyakht</surname> <given-names>A. B.</given-names>
</name>
<name>
<surname>Alexeev</surname> <given-names>D. G.</given-names>
</name>
<name>
<surname>Boytsov</surname> <given-names>S. A.</given-names>
</name>
</person-group> (<year>2016</year>). <article-title>Association between the gut microbiota and diet: Fetal life, early childhood, and further life</article-title>. <source>Nutrition</source> <volume>32</volume>, <fpage>620</fpage>&#x2013;<lpage>627</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.nut.2015.12.037</pub-id>
</citation>
</ref>
<ref id="B27">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Kim</surname> <given-names>N. Y.</given-names>
</name>
<name>
<surname>Cho</surname> <given-names>H. J.</given-names>
</name>
<name>
<surname>Kim</surname> <given-names>H. Y.</given-names>
</name>
<name>
<surname>Yang</surname> <given-names>K. M.</given-names>
</name>
<name>
<surname>Ahn</surname> <given-names>H. K.</given-names>
</name>
<name>
<surname>Thornton</surname> <given-names>S.</given-names>
</name>
<etal/>
</person-group>. (<year>2011</year>). <article-title>Thyroid autoimmunity and its association with cellular and humoral immunity in women with reproductive failures</article-title>. <source>Am. J. Reprod. Immunol.</source> <volume>65</volume>, <fpage>78</fpage>&#x2013;<lpage>87</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1111/aji.2010.65.issue-1</pub-id>
</citation>
</ref>
<ref id="B28">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Kiseleva</surname> <given-names>E. P.</given-names>
</name>
<name>
<surname>Mikhailopulo</surname> <given-names>K. I.</given-names>
</name>
<name>
<surname>Sviridov</surname> <given-names>O. V.</given-names>
</name>
<name>
<surname>Novik</surname> <given-names>G. I.</given-names>
</name>
<name>
<surname>Knirel</surname> <given-names>Y. A.</given-names>
</name>
<name>
<surname>Szwajcer Dey</surname> <given-names>E.</given-names>
</name>
</person-group> (<year>2011</year>). <article-title>The role of components of Bifidobacterium and Lactobacillus in pathogenesis and serologic diagnosis of autoimmune thyroid diseases</article-title>. <source>Benef Microbes</source> <volume>2</volume>, <fpage>139</fpage>&#x2013;<lpage>154</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.3920/BM2010.0011</pub-id>
</citation>
</ref>
<ref id="B29">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Knezevic</surname> <given-names>J.</given-names>
</name>
<name>
<surname>Starchl</surname> <given-names>C.</given-names>
</name>
<name>
<surname>Tmava Berisha</surname> <given-names>A.</given-names>
</name>
<name>
<surname>Amrein</surname> <given-names>K.</given-names>
</name>
</person-group> (<year>2020</year>). <article-title>Thyroid-gut-axis: how does the microbiota influence thyroid function</article-title>? <source>Nutrients</source> <volume>12</volume> (<issue>2</issue>), <fpage>1769</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.3390/nu12061769</pub-id>
</citation>
</ref>
<ref id="B30">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Knip</surname> <given-names>M.</given-names>
</name>
<name>
<surname>Honkanen</surname> <given-names>J.</given-names>
</name>
</person-group> (<year>2017</year>). <article-title>Modulation of type 1 diabetes risk by the intestinal microbiome</article-title>. <source>Curr. Diabetes Rep.</source> <volume>17</volume>, <fpage>105</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1007/s11892-017-0933-9</pub-id>
</citation>
</ref>
<ref id="B31">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>K&#xf6;hling</surname> <given-names>H. L.</given-names>
</name>
<name>
<surname>Plummer</surname> <given-names>S. F.</given-names>
</name>
<name>
<surname>Marchesi</surname> <given-names>J. R.</given-names>
</name>
<name>
<surname>Davidge</surname> <given-names>K. S.</given-names>
</name>
<name>
<surname>Ludgate</surname> <given-names>M.</given-names>
</name>
</person-group> (<year>2017</year>). <article-title>The microbiota and autoimmunity: Their role in thyroid autoimmune diseases</article-title>. <source>Clin. Immunol.</source> <volume>183</volume>, <fpage>63</fpage>&#x2013;<lpage>74</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.clim.2017.07.001</pub-id>
</citation>
</ref>
<ref id="B32">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Koren</surname> <given-names>O.</given-names>
</name>
<name>
<surname>Goodrich</surname> <given-names>J. K.</given-names>
</name>
<name>
<surname>Cullender</surname> <given-names>T. C.</given-names>
</name>
<name>
<surname>Spor</surname> <given-names>A.</given-names>
</name>
<name>
<surname>Laitinen</surname> <given-names>K.</given-names>
</name>
<name>
<surname>B&#xe4;ckhed</surname> <given-names>H. K.</given-names>
</name>
<etal/>
</person-group>. (<year>2012</year>). <article-title>Host remodeling of the gut microbiome and metabolic changes during pregnancy</article-title>. <source>Cell</source> <volume>150</volume>, <fpage>470</fpage>&#x2013;<lpage>480</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.cell.2012.07.008</pub-id>
</citation>
</ref>
<ref id="B33">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Korevaar</surname> <given-names>T. I. M.</given-names>
</name>
<name>
<surname>Derakhshan</surname> <given-names>A.</given-names>
</name>
<name>
<surname>Taylor</surname> <given-names>P. N.</given-names>
</name>
<name>
<surname>Meima</surname> <given-names>M.</given-names>
</name>
<name>
<surname>Chen</surname> <given-names>L.</given-names>
</name>
<name>
<surname>Bliddal</surname> <given-names>S.</given-names>
</name>
<etal/>
</person-group>. (<year>2019</year>). <article-title>Association of thyroid function test abnormalities and thyroid autoimmunity with preterm birth: A systematic review and meta-analysis</article-title>. <source>Jama</source> <volume>322</volume>, <fpage>632</fpage>&#x2013;<lpage>641</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1001/jama.2019.10931</pub-id>
</citation>
</ref>
<ref id="B34">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Krassas</surname> <given-names>G.</given-names>
</name>
<name>
<surname>Karras</surname> <given-names>S. N.</given-names>
</name>
<name>
<surname>Pontikides</surname> <given-names>N.</given-names>
</name>
</person-group> (<year>2015</year>). <article-title>Thyroid diseases during pregnancy: a number of important issues</article-title>. <source>Hormones (Athens)</source> <volume>14</volume>, <fpage>59</fpage>&#x2013;<lpage>69</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1007/BF03401381</pub-id>
</citation>
</ref>
<ref id="B35">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Krassas</surname> <given-names>G. E.</given-names>
</name>
<name>
<surname>Poppe</surname> <given-names>K.</given-names>
</name>
<name>
<surname>Glinoer</surname> <given-names>D.</given-names>
</name>
</person-group> (<year>2010</year>). <article-title>Thyroid function and human reproductive health</article-title>. <source>Endocr. Rev.</source> <volume>31</volume>, <fpage>702</fpage>&#x2013;<lpage>755</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1210/er.2009-0041</pub-id>
</citation>
</ref>
<ref id="B36">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Lee</surname> <given-names>H. J.</given-names>
</name>
<name>
<surname>Li</surname> <given-names>C. W.</given-names>
</name>
<name>
<surname>Hammerstad</surname> <given-names>S. S.</given-names>
</name>
<name>
<surname>Stefan</surname> <given-names>M.</given-names>
</name>
<name>
<surname>Tomer</surname> <given-names>Y.</given-names>
</name>
</person-group> (<year>2015</year>). <article-title>Immunogenetics of autoimmune thyroid diseases: A comprehensive review</article-title>. <source>J. Autoimmun</source> <volume>64</volume>, <fpage>82</fpage>&#x2013;<lpage>90</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.jaut.2015.07.009</pub-id>
</citation>
</ref>
<ref id="B37">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Leng</surname> <given-names>T.</given-names>
</name>
<name>
<surname>Li</surname> <given-names>X.</given-names>
</name>
<name>
<surname>Zhang</surname> <given-names>H.</given-names>
</name>
</person-group> (<year>2022</year>). <article-title>Levothyroxine treatment for subclinical hypothyroidism improves the rate of live births in pregnant women with recurrent pregnancy loss: a randomized clinical trial</article-title>. <source>Gynecol Endocrinol.</source> <volume>38</volume>, <fpage>488</fpage>&#x2013;<lpage>494</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1080/09513590.2022.2063831</pub-id>
</citation>
</ref>
<ref id="B38">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Lerner</surname> <given-names>A.</given-names>
</name>
<name>
<surname>Jeremias</surname> <given-names>P.</given-names>
</name>
<name>
<surname>Matthias</surname> <given-names>T.</given-names>
</name>
</person-group> (<year>2017</year>). <article-title>Gut-thyroid axis and celiac disease</article-title>. <source>Endocr. Connect</source> <volume>6</volume>, <fpage>R52</fpage>&#x2013;<lpage>r58</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1530/EC-17-0021</pub-id>
</citation>
</ref>
<ref id="B39">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Liontiris</surname> <given-names>M. I.</given-names>
</name>
<name>
<surname>Mazokopakis</surname> <given-names>E. E.</given-names>
</name>
</person-group> (<year>2017</year>). <article-title>A concise review of Hashimoto thyroiditis (HT) and the importance of iodine, selenium, vitamin D and gluten on the autoimmunity and dietary management of HT patients.Points that need more investigation</article-title>. <source>Hell J. Nucl. Med.</source> <volume>20</volume>, <fpage>51</fpage>&#x2013;<lpage>56</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1967/s002449910507</pub-id>
</citation>
</ref>
<ref id="B40">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Liu</surname> <given-names>J.</given-names>
</name>
<name>
<surname>Yang</surname> <given-names>H.</given-names>
</name>
<name>
<surname>Yin</surname> <given-names>Z.</given-names>
</name>
<name>
<surname>Jiang</surname> <given-names>X.</given-names>
</name>
<name>
<surname>Zhong</surname> <given-names>H.</given-names>
</name>
<name>
<surname>Qiu</surname> <given-names>D.</given-names>
</name>
<etal/>
</person-group>. (<year>2017</year>). <article-title>Remodeling of the gut microbiota and structural shifts in Preeclampsia patients in South China</article-title>. <source>Eur. J. Clin. Microbiol. Infect. Dis.</source> <volume>36</volume>, <fpage>713</fpage>&#x2013;<lpage>719</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1007/s10096-016-2853-z</pub-id>
</citation>
</ref>
<ref id="B41">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Liu</surname> <given-names>S.</given-names>
</name>
<name>
<surname>An</surname> <given-names>Y.</given-names>
</name>
<name>
<surname>Cao</surname> <given-names>B.</given-names>
</name>
<name>
<surname>Sun</surname> <given-names>R.</given-names>
</name>
<name>
<surname>Ke</surname> <given-names>J.</given-names>
</name>
<name>
<surname>Zhao</surname> <given-names>D.</given-names>
</name>
</person-group> (<year>2020</year>a). <article-title>The composition of gut microbiota in patients bearing hashimoto&#x2019;s thyroiditis with euthyroidism and hypothyroidism</article-title>. <source>Int. J. Endocrinol. 2020</source> <volume>p</volume>, <fpage>5036959</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1155/2020/5036959</pub-id>
</citation>
</ref>
<ref id="B42">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Liu</surname> <given-names>S.</given-names>
</name>
<name>
<surname>Xu</surname> <given-names>F.</given-names>
</name>
<name>
<surname>Wei</surname> <given-names>H.</given-names>
</name>
<name>
<surname>Huang</surname> <given-names>C.</given-names>
</name>
<name>
<surname>Chen</surname> <given-names>X.</given-names>
</name>
<name>
<surname>Lian</surname> <given-names>R.</given-names>
</name>
<etal/>
</person-group>. (<year>2020</year>b). <article-title>The correlation of thyroid autoimmunity and peripheral and uterine immune status in women with recurrent miscarriage</article-title>. <source>J. Reprod. Immunol.</source> <volume>139</volume>, <fpage>103118</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.jri.2020.103118</pub-id>
</citation>
</ref>
<ref id="B43">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Luo</surname> <given-names>X. M.</given-names>
</name>
<name>
<surname>Edwards</surname> <given-names>M. R.</given-names>
</name>
<name>
<surname>Mu</surname> <given-names>Q.</given-names>
</name>
<name>
<surname>Yu</surname> <given-names>Y.</given-names>
</name>
<name>
<surname>Vieson</surname> <given-names>M. D.</given-names>
</name>
<name>
<surname>Reilly</surname> <given-names>C. M.</given-names>
</name>
<etal/>
</person-group>. (<year>2018</year>). <article-title>Gut microbiota in human systemic lupus erythematosus and a mouse model of lupus</article-title>. <source>Appl. Environ. Microbiol.</source> <volume>84</volume> (<issue>4</issue>), <elocation-id>e02288-17</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.1128/AEM.02288-17</pub-id>
</citation>
</ref>
<ref id="B44">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Maeda</surname> <given-names>Y.</given-names>
</name>
<name>
<surname>Takeda</surname> <given-names>K.</given-names>
</name>
</person-group> (<year>2019</year>). <article-title>Host-microbiota interactions in rheumatoid arthritis</article-title>. <source>Exp. Mol. Med.</source> <volume>51</volume>, <fpage>1</fpage>&#x2013;<lpage>6</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1038/s12276-019-0283-6</pub-id>
</citation>
</ref>
<ref id="B45">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Marchesi</surname> <given-names>J. R.</given-names>
</name>
<name>
<surname>Adams</surname> <given-names>D. H.</given-names>
</name>
<name>
<surname>Fava</surname> <given-names>F.</given-names>
</name>
<name>
<surname>Hermes</surname> <given-names>G. D.</given-names>
</name>
<name>
<surname>Hirschfield</surname> <given-names>G. M.</given-names>
</name>
<name>
<surname>Hold</surname> <given-names>G.</given-names>
</name>
<etal/>
</person-group>. (<year>2016</year>). <article-title>The gut microbiota and host health: a new clinical frontier</article-title>. <source>Gut</source> <volume>65</volume>, <fpage>330</fpage>&#x2013;<lpage>339</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1136/gutjnl-2015-309990</pub-id>
</citation>
</ref>
<ref id="B46">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Miyake</surname> <given-names>S.</given-names>
</name>
<name>
<surname>Kim</surname> <given-names>S.</given-names>
</name>
<name>
<surname>Suda</surname> <given-names>W.</given-names>
</name>
<name>
<surname>Oshima</surname> <given-names>K.</given-names>
</name>
<name>
<surname>Nakamura</surname> <given-names>M.</given-names>
</name>
<name>
<surname>Matsuoka</surname> <given-names>T.</given-names>
</name>
<etal/>
</person-group>. (<year>2015</year>). <article-title>Dysbiosis in the gut microbiota of patients with multiple sclerosis, with a striking depletion of species belonging to clostridia XIVa and IV clusters</article-title>. <source>PloS One</source> <volume>10</volume>, <elocation-id>e0137429</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.1371/journal.pone.0137429</pub-id>
</citation>
</ref>
<ref id="B47">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Mori</surname> <given-names>K.</given-names>
</name>
<name>
<surname>Nakagawa</surname> <given-names>Y.</given-names>
</name>
<name>
<surname>Ozaki</surname> <given-names>H.</given-names>
</name>
</person-group> (<year>2012</year>). <article-title>Does the gut microbiota trigger Hashimoto&#x2019;s thyroiditis</article-title>? <source>Discovery Med.</source> <volume>14</volume>, <fpage>321</fpage>&#x2013;<lpage>326</lpage>.</citation>
</ref>
<ref id="B48">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Mu</surname> <given-names>Q.</given-names>
</name>
<name>
<surname>Kirby</surname> <given-names>J.</given-names>
</name>
<name>
<surname>Reilly</surname> <given-names>C. M.</given-names>
</name>
<name>
<surname>Luo</surname> <given-names>X. M.</given-names>
</name>
</person-group> (<year>2017</year>). <article-title>Leaky gut as a danger signal for autoimmune diseases</article-title>. <source>Front. Immunol.</source> <volume>8</volume>, <elocation-id>598</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.3389/fimmu.2017.00598</pub-id>
</citation>
</ref>
<ref id="B49">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Mulak</surname> <given-names>A.</given-names>
</name>
<name>
<surname>Tach&#xe9;</surname> <given-names>Y.</given-names>
</name>
<name>
<surname>Larauche</surname> <given-names>M.</given-names>
</name>
</person-group> (<year>2014</year>). <article-title>Sex hormones in the modulation of irritable bowel syndrome</article-title>. <source>World J. Gastroenterol.</source> <volume>20</volume>, <fpage>2433</fpage>&#x2013;<lpage>2448</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.3748/wjg.v20.i10.2433</pub-id>
</citation>
</ref>
<ref id="B50">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Nuriel-Ohayon</surname> <given-names>M.</given-names>
</name>
<name>
<surname>Neuman</surname> <given-names>H.</given-names>
</name>
<name>
<surname>Ziv</surname> <given-names>O.</given-names>
</name>
<name>
<surname>Belogolovski</surname> <given-names>A.</given-names>
</name>
<name>
<surname>Barsheshet</surname> <given-names>Y.</given-names>
</name>
<name>
<surname>Bloch</surname> <given-names>N.</given-names>
</name>
<etal/>
</person-group>. (<year>2019</year>). <article-title>Progesterone increases bifidobacterium relative abundance during late pregnancy</article-title>. <source>Cell Rep.</source> <volume>27</volume>, <fpage>730</fpage>&#x2013;<lpage>736.e3</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.celrep.2019.03.075</pub-id>
</citation>
</ref>
<ref id="B51">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Ortona</surname> <given-names>E.</given-names>
</name>
<name>
<surname>Pierdominici</surname> <given-names>M.</given-names>
</name>
<name>
<surname>Maselli</surname> <given-names>A.</given-names>
</name>
<name>
<surname>Veroni</surname> <given-names>C.</given-names>
</name>
<name>
<surname>Aloisi</surname> <given-names>F.</given-names>
</name>
<name>
<surname>Shoenfeld</surname> <given-names>Y.</given-names>
</name>
</person-group> (<year>2016</year>). <article-title>Sex-based differences in autoimmune diseases</article-title>. <source>Ann. Ist Super Sanita</source> <volume>52</volume>, <fpage>205</fpage>&#x2013;<lpage>212</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.4415/ANN_16_02_12</pub-id>
</citation>
</ref>
<ref id="B52">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Pascale</surname> <given-names>A.</given-names>
</name>
<name>
<surname>Marchesi</surname> <given-names>N.</given-names>
</name>
<name>
<surname>Govoni</surname> <given-names>S.</given-names>
</name>
<name>
<surname>Coppola</surname> <given-names>A.</given-names>
</name>
<name>
<surname>Gazzaruso</surname> <given-names>C.</given-names>
</name>
</person-group> (<year>2019</year>). <article-title>The role of gut microbiota in obesity, diabetes mellitus, and effect of metformin: new insights into old diseases</article-title>. <source>Curr. Opin. Pharmacol.</source> <volume>49</volume>, <fpage>1</fpage>&#x2013;<lpage>5</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.coph.2019.03.011</pub-id>
</citation>
</ref>
<ref id="B53">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Poppe</surname> <given-names>K.</given-names>
</name>
<name>
<surname>Glinoer</surname> <given-names>D.</given-names>
</name>
<name>
<surname>Van Steirteghem</surname> <given-names>A.</given-names>
</name>
<name>
<surname>Tournaye</surname> <given-names>H.</given-names>
</name>
<name>
<surname>Devroey</surname> <given-names>P.</given-names>
</name>
<name>
<surname>Schiettecatte</surname> <given-names>J.</given-names>
</name>
<etal/>
</person-group>. (<year>2002</year>). <article-title>Thyroid dysfunction and autoimmunity in infertile women</article-title>. <source>Thyroid</source> <volume>12</volume>, <fpage>997</fpage>&#x2013;<lpage>1001</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1089/105072502320908330</pub-id>
</citation>
</ref>
<ref id="B54">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Quintero</surname> <given-names>O. L.</given-names>
</name>
<name>
<surname>Amador-Patarroyo</surname> <given-names>M. J.</given-names>
</name>
<name>
<surname>Montoya-Ortiz</surname> <given-names>G.</given-names>
</name>
<name>
<surname>Rojas-Villarraga</surname> <given-names>A.</given-names>
</name>
<name>
<surname>Anaya</surname> <given-names>J. M.</given-names>
</name>
</person-group> (<year>2012</year>). <article-title>Autoimmune disease and gender: plausible mechanisms for the female predominance of autoimmunity</article-title>. <source>J. Autoimmun</source> <volume>38</volume>, <fpage>J109</fpage>&#x2013;<lpage>J119</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.jaut.2011.10.003</pub-id>
</citation>
</ref>
<ref id="B55">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Quintino-Moro</surname> <given-names>A.</given-names>
</name>
<name>
<surname>Zantut-Wittmann</surname> <given-names>D. E.</given-names>
</name>
<name>
<surname>Tambascia</surname> <given-names>M.</given-names>
</name>
<name>
<surname>Machado Hda</surname> <given-names>C.</given-names>
</name>
<name>
<surname>Fernandes</surname> <given-names>A.</given-names>
</name>
</person-group> (<year>2014</year>). <article-title>High prevalence of infertility among women with graves&#x2019; Disease and hashimoto&#x2019;s thyroiditis</article-title>. <source>Int. J. Endocrinol.</source> <volume>2014</volume>, <fpage>982705</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1155/2014/982705</pub-id>
</citation>
</ref>
<ref id="B56">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Rodr&#xed;guez</surname> <given-names>J. M.</given-names>
</name>
<name>
<surname>Murphy</surname> <given-names>K.</given-names>
</name>
<name>
<surname>Stanton</surname> <given-names>C.</given-names>
</name>
<name>
<surname>Ross</surname> <given-names>R. P.</given-names>
</name>
<name>
<surname>Kober</surname> <given-names>O. I.</given-names>
</name>
<name>
<surname>Juge</surname> <given-names>N.</given-names>
</name>
<etal/>
</person-group>. (<year>2015</year>). <article-title>The composition of the gut microbiota throughout life, with an emphasis on early life</article-title>. <source>Microb. Ecol. Health Dis.</source> <volume>26</volume>, <fpage>26050</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.3402/mehd.v26.26050</pub-id>
</citation>
</ref>
<ref id="B57">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Santacruz</surname> <given-names>A.</given-names>
</name>
<name>
<surname>Collado</surname> <given-names>M. C.</given-names>
</name>
<name>
<surname>Garc&#xed;a-Vald&#xe9;s</surname> <given-names>L.</given-names>
</name>
<name>
<surname>Segura</surname> <given-names>M. T.</given-names>
</name>
<name>
<surname>Mart&#xed;n-Lagos</surname> <given-names>J. A.</given-names>
</name>
<name>
<surname>Anjos</surname> <given-names>T.</given-names>
</name>
<etal/>
</person-group>. (<year>2010</year>). <article-title>Gut microbiota composition is associated with body weight, weight gain and biochemical parameters in pregnant women</article-title>. <source>Br. J. Nutr.</source> <volume>104</volume>, <fpage>83</fpage>&#x2013;<lpage>92</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1017/S0007114510000176</pub-id>
</citation>
</ref>
<ref id="B58">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Schwiertz</surname> <given-names>A.</given-names>
</name>
<name>
<surname>Taras</surname> <given-names>D.</given-names>
</name>
<name>
<surname>Sch&#xe4;fer</surname> <given-names>K.</given-names>
</name>
<name>
<surname>Beijer</surname> <given-names>S.</given-names>
</name>
<name>
<surname>Bos</surname> <given-names>N. A.</given-names>
</name>
<name>
<surname>Donus</surname> <given-names>C.</given-names>
</name>
<etal/>
</person-group>. (<year>2010</year>). <article-title>Microbiota and SCFA in lean and overweight healthy subjects</article-title>. <source>Obes. (Silver Spring)</source> <volume>18</volume>, <fpage>190</fpage>&#x2013;<lpage>195</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1038/oby.2009.167</pub-id>
</citation>
</ref>
<ref id="B59">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Shan</surname> <given-names>Z. Y.</given-names>
</name>
<name>
<surname>Wang</surname> <given-names>L. H.</given-names>
</name>
</person-group> (<year>2022</year>). <article-title>Guidelines for prevention and management of thyroid diseases during pregnancy and perinatal period</article-title>. <source>China J. Endocrinol. Metab</source>. <volume>38</volume> (<issue>7</issue>). doi:&#xa0;<pub-id pub-id-type="doi">10.3760/cma.j.cn311282-20220416-00234</pub-id>
</citation>
</ref>
<ref id="B60">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Sharma</surname> <given-names>D.</given-names>
</name>
<name>
<surname>Shastri</surname> <given-names>S.</given-names>
</name>
<name>
<surname>Sharma</surname> <given-names>P.</given-names>
</name>
</person-group> (<year>2016</year>). <article-title>Intrauterine growth restriction: antenatal and postnatal aspects</article-title>. <source>Clin. Med. Insights Pediatr.</source> <volume>10</volume>, <fpage>67</fpage>&#x2013;<lpage>83</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.4137/CMPed.S40070</pub-id>
</citation>
</ref>
<ref id="B61">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Sililas</surname> <given-names>P.</given-names>
</name>
<name>
<surname>Huang</surname> <given-names>L.</given-names>
</name>
<name>
<surname>Thonusin</surname> <given-names>C.</given-names>
</name>
<name>
<surname>Luewan</surname> <given-names>S.</given-names>
</name>
<name>
<surname>Chattipakorn</surname> <given-names>N.</given-names>
</name>
<name>
<surname>Chattipakorn</surname> <given-names>S.</given-names>
</name>
<etal/>
</person-group>. (<year>2021</year>). <article-title>Association between gut microbiota and development of gestational diabetes mellitus</article-title>. <source>Microorganisms</source> <volume>9</volume> (<issue>8</issue>), <fpage>1686</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.3390/microorganisms9081686</pub-id>
</citation>
</ref>
<ref id="B62">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Stanislawski</surname> <given-names>M. A.</given-names>
</name>
<name>
<surname>Dabelea</surname> <given-names>D.</given-names>
</name>
<name>
<surname>Wagner</surname> <given-names>B. D.</given-names>
</name>
<name>
<surname>Sontag</surname> <given-names>M. K.</given-names>
</name>
<name>
<surname>Lozupone</surname> <given-names>C. A.</given-names>
</name>
<name>
<surname>Eggesb&#xf8;</surname> <given-names>M.</given-names>
</name>
</person-group> (<year>2017</year>). <article-title>Pre-pregnancy weight, gestational weight gain, and the gut microbiota of mothers and their infants</article-title>. <source>Microbiome</source> <volume>5</volume>, <fpage>113</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1186/s40168-017-0332-0</pub-id>
</citation>
</ref>
<ref id="B63">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Stavreus Evers</surname> <given-names>A.</given-names>
</name>
</person-group> (<year>2012</year>). <article-title>Paracrine interactions of thyroid hormones and thyroid stimulation hormone in the female reproductive tract have an impact on female fertility</article-title>. <source>Front. Endocrinol. (Lausanne)</source> <volume>3</volume>, <elocation-id>50</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.3389/fendo.2012.00050</pub-id>
</citation>
</ref>
<ref id="B64">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Sun</surname> <given-names>Y.</given-names>
</name>
<name>
<surname>Chen</surname> <given-names>Q.</given-names>
</name>
<name>
<surname>Lin</surname> <given-names>P.</given-names>
</name>
<name>
<surname>Xu</surname> <given-names>R.</given-names>
</name>
<name>
<surname>He</surname> <given-names>D.</given-names>
</name>
<name>
<surname>Ji</surname> <given-names>W.</given-names>
</name>
<etal/>
</person-group>. (<year>2019</year>). <article-title>Characteristics of gut microbiota in patients with rheumatoid arthritis in Shanghai, China</article-title>. <source>Front. Cell Infect. Microbiol.</source> <volume>9</volume>, <elocation-id>369</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.3389/fcimb.2019.00369</pub-id>
</citation>
</ref>
<ref id="B65">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Tang</surname> <given-names>L.</given-names>
</name>
<name>
<surname>Li</surname> <given-names>P.</given-names>
</name>
<name>
<surname>Zhou</surname> <given-names>H.</given-names>
</name>
<name>
<surname>Li</surname> <given-names>L.</given-names>
</name>
</person-group> (<year>2021</year>). <article-title>A longitudinal study of thyroid markers during pregnancy and the risk of gestational diabetes mellitus and post-partum glucose metabolism</article-title>. <source>Diabetes Metab. Res. Rev.</source> <volume>37</volume>, <elocation-id>e3441</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.1002/dmrr.3441</pub-id>
</citation>
</ref>
<ref id="B66">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Taylor</surname> <given-names>P. N.</given-names>
</name>
<name>
<surname>Albrecht</surname> <given-names>D.</given-names>
</name>
<name>
<surname>Scholz</surname> <given-names>A.</given-names>
</name>
<name>
<surname>Gutierrez-Buey</surname> <given-names>G.</given-names>
</name>
<name>
<surname>Lazarus</surname> <given-names>J. H.</given-names>
</name>
<name>
<surname>Dayan</surname> <given-names>C. M.</given-names>
</name>
<etal/>
</person-group>. (<year>2018</year>). <article-title>Global epidemiology of hyperthyroidism and hypothyroidism</article-title>. <source>Nat. Rev. Endocrinol.</source> <volume>14</volume>, <fpage>301</fpage>&#x2013;<lpage>316</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1038/nrendo.2018.18</pub-id>
</citation>
</ref>
<ref id="B67">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Tomasello</surname> <given-names>G.</given-names>
</name>
<name>
<surname>Tralongo</surname> <given-names>P.</given-names>
</name>
<name>
<surname>Amoroso</surname> <given-names>F.</given-names>
</name>
<name>
<surname>Damiani</surname> <given-names>P.</given-names>
</name>
<name>
<surname>Sinagra</surname> <given-names>E.</given-names>
</name>
<name>
<surname>Noto</surname> <given-names>M.</given-names>
</name>
<etal/>
</person-group>. (<year>2015</year>). <article-title>Dysmicrobism, inflammatory bowel disease and thyroiditis: analysis of the literature</article-title>. <source>J. Biol. Regul. Homeost Agents</source> <volume>29</volume>, <fpage>265</fpage>&#x2013;<lpage>272</lpage>.</citation>
</ref>
<ref id="B68">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Topliss</surname> <given-names>D. J.</given-names>
</name>
</person-group> (<year>2016</year>). <article-title>Clinical update in aspects of the management of autoimmune thyroid diseases</article-title>. <source>Endocrinol. Metab. (Seoul)</source> <volume>31</volume>, <fpage>493</fpage>&#x2013;<lpage>499</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.3803/EnM.2016.31.4.493</pub-id>
</citation>
</ref>
<ref id="B69">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Tortosa</surname> <given-names>F.</given-names>
</name>
</person-group> (<year>2011</year>). <article-title>[Subclinical thyroid dysfunction in pregnancy]</article-title>. <source>Endocrinol. Nutr.</source> <volume>58</volume>, <fpage>255</fpage>&#x2013;<lpage>257</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.endonu.2011.05.001</pub-id>
</citation>
</ref>
<ref id="B70">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Tu</surname> <given-names>X.</given-names>
</name>
<name>
<surname>Duan</surname> <given-names>C.</given-names>
</name>
<name>
<surname>Lin</surname> <given-names>B.</given-names>
</name>
<name>
<surname>Li</surname> <given-names>K.</given-names>
</name>
<name>
<surname>Gao</surname> <given-names>J.</given-names>
</name>
<name>
<surname>Yan</surname> <given-names>H.</given-names>
</name>
<etal/>
</person-group>. (<year>2022</year>). <article-title>Characteristics of the gut microbiota in pregnant women with fetal growth restriction</article-title>. <source>BMC Pregnancy Childbirth</source> <volume>22</volume>, <fpage>297</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1186/s12884-022-04635-w</pub-id>
</citation>
</ref>
<ref id="B71">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Unuane</surname> <given-names>D.</given-names>
</name>
<name>
<surname>Velkeniers</surname> <given-names>B.</given-names>
</name>
<name>
<surname>Anckaert</surname> <given-names>E.</given-names>
</name>
<name>
<surname>Schiettecatte</surname> <given-names>J.</given-names>
</name>
<name>
<surname>Tournaye</surname> <given-names>H.</given-names>
</name>
<name>
<surname>Haentjens</surname> <given-names>P.</given-names>
</name>
<etal/>
</person-group>. (<year>2013</year>). <article-title>Thyroglobulin autoantibodies: is there any added value in the detection of thyroid autoimmunity in women consulting for fertility treatment</article-title>? <source>Thyroid</source> <volume>23</volume>, <fpage>1022</fpage>&#x2013;<lpage>1028</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1089/thy.2012.0562</pub-id>
</citation>
</ref>
<ref id="B72">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>van Dijk</surname> <given-names>M. M.</given-names>
</name>
<name>
<surname>Vissenberg</surname> <given-names>R.</given-names>
</name>
<name>
<surname>Fliers</surname> <given-names>E.</given-names>
</name>
<name>
<surname>van der Post</surname> <given-names>J. A. M.</given-names>
</name>
<name>
<surname>van der Hoorn</surname> <given-names>M. P.</given-names>
</name>
<name>
<surname>de Weerd</surname> <given-names>S.</given-names>
</name>
<etal/>
</person-group>. (<year>2022</year>). <article-title>Levothyroxine in euthyroid thyroid peroxidase antibody positive women with recurrent pregnancy loss (T4LIFE trial): a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial</article-title>. <source>Lancet Diabetes Endocrinol.</source> <volume>10</volume>, <fpage>322</fpage>&#x2013;<lpage>329</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/S2213-8587(22)00045-6</pub-id>
</citation>
</ref>
<ref id="B73">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Ventura</surname> <given-names>R. E.</given-names>
</name>
<name>
<surname>Iizumi</surname> <given-names>T.</given-names>
</name>
<name>
<surname>Battaglia</surname> <given-names>T.</given-names>
</name>
<name>
<surname>Liu</surname> <given-names>M.</given-names>
</name>
<name>
<surname>Perez-Perez</surname> <given-names>G. I.</given-names>
</name>
<name>
<surname>Herbert</surname> <given-names>J.</given-names>
</name>
<etal/>
</person-group>. (<year>2019</year>). <article-title>Gut microbiome of treatment-na&#xef;ve MS patients of different ethnicities early in disease course</article-title>. <source>Sci. Rep.</source> <volume>9</volume>, <fpage>16396</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1038/s41598-019-52894-z</pub-id>
</citation>
</ref>
<ref id="B74">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Wang</surname> <given-names>H.</given-names>
</name>
<name>
<surname>Gao</surname> <given-names>H.</given-names>
</name>
<name>
<surname>Chi</surname> <given-names>H.</given-names>
</name>
<name>
<surname>Zeng</surname> <given-names>L.</given-names>
</name>
<name>
<surname>Xiao</surname> <given-names>W.</given-names>
</name>
<name>
<surname>Wang</surname> <given-names>Y.</given-names>
</name>
<etal/>
</person-group>. (<year>2017</year>). <article-title>Effect of levothyroxine on miscarriage among women with normal thyroid function and thyroid autoimmunity undergoing <italic>in vitro</italic> fertilization and embryo transfer: A randomized clinical trial</article-title>. <source>Jama</source> <volume>318</volume>, <fpage>2190</fpage>&#x2013;<lpage>2198</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1001/jama.2017.18249</pub-id>
</citation>
</ref>
<ref id="B75">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Wu</surname> <given-names>Z.</given-names>
</name>
<name>
<surname>Cai</surname> <given-names>Y.</given-names>
</name>
<name>
<surname>Xia</surname> <given-names>Q.</given-names>
</name>
<name>
<surname>Liu</surname> <given-names>T.</given-names>
</name>
<name>
<surname>Yang</surname> <given-names>H.</given-names>
</name>
<name>
<surname>Wang</surname> <given-names>F.</given-names>
</name>
<etal/>
</person-group>. (<year>2019</year>). <article-title>Hashimoto&#x2019;s thyroiditis impairs embryo implantation by compromising endometrial morphology and receptivity markers in euthyroid mice</article-title>. <source>Reprod. Biol. Endocrinol.</source> <volume>17</volume>, <fpage>94</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1186/s12958-019-0526-3</pub-id>
</citation>
</ref>
<ref id="B76">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Yoon</surname> <given-names>K.</given-names>
</name>
<name>
<surname>Kim</surname> <given-names>N.</given-names>
</name>
</person-group> (<year>2021</year>). <article-title>Roles of sex hormones and gender in the gut microbiota</article-title>. <source>J. Neurogastroenterol Motil.</source> <volume>27</volume>, <fpage>314</fpage>&#x2013;<lpage>325</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.5056/jnm20208</pub-id>
</citation>
</ref>
<ref id="B77">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Zhao</surname> <given-names>F.</given-names>
</name>
<name>
<surname>Feng</surname> <given-names>J.</given-names>
</name>
<name>
<surname>Li</surname> <given-names>J.</given-names>
</name>
<name>
<surname>Zhao</surname> <given-names>L.</given-names>
</name>
<name>
<surname>Liu</surname> <given-names>Y.</given-names>
</name>
<name>
<surname>Chen</surname> <given-names>H.</given-names>
</name>
<etal/>
</person-group>. (<year>2018</year>). <article-title>Alterations of the gut microbiota in hashimoto&#x2019;s thyroiditis patients</article-title>. <source>Thyroid</source> <volume>28</volume>, <fpage>175</fpage>&#x2013;<lpage>186</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1089/thy.2017.0395</pub-id>
</citation>
</ref>
<ref id="B78">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Zhao</surname> <given-names>H.</given-names>
</name>
<name>
<surname>Yuan</surname> <given-names>L.</given-names>
</name>
<name>
<surname>Zhu</surname> <given-names>D.</given-names>
</name>
<name>
<surname>Sun</surname> <given-names>B.</given-names>
</name>
<name>
<surname>Du</surname> <given-names>J.</given-names>
</name>
<name>
<surname>Wang</surname> <given-names>J.</given-names>
</name>
</person-group> (<year>2022</year>). <article-title>Alterations and mechanism of gut microbiota in graves&#x2019; Disease and hashimoto&#x2019;s thyroiditis</article-title>. <source>Pol. J. Microbiol.</source> <volume>71</volume>, <fpage>173</fpage>&#x2013;<lpage>189</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.33073/pjm-2022-016</pub-id>
</citation>
</ref>
<ref id="B79">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Zhou</surname> <given-names>P.</given-names>
</name>
<name>
<surname>Yao</surname> <given-names>Q.</given-names>
</name>
<name>
<surname>Zhao</surname> <given-names>Q.</given-names>
</name>
<name>
<surname>Yang</surname> <given-names>L.</given-names>
</name>
<name>
<surname>Yu</surname> <given-names>Y.</given-names>
</name>
<name>
<surname>Xie</surname> <given-names>J.</given-names>
</name>
<etal/>
</person-group>. (<year>2022</year>). <article-title>IVF/ICSI outcomes of euthyroid infertile women with thyroid autoimmunity: does treatment with aspirin plus prednisone matter</article-title>? <source>BMC Pregnancy Childbirth</source> <volume>22</volume>, <fpage>263</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1186/s12884-022-04532-2</pub-id>
</citation>
</ref>
</ref-list>
</back>
</article>