SummaryBackgroundIn the last 2 decades, several studies have examined the association between maternal thyroid hormone insufficiency during pregnancy and neurodevelopmental disorders in children and shown conflicting results.AimThis systematic review aimed to assess the evidence for an association between maternal thyroid hormone insufficiency during pregnancy and neurodevelopmental disorders in children. We also sought to assess whether levothyroxine treatment for maternal thyroid hormone insufficiency improves child neurodevelopment outcomes.MethodsWe performed systematic literature searches in MEDLINE, EMBASE, PSYCinfo, CINAHL, AMED, BNI, Cochrane, Scopus, Web of Science, GreyLit, Grey Source and Open Grey (latest search: March 2017). We also conducted targeted web searching and performed forwards and backwards citation chasing. Meta‐analyses of eligible studies were carried out using the random‐effects model.ResultsWe identified 39 eligible articles (37 observational studies and 2 randomized controlled trials [RCT]). Meta‐analysis showed that maternal subclinical hypothyroidism and hypothyroxinaemia are associated with indicators of intellectual disability in offspring (odds ratio [OR] 2.14, 95% confidence interval [CI] 1.20 to 3.83, P = .01, and OR 1.63, 95% CI 1.03 to 2.56, P = .04, respectively). Maternal subclinical hypothyroidism and hypothyroxinaemia were not associated with attention deficit hyperactivity disorder, and their effect on the risk of autism in offspring was unclear. Meta‐analysis of RCTs showed no evidence that levothyroxine treatment for maternal hypothyroxinaemia or subclinical hypothyroidism reduces the incidence of low intelligence quotient in offspring.LimitationsAlthough studies were generally of good quality, there was evidence of heterogeneity between the included observational studies (I 2 72%‐79%).ConclusionMaternal hypothyroxinaemia and subclinical hypothyroidism may be associated with intellectual disability in offspring. Currently, there is no evidence that levothyroxine treatment, when initiated 8‐ to 20‐week gestation (mostly between 12 and 17 weeks), for mild maternal thyroid hormone insufficiency during pregnancy reduces intellectual disability in offspring.

Patient-initiated appointment systems for adults with chronic conditions in secondary care (Review)

Non‐pharmacological interventions for attention‐deficit/hyperactivity disorder are useful treatments, but it is unclear how effective school‐based interventions are for a range of outcomes and which features of interventions are most effective. This paper systematically reviews randomised controlled trial evidence of the effectiveness of interventions for children with ADHD in school settings. Three methods of synthesis were used to explore the effectiveness of interventions, whether certain types of interventions are more effective than others and which components of interventions lead to effective academic outcomes. Twenty‐eight studies (n = 1807) were included in the review. Eight types of interventions were evaluated and a range of different ADHD symptoms, difficulties and school outcomes were assessed across studies. Meta‐analyses demonstrated beneficial effects for interventions that combine multiple features (median effect size g = 0.37, interquartile range 0.32, range 0.09–1.13) and suggest some promise for daily report card interventions (median g = 0.62, IQR = 0.25, range 0.13–1.62). Meta‐regression analyses did not give a consistent message regarding which types of interventions were more effective than others. Finally, qualitative comparative analysis demonstrated that self‐regulation and one‐to‐one intervention delivery were important components of interventions that were effective for academic outcomes. These two components were not sufficient though; when they appeared with personalisation for individual recipients and delivery in the classroom, or when interventions did not aim to improve child relationships, interventions were effective. This review provides updated information about the effectiveness of non‐pharmacological interventions specific to school settings and gives tentative messages about important features of these interventions for academic outcomes.

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