Maternal thyroid peroxidase antibodies during pregnancy: a marker of impaired child development?

Abstract

Women with antibodies against the enzyme thyroid peroxidase [TPO-Ab; formerly microsomal antibodies (MsAb)] are at particular risk for developing postpartum thyroid dysfunction; the latter is significantly associated with postpartum depression. Although the negative effect of postpartum maternal depression on child development is well documented, the consequences of elevated titers of TPO-Ab during pregnancy and subsequent postpartum thyroid dysfunction on child development are not known. In a prospective study of a cohort of 293 pregnant women, the occurrence of TPO-Ab during gestation, thyroid dysfunction, and depression was investigated. Five years after delivery, child development was assessed in 230 children of the original cohort using the Dutch translation of the McCarthy Scales of Children's Abilities. Children of women with TPO-Ab during late gestation (n = 19, with normal thyroid function) had significantly lower scores (by t test) on the McCarthy Scales of Children's Abilities than antibody-negative women. The difference on the General Cognitive Scale, which reflects IQ scores, was substantial (10.5 points; t = 2.8; P = 0.005). After correction for possibly confounding variables, maternal TPO-Ab during gestation was found to be the most important factor related to the scores on the General Cognitive Scale (odds ratio = 10.5; 95% confidence interval = 3-34; P = 0.003). We conclude that children of pregnant women who had elevated titers of TPO-Ab but normal thyroid function are at risk for impaired development.

Value of Combined Clinical Information and Thyroid Peroxidase Antibodies in Pregnancy for the Prediction of Postpartum Thyroid Dysfunction

“…Its occurrence in TPOAb‐negative women, although infrequent, 6 weakens antibodies as predictors of PPTD. Furthermore, the presence of TPOAb in early pregnancy is also a marker for postpartum depressive symptoms, 9 and has been associated with impaired neuropsychological development of children of affected mothers, 10 although more recent data suggest a stronger relationship with early maternal hypothyroxinemia 11 …”

Maternal Hypothyroidism and Child Development

“…The study of Pop et al [14]is interesting because they reported lower IQs in the children of mothers with antibodies to thyroid peroxidase but normal thyroid hormonal values at 32 weeks gestation. They suggested that the antibodies did not cause the CNS problems but were an epiphenomenon.…”

Maternal Thyroid Hypofunction and Pregnancy Outcome

“…[5][6][7][8][9] Antithyroid antibodies may also have an influence on the fetal brain and subsequent pediatric neurodevelopment. [10][11][12] Obstetric factors may be responsible for some of the differences in neurologic outcomes seen in the offspring of women with maternal thyroid hypofunction compared with their euthyroid counterparts. 4,13 The purpose of this study was to estimate if maternal thyroid hypofunction, diagnosed during the first or second trimesters, affects obstetric outcomes in a subset of patients from the First And Second Trimester Evaluation of Risk (FASTER) Trial.…”