Risk factors for discontinuation of thyroid hormone replacement therapy in early pregnancy: a study from the Norwegian Mother and Child Cohort Study and the Medical Birth Registry of Norway

Frank, Anna-Simone; Lupattelli, Angela; Nordeng, Hedvig

doi:10.1111/aogs.13339

Cited by 5 publications

(5 citation statements)

References 26 publications

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“…In Switzerland, healthcare claims data are underused on an institutional level, and drug utilization on a national level is largely unknown. Other western countries, such as all Scandinavian countries, France, Germany, and the United States, have used healthcare claims data for surveillance of drug use and safety for decades, enhancing them with external data to study vulnerable populations such as pregnant women [40][41][42][43]. The Swiss federal council's health policy strategy 2020-2030 declared that the technological and digital transformation of the healthcare sector was one of its four main goals in order to improve public health over the next decade [44].…”

Section: Discussionmentioning

confidence: 99%

Use of valproate in pregnancy and in women of childbearing age between 2014 and 2018 in Switzerland: a retrospective analysis of Swiss healthcare claims data

et al. 2021

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AIMS OF THE STUDY: The prevalence of the use of valproate during pregnancy and by women of childbearing age in Switzerland is not known. We aimed to study the use of antiseizure drugs by these women in Switzerland, with a particular focus on valproate. METHODS:We conducted a retrospective descriptive study using the healthcare claims database of the Swiss health insurance Helsana (2014-18). We established two separate study populations: (1) a cohort of pregnancies leading to a delivery, and (2) all women of childbearing age (15-45 years) who were insured with Helsana for at least one year during the study period. We identified the dispensation of valproate, lamotrigine, carbamazepine, levetiracetam, topiramate, pregabalin, gabapentin, phenobarbital, and phenytoin (1) between delivery and three months prior to the estimated date of the last menstrual period, and (2) by calendar year. We quantified exposure prevalence of each antiseizure drug as the number of women with ≥1 prescription fill per 10,000 (1) pregnancies, and (2) women by calendar year. Results were weighted for the demographic distribution of the Helsana population relative to the Swiss population.RESULTS: We identified a weighted pregnancy population of 387,418 pregnancies, with a mean maternal age at delivery of 31.9 years (standard deviation 5.1). Lamotrigine was the most frequently dispensed antiseizure drug during pregnancy (20/10,000), followed by levetiracetam (11/ 10,000), and pregabalin (3.8/10,000). Valproate was dispensed to 1.9/10,000 women during pregnancy and to 1.3/ 10,000 women within 90 days prior to the last menstru-al period but not during pregnancy. The weighted study population of women aged 15-45 years consisted of 2,781,151 women, of whom 74,080 (270/10,000) were exposed to ≥1 of the evaluated antiseizure drugs. Pregabalin was the most frequently dispensed antiseizure drug (64/ 10,000), followed by lamotrigine (46/10,000), topiramate (32/10,000), and valproate (25/10,000). The use of valproate decreased from 28/10,000 women in 2014 to 21/ 10,000 women in 2018. CONCLUSIONS:The prevalence of exposure to valproate during pregnancy was comparable to Denmark and lower than in other European countries. Despite decreasing exposure prevalence, the use of valproate in women of childbearing age in Switzerland seems higher than the actual clinical need.

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Section: Discussionmentioning

confidence: 99%

Use of valproate in pregnancy and in women of childbearing age between 2014 and 2018 in Switzerland: a retrospective analysis of Swiss healthcare claims data

et al. 2021

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“…[9][10][11][14][15][16][17] We found no difference in fine and gross motor function, communication skills, and behavior. This is important because some women discontinue their THRT upon recognition of pregnancy 37,38 and, among those who are medicated, adherence to THRT is not always optimal. 39 Juch et al 39 found that 17% of pregnant women with hypothyroidism exhibit low adherence during pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Thyroid hormone replacement therapy in pregnancy and motor function, communication skills, and behavior of preschool children: The Norwegian Mother, Father, and Child Cohort Study

Broek

Lupattelli

Frank

et al. 2020

Pharmacoepidemiology and Drug

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Purpose: Limited research has focused on the association between prenatal thyroid hormone replacement therapy (THRT) and motor function, communication skills, and behavior in preschool children. Here, we estimated the association between THRT during pregnancy and the first trimester and these developmental outcomes.Methods: This study was based on the Norwegian Mother, Father, and Child Cohort Study (MoBa) and other national registries. We included mother-child pairs exposed to THRT during pregnancy (n = 663), after delivery (n = 728), or unexposed (n = 28 040).Exposure to THRT was defined according to filled prescriptions. Child outcomes, presented as T-score differences, were parent-reported using the Ages and Stages Questionnaire, Strengths and Difficulties Questionnaire, and Child Behavior Checklist.Results: Of 29 431 mother-child pairs, 2.3% were prenatally exposed to THRT. We found no difference between prenatally exposed and unexposed children in regards to gross motor function (β: 0.17, 95% CI −1.19, 1.54), fine motor function (β: −0.17, 95%

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“…Only about half of LT4-treated women have high LT4 adherence during pregnancy [42–44,45 ▪ ]. In a Norwegian population-based cohort, 13% of hypothyroid women using thyroid hormone therapy before pregnancy discontinued treatment in early pregnancy [42]. In the same study, 5.8% of women had low adherence, and only 50% had adequate adherence to prescribed thyroid hormone [43].…”

Section: Indications For Treatment Of Maternal Thyroid Hypofunctionmentioning

confidence: 95%

Section: Indications For Treatment Of Maternal Thyroid Hypofunctionmentioning

confidence: 99%

“…Other population-based cohorts found that 37.5% of hypothyroid pregnant women in Finland [44] and 50% in Spain [45 ▪ ] reported using LT4 consistently. Women with untreated mental disorders and noncompliance with recommended nutritional supplements are at risk for LT4 nonadherence in pregnancy [42]. However, taking prescribed LT4 consistently may reduce adverse pregnancy outcomes including gestational hypertension, severe preeclampsia, and preterm births [44].…”

Section: Indications For Treatment Of Maternal Thyroid Hypofunctionmentioning

confidence: 99%

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Under and overtreatment with thyroid hormone replacement during pregnancy

Peng

Maraka

Pearce

2022

Current Opinion in Endocrinology, Diabetes &Amp; Obesity

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Purpose of review Among pregnant women on thyroid hormone replacement therapy undertreatment is common, while overtreatment is rare. Both deficient and excessive maternal thyroid hormone have been related to adverse maternofetal and long-term offspring outcomes, although studies' results are inconsistent. This review aims to discuss recent evidence regarding the effects of under-and overtreatment with thyroid hormone replacement during pregnancy and how current practices could be improved. Recent findingsWhether or not thyroid hormone therapy needs to be initiated for maternal subclinical hypothyroidism remains unclear, but recent meta-analyses have confirmed associations between adverse maternal, neonatal, and offspring outcomes in both overt and subclinical hypothyroidism. Subclinical hyperthyroidism in pregnancy is related to fewer adverse outcomes. Current adherence to levothyroxine during pregnancy and medication counseling by healthcare providers are suboptimal.

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Risk factors for discontinuation of thyroid hormone replacement therapy in early pregnancy: a study from the Norwegian Mother and Child Cohort Study and the Medical Birth Registry of Norway

Cited by 5 publications

References 26 publications

Use of valproate in pregnancy and in women of childbearing age between 2014 and 2018 in Switzerland: a retrospective analysis of Swiss healthcare claims data

Use of valproate in pregnancy and in women of childbearing age between 2014 and 2018 in Switzerland: a retrospective analysis of Swiss healthcare claims data

Thyroid hormone replacement therapy in pregnancy and motor function, communication skills, and behavior of preschool children: The Norwegian Mother, Father, and Child Cohort Study

Under and overtreatment with thyroid hormone replacement during pregnancy

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