Screening for Thyroid Dysfunction in Pregnancy With Targeted High-Risk Case Finding: Can It Be Improved?

Sitoris, Georgiana; Veltri, Flora; Kleynen, Pierre; Belhomme, Julie; Rozenberg, Serge; Poppe, Kris

doi:10.1210/jc.2018-02303

Cited by 14 publications

(8 citation statements)

References 43 publications

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“…Sixteen of them were downloaded in full and read carefully. Eight articles were excluded because the data couldn't be extracted (20,21) or the research subjects were not grouped according to ID (10,(22)(23)(24)(25)(26). Finally, a total of eight articles were included in our meta-analysis ( Figure 1).…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

Iron Deficiency, a Risk Factor of Thyroid Disorders in Reproductive-Age and Pregnant Women: A Systematic Review and Meta-Analysis

Luo

Wang

et al. 2021

Front. Endocrinol.

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BackgroundIron deficiency (ID) is concerned as the most common nutritional deficiency worldwide. The effects of ID on thyroid function and autoimmunity in pregnant women and reproductive-age women are controversial. The aim of the current study was to summarize the evidences and evaluate the relationship between ID and thyroid disorders.MethodsIn this systematic review and meta-analysis, studies published on the Cochrane, Embase, Medline, and PubMed databases by October 2020 were searched. A total of 636 studies which discussed the correlation between ID and thyroid disorders were eligible in the initial search. Pooled mean differences (MD) and 95% confidence intervals (CI) were calculated for the assessment of thyrotropin (TSH) and free thyroxine (FT4) levels. Combined odd ratios (OR) and 95% CI were calculated for the assessment of the prevalence of overt and subclinical hypothyroidism, positive thyroid peroxidase antibody (TPOAb), and thyroglobulin antibody (TgAb).ResultsFor women of reproductive age, ID could significantly increase the risk of positive TPOAb (OR: 1.89; 95% CI: 1.17, 3.06: P = 0.01) and both positive TPOAb and TgAb (OR: 1.48; 95% CI: 1.03, 2.11: P = 0.03). The meta-analysis of pregnant women showed that pregnant women with ID had increased serum TSH levels (MD: 0.12; 95% CI: 0.07, 0.17; P < 0.00001) and decreased FT4 levels (MD: −0.73; 95% CI: −1.04, −0.41; P < 0.00001). Meanwhile, the prevalence of overt (OR: 1.60; 95% CI: 1.17, 2.19; P = 0.004) and subclinical (OR: 1.37; 95% CI: 1.13, 1.66; P = 0.001) hypothyroidism in pregnant women with ID was significantly increased.ConclusionsID may adversely affect thyroid function and autoimmunity of pregnant and reproductive-age women and it is very necessary for monitoring iron nutritional status and early treatment of ID for them.

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Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

Iron Deficiency, a Risk Factor of Thyroid Disorders in Reproductive-Age and Pregnant Women: A Systematic Review and Meta-Analysis

Luo

Wang

et al. 2021

Front. Endocrinol.

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“…However, the study is limited because of the use of only a subset of the 11 different criteria for case-finding as recommended by ATA [1 ,17]. Nevertheless, in keeping with these findings, a recent cross-sectional study showed that case-finding screening of patients with high risk for thyroid disorders (those with at least one ATA guideline criteria) was not effective in the detection of SCH compared with universal screening [18]. Some authors have proposed the use of prepregnancy thyroid function assessment as another useful tool to predict future adverse pregnancy outcomes.…”

Section: Thyroid Dysfunction Screeningmentioning

confidence: 99%

Subclinical hypothyroidism in pregnancy

Toloza

Abedzadeh-Anaraki

Maraka

2019

Current Opinion in Endocrinology, Diabetes &Amp; Obesity

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Purpose of review Subclinical hypothyroidism (SCH) is a common diagnosis among women of reproductive age. The importance of sufficient maternal thyroid supply during pregnancy is well known. Nevertheless, the effects of SCH during pregnancy and the efficacy of its treatment on maternofetal outcomes are not well established. This review discusses the recent evidence on SCH in pregnancy and how this evidence is reflected in current clinical care. Recent findingsRecent observational studies have found a positive association between SCH during pregnancy and adverse maternal, neonatal and offspring outcomes, mainly in thyroid peroxidase autoantibody positive women. Although interventional studies have shown a benefit of levothyroxine (LT4) treatment on selected pregnancy outcomes, there was no effect on offspring neurodevelopment.

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“…Since our results are in favour of treating women with SCH, it adds some evidence in favour of a systematic screening for serum TSH in pregnant women [50,51].…”

Section: Discussionmentioning

confidence: 51%

Impact of thyroid hormone treatment on maternal pregnancy outcomes in women with subclinical hypothyroidism without TPOAb

Sitoris

Veltri

Jelloul

et al. 2022

Preprint

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Purpose: To investigate the impact of thyroid hormone treatment (LT4) on maternal pregnancy outcomes in women with subclinical hypothyroidism (SCH) without thyroid peroxidase antibodies (TPOAb) positivity. Design/Methods: Single centre, cross-sectional study in 1460 women screened for TSH, free T4 and TPOAb at median 13 (11-17) weeks of gestation during the period 2013-2014. Exclusion criteria were twin- and assisted reproduction pregnancies, TPO positivity, overt hyperthyroidism, and treatment with LT4 before screening. The impact of LT4 on maternal pregnancy outcomes was investigated in a group of 53 women with SCH (TSH >3.74 mIU/L) in which LT4 was initiated at median 13 (10-22) weeks (treated group). The control group included 18 women with SCH (TSH >3.74 mIU/L; untreated group). The prevalence of pregnancy complications in these two groups was compared with that in a reference group of 1389 women (TSH £3.74 mIU/L and no TPOAb; REF group). Results: The prevalence of pre-eclampsia and gestational diabetes (GDM) was higher in the control group vs that in the REF group (16.7% vs 5.0% and 27.8% vs 18.9%; p=0.017 and p=0.016, respectively), but comparable in the LT4 treated SCH group vs the REF group (7.6% vs 5.0% and 22.6% vs 18.9%; p=0.918 and 0.676, respectively). The prevalence of iron-deficiency anaemia was lower in the LT4 treated vs the REF group (17.0% vs 32.5%; p=0.017). Conclusions: Pregnant women with SCH and without TPOAb positivity who were LT4 untreated had a higher prevalence of pre-eclampsia and GDM compared with euthyroid women, while this was not the case when SCH women were treated with LT4, even when it was initiated after the first trimester.

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Screening for Thyroid Dysfunction in Pregnancy With Targeted High-Risk Case Finding: Can It Be Improved?

Cited by 14 publications

References 43 publications

Iron Deficiency, a Risk Factor of Thyroid Disorders in Reproductive-Age and Pregnant Women: A Systematic Review and Meta-Analysis

Iron Deficiency, a Risk Factor of Thyroid Disorders in Reproductive-Age and Pregnant Women: A Systematic Review and Meta-Analysis

Subclinical hypothyroidism in pregnancy

Impact of thyroid hormone treatment on maternal pregnancy outcomes in women with subclinical hypothyroidism without TPOAb

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