Subclinical Hypothyroidism with Negative for Thyroid Peroxidase Antibodies in Pregnancy: Intellectual Development of Offspring

Chen, Jiajia; Zhu, Jing; Huang, Xiaobi; Zhao, Shenzhi; Xiang, Huiqiu; Zhou, Panpan; Zhou, Tong; Xu, Zhangye

doi:10.1089/thy.2021.0374

Cited by 20 publications

(34 citation statements)

References 19 publications

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“…A total of 22 ( 17 – 38 ) studies were included, including 9 RCTs ( 18 – 20 , 24 – 26 , 30 , 33 , 37 ) and 13 cohort studies ( 17 , 21 – 23 , 27 – 29 , 31 , 32 , 34 – 36 , 38 ), comprising 11,273 pregnant women with SCH. These studies were conducted in Iran ( 19 , 20 ), the United States ( 23 , 24 ), China ( 17 , 22 , 25 – 38 ), Japan ( 21 ) and South Korea ( 18 ). Detailed characteristics of the included studies are shown in Supplementary Table 2 .…”

Section: Resultsmentioning

confidence: 99%

“…Overall, 3 (33%) RCTs ( 18 , 19 , 24 ) were rated at low risk of bias, 1 (11%) RCT ( 20 ) was rated at some concerns (moderate risk of bias), and the remaining (56%) RCTs ( 25 , 26 , 30 , 33 , 37 ) were rated at high risk of bias. For cohort studies, judging by the NOS score, 1 (8%) cohort study ( 23 ) was rated at low risk of bias, 4 (31%) cohort studies ( 17 , 21 , 22 , 31 ) were rated at moderate risk of bias, and the remaining (61%) studies ( 27 – 29 , 32 , 34 – 36 , 38 ) were rated at high risk of bias.…”

Section: Resultsmentioning

confidence: 99%

“…A total of 8 RCTs ( 19 , 20 , 24 – 26 , 30 , 33 , 37 ) and 11 cohort studies ( 17 , 22 , 23 , 27 – 29 , 32 , 34 – 36 , 38 ) reported preterm delivery.…”

Section: Resultsmentioning

confidence: 99%

“…For cohort studies, the meta-analysis of all cohort studies indicated that LT4 group had a lower risk of preterm delivery compared with the control group (OR=0.57, 95%CI: 0.37-0.87, P =0.009, I 2 = 69%) ( 17 , 22 , 23 , 27 – 29 , 32 , 34 – 36 , 38 ). However, when we excluded cohort studies with high risk of bias, there was no statistically significant difference between LT4 group and control group in preterm delivery (OR=1.21, 95%CI: 0.78-1.87, P =0.390, I 2 = 0%) ( 17 , 22 , 23 ) ( Table 1 ).…”

Section: Resultsmentioning

confidence: 99%

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The impact of levothyroxine therapy on the pregnancy, neonatal and childhood outcomes of subclinical hypothyroidism during pregnancy: An updated systematic review, meta-analysis and trial sequential analysis

et al. 2022

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BackgroundSeveral systematic reviews and meta-analyses have investigated the effect of levothyroxine (LT4) therapy in pregnant women with subclinical hypothyroidism (SCH). However, all these studies have clinical or methodological problems (such as adopting the old 2011 American Thyroid Association [ATA] diagnostic criteria, directly combining randomized controlled trials [RCTs] and cohort studies for meta-analysis, and so on), and cannot provide accurate and satisfactory results. Thus, we performed this updated systematic review, meta-analysis and trial sequential analysis (TSA) to assess the effect of LT4 therapy in pregnant women with SCH, with the goal of providing more accurate and reliable evidence for clinical practice.MethodsWe searched nine databases from inception to February 2022. The search strategy targeted the RCTs and cohort studies on pregnancy, neonatal and childhood outcomes following LT4 treatment in pregnant women with SCH based on the new 2017 ATA diagnostic criteria. We performed meta-analyses of RCTs and cohort studies separately, and further performed meta-analyses by excluding studies with high risk of bias. TSA was performed to test whether the current evidence was sufficient, and the quality of evidence was evaluated using the GRADE method.ResultsA total of 9 RCTs and 13 cohort studies comprising 11273 pregnant women with SCH were included. There were no statistically significant differences between LT4 group and control group in all primary and secondary outcomes, such as preterm delivery (RR=0.46, 95%CI: 0.19-1.09, P=0.08, I2 = 65%), miscarriage (RR=0.36, 95%CI: 0.13-1.03, P=0.06, I2 = 38%), gestational hypertension (RR=0.91, 95%CI: 0.58-1.43, P=0.69, I2 = 0%), preeclampsia (RR=1.10, 95%CI: 0.61-1.97, P=0.76, I2 = 0%), gestational diabetes (RR=0.80, 95%CI: 0.51-1.25, P=0.32, I2 = 34%), and so on. TSA showed that the results for all outcomes were insufficient and inconclusive. According to GRADE, the evidences for four outcomes (miscarriage, gestational hypertension, gestational diabetes, and small for gestational age) were rated as moderate quality, while the evidences for the other outcomes were rated as low or very low quality.ConclusionUnlike previous systematic reviews and meta-analyses, our study found no evidence of benefit of LT4 therapy on pregnancy, neonatal and childhood outcomes in pregnant women with SCH.Systematic Review RegistrationPROSPERO, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022321937, identifier CRD42022321937.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…A total of 8 RCTs ( 19 , 20 , 24 – 26 , 30 , 33 , 37 ) and 11 cohort studies ( 17 , 22 , 23 , 27 – 29 , 32 , 34 – 36 , 38 ) reported preterm delivery.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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The impact of levothyroxine therapy on the pregnancy, neonatal and childhood outcomes of subclinical hypothyroidism during pregnancy: An updated systematic review, meta-analysis and trial sequential analysis

et al. 2022

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“…The intellectual development of offspring of subclinical hypothyroidism with TPOAb-negative during pregnancy is associated with TSH level. Standardized treatment of subclinical hypothyroidism with TPOAb-negative during pregnancy and control of TSH level at 4.0∼10.0 mIU/L before 8 weeks of pregnant women can significantly improve the intellectual development level of offspring at 2 years old [ 28 ]. The results of this study show that the one-year-old development quotient (DQ) of the treatment group and the control group is higher than that of the untreated group, indicating that L-T4 treatment is of positive significance.…”

Section: Discussionmentioning

confidence: 99%

Effect of Levothyroxine Sodium Tablets on Pregnancy Outcome and Offspring Development Quotient of SCH during Pregnancy

Qian

Sun

2022

Journal of Healthcare Engineering

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Objective. To investigate the effect of levothyroxine sodium tablets (L-T4) on pregnancy outcome and offspring development quotient in patients with subclinical hypothyroidism (SCH) during pregnancy. Material and Methods. Pregnant women with gestational age less than 12 weeks who underwent the first prenatal examination in our hospital from January 2019 to December 2019 were prospectively selected as subjects. According to the level of thyroid hormone in pregnant women, they were divided into the treatment group (n = 63) and received L-T4 treatment, untreated group (n = 64), and control group (n = 54). Three groups of pregnancy outcomes, children’s physical development, and the development of offspring were compared at when one full year of life. Results. After treatment, the contrast difference of the three groups about abortion and gestational diabetes mellitus (GDM) was statistically significant ( P < 0.05 ). The abortion rate and gestational diabetes mellitus (GDM) in the untreated group were higher than those in the control group ( P < 0.05 ). The contrast difference of the treatment group and control group about abortion and gestational diabetes mellitus (GDM) is not statistically significant ( P > 0.05 ); The contrast difference of the three groups about a filial generation at birth and one-year-old body length is not statistically significant ( P > 0.05 ). The contrast difference between the three groups of individual children who are one-year old having the individual action energy, material ability, speech ability, and human ability is statistically significant ( P < 0.05 ). One-year-old developmental quotient (DQ) of the treatment group and control group was higher than that of the untreated group ( P < 0.05 ); the Pearson correlation analysis showed that the treatment group TSH levels have no correlation between the offspring developmental quotient (DQ) level of one-year-old children ( P > 0.05 ). Conclusion. Levothyroxine sodium tablets (L-T4) can not only improve the pregnancy outcome of patients with SCH during pregnancy but also play a positive role in improving the neurointellectual development of their offspring.

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A first-trimester serum TSH in the 4–10 mIU/L range is associated with obstetric complications in thyroid peroxidase antibody-negative women

Magri

Bellingeri

Maggio

et al. 2022

J Endocrinol Invest

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Subclinical Hypothyroidism with Negative for Thyroid Peroxidase Antibodies in Pregnancy: Intellectual Development of Offspring

Cited by 20 publications

References 19 publications

The impact of levothyroxine therapy on the pregnancy, neonatal and childhood outcomes of subclinical hypothyroidism during pregnancy: An updated systematic review, meta-analysis and trial sequential analysis

The impact of levothyroxine therapy on the pregnancy, neonatal and childhood outcomes of subclinical hypothyroidism during pregnancy: An updated systematic review, meta-analysis and trial sequential analysis

Effect of Levothyroxine Sodium Tablets on Pregnancy Outcome and Offspring Development Quotient of SCH during Pregnancy

A first-trimester serum TSH in the 4–10 mIU/L range is associated with obstetric complications in thyroid peroxidase antibody-negative women

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