The Increased Trend of Medical Treatment for Thyroid Diseases during Pregnancy: A 13-Year National Study

Turunen, Suvi; Vääräsmäki, Marja; Leinonen, Maarit K.; Gissler, Mika; Männistö, Tuija; Suvanto, Eila

doi:10.1159/000515125

Cited by 10 publications

(8 citation statements)

References 28 publications

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“…Our results are very much comparable to the recent similar study in Finland which found a five-fold increase in levothyroxine use among pregnant women from 1.1% in 2004 to 6.2% in 2016 (14). We found a smaller increase in the Norwegian numbers (2.4-fold); however, the proportion of women using thyroid hormone replacement therapy was lower (3.57% in 2018).…”

Section: Discussionsupporting

confidence: 88%

Antenatal thyroid hormone therapy and antithyroid drug use in Norway from 2004 to 2018

Bakken

Nermo

Nedrebø

et al. 2022

Endocrine Connections

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Objective: Thyroid disease during pregnancy is associated with adverse pregnancy outcomes and suboptimal fetal development. During the last decades, guidelines for diagnosing thyroid disease during pregnancy have changed considerably, and there has been increased awareness. This study aimed to describe the prevalence of thyroid disease treatment over time among pregnant women in Norway. Design: Nation-wide register-based study. Methods: We combined historical data from the Medical Birth Registry of Norway and the Norwegian Prescription Database, identifying pregnant women using thyroid therapy from 2004 to 2018. Results: A total of 855,067 pregnancies were included in the analyses. The proportion of women using thyroid hormone replacement therapy during pregnancy increased from 1.46% (n=800) in 2004 to 3.57% (n=1940) in 2018. The proportion of women using antithyroid medications also increased from 0.04% (n=20) in 2004 to 0.10% (n=56). During these 15 years, the mean maternal age increased by 0.9 years. When adjusting for age, the risk for being on thyroid hormone replacement therapy during pregnancy increased by an average of 5% per year (odds ratio 1.05, 95% confidence interval 1.05–1.05). Conclusion: During the recent 15 years, there has been a substantial increase in the use of thyroid hormone therapy in Norwegian pregnant women. We speculate that this could be due to an increased awareness in combination with overdiagnosis because of inappropriate diagnostic criteria. To truly understand the possible causes and consequences of this development, further research is warranted.

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Section: Discussionsupporting

confidence: 88%

Antenatal thyroid hormone therapy and antithyroid drug use in Norway from 2004 to 2018

Bakken

Nermo

Nedrebø

et al. 2022

Endocrine Connections

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“…Studies from other countries of trimester‐specific medication use also reported anti‐infectives to be the most commonly prescribed medication in the first trimester, including in Canada, Norway, Sweden, and Denmark 31–36 . In concordance with our findings, use of anti‐infectives, NVP, anti‐depression/anxiety, fertility, anti‐diabetic and thyroid medications appear to be increasing outside of the United States 24,33,37–41 . However, demographic patterns of medication use among pregnant women in other countries differed from those presented here, owing to variations in prescribing patterns of specific products 27 …”

Section: Discussionsupporting

confidence: 85%

“…[31][32][33][34][35][36] In concordance with our findings, use of antiinfectives, NVP, anti-depression/anxiety, fertility, anti-diabetic and thyroid medications appear to be increasing outside of the United States. 24,33,[37][38][39][40][41] However, demographic patterns of medication use among pregnant women in other countries differed from those presented here, owing to variations in prescribing patterns of specific products. 27 In conclusion, we found that prescription medication use in the first trimester of pregnancy is common and increasing.…”

Section: Articlecontrasting

confidence: 73%

Patterns of Prescription Medication Use during the First Trimester of Pregnancy in the United States, 1997–2018

Werler

Kerr

Ailes

et al. 2023

Clin Pharma and Therapeutics

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The objective of this analysis was to describe patterns of prescription medication use during pregnancy, including secular trends, with consideration of indication, and distributions of use within demographic subgroups. We conducted a descriptive secondary analysis using data from 9,755 women whose infants served as controls in two large United States case–control studies from 1997–2011 and 2014–2018. After excluding vitamin, herbal, mineral, vaccine, i.v. fluid, and topical products and over‐the‐counter medications, the proportion of women that reported taking at least one prescription medication in the first trimester increased over the study years, from 37% to 50% of women. The corresponding proportions increased with increasing maternal age and years of education, were highest for non‐Hispanic White women (47%) and lowest for Hispanic women (24%). The most common indication for first trimester use of a medication was infection (12–15%). Increases were observed across the years for medications used for indications related to nausea/vomiting, depression/anxiety, infertility, thyroid disease, diabetes, and epilepsy. The largest relative increase in use among women was observed for medications to treat nausea/vomiting, which increased from 3.8% in the earliest years of the study (1997–2001) to 14.8% in 2014–2018, driven in large part by ondansetron use. Prescription medication use in the first trimester of pregnancy is common and increasing. Many medical conditions require treatments among pregnant women, often involving pharmacotherapy, which necessitates consideration of the risk and safety profiles for both mother and fetus.

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“…The variations in our trimester-specific reference ranges, alongside disparities noted in published data from international studies, prompt questioning the accuracy of thyroid function test interpretation in pregnant women. Following fixed reference ranges often results in unnecessary or untimely treatment, posing risks of both delayed diagnosis and treatment and overdiagnosis, which can lead to complications during pregnancy [9,[35][36][37][38].…”

Section: Discussionmentioning

confidence: 99%

Defining Trimester-Specific Reference Intervals for Thyroid Hormones: Insights from a Bulgarian Monocenter Study

Yanachkova,

Staynova,

Naseva

2024

Medicina

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Background and Objectives: Pregnancy introduces various interfering factors that, alongside individual variations, impact the assessment of thyroid function tests. This underscores the necessity of defining trimester-specific reference intervals for thyroid-stimulating hormone (TSH) levels. Differences in population characteristics, including ethnicity, socio-economic factors, iodine prophylaxis, and obesity, emphasize the need to establish trimester-specific TSH ranges for women of reproductive age in the respective region or center. The aim of the present study was to establish first- and second-trimester-specific reference intervals for TSH and free thyroxine (FT4) in a relevant pregnant population. Materials and Methods: A retrospective monocenter analysis utilized the electronic database of Ob/Gyn Hospital “Dr. Shterev”, Sofia, Bulgaria. The analysis involved data from 497 pregnant and 250 non-pregnant women, all without evidence of thyroid dysfunction or a family history thereof, no indication of taking medication interfering with thyroid function, no evidence of levothyroxine treatment, and no history of sterility treatment. To establish the limits of the TSH reference range, the percentile method was applied using a bootstrapping procedure following the recommendations of the International Federation of Clinical Chemistry (IFCC). Results: Trimester-specific reference intervals for TSH and FT4 in our center were established as follows: first trimester—0.38–2.91 mU/L, FT4-12.18–19.48 pmol/L; second trimester—0.72–4.22 mIU/L and 9.64–17.39 pmol/L, respectively. We also established the normal reference range for the non-pregnant control group, which is similar to that applicable in our laboratory. Conclusions: Our results differ from the fixed limits recommended by the American Thyroid Association, European Thyroid Association, and Endocrine Society Guidelines. Following the relevant established intervals would significantly impact timely diagnosis and therapy requirements for a substantial proportion of pregnant women.

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The Increased Trend of Medical Treatment for Thyroid Diseases during Pregnancy: A 13-Year National Study

Cited by 10 publications

References 28 publications

Antenatal thyroid hormone therapy and antithyroid drug use in Norway from 2004 to 2018

Antenatal thyroid hormone therapy and antithyroid drug use in Norway from 2004 to 2018

Patterns of Prescription Medication Use during the First Trimester of Pregnancy in the United States, 1997–2018

Defining Trimester-Specific Reference Intervals for Thyroid Hormones: Insights from a Bulgarian Monocenter Study

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