Thyroid Medication Use and Birth Defects in the National Birth Defects Prevention Study

Howley, Meredith M.; Fisher, Sarah C.; Zutphen, Alissa R. Van; Waller, D. Kim; Carmichael, Suzan L.; Browne, Marilyn L.

doi:10.1002/bdr2.1095

Cited by 11 publications

(13 citation statements)

References 59 publications

(108 reference statements)

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“…Cardiac (situs inversus ± dextrocardia and cardio outflow tract defects) and renal (isolated unilateral kidney a/dysgenesis) anomalies were found in one study but with five or fewer cases for each anomaly (Clementi et al, 2010). Cardiac (coarctation of the aorta and aortic valve stenosis) were found in a different study but with four or fewer cases for each anomaly (Howley et al, 2017). PTU alone was associated with anomalies of the face and neck (Andersen et al, 2013;Andersen, Olsen, Wu, & Laurberg, 2014), ear (Andersen et al, 2017), urinary systems (Andersen et al, 2014;Andersen et al, 2017;Korelitz et al, 2013), and musculoskeletal systems (Seo, Kim, & Chung, 2018) using retrospective searches based on ICD codes.…”

Section: Propylthioruacilmentioning

confidence: 95%

“…PTU is associated with an increase in congenital anomalies less often than MMI/CMZ but some studies have noted an increased risk (Andersen, Lonn, Vestergaard, & Torring, 2017;Andersen, Olsen, Wu, & Laurberg, 2013;Howley et al, 2017;Leung, Yamamoto, Luca, Beaudry, & McKeen, 2015). A case study identified intestinal malrotation with congenital bands (Leung et al, 2015).…”

Section: Propylthioruacilmentioning

confidence: 99%

“…Andersen et al (2014) again noted a case of urinary tract anomalies in a case with exposure to both MMI/CMZ and PTU in the same pregnancy without a statistically significant increased risk for the combination. Howley et al (2017) noted an increased risk for aortic valve stenosis for MMI and PTU combined, presumably combining cases to achieve a larger sample size, without mentioning if the two medications were taken together in the same pregnancy. Seo et al (2018) noted an increased risk of congenital anomalies for women who switched from PTU to MMI in the first trimester and noted no decrease in risk when switching from MMI to PTU before or during the first trimester.…”

Section: Propylthioruacilmentioning

confidence: 99%

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Teratogen update: Antithyroid medications

Romeo

Običan

2020

Birth Defects Research

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Objective Thyroid disorders including hyperthyroidism are common during pregnancy. Untreated hyperthyroidism can result in adverse outcomes for pregnancy. Methods Iodine, propylthiouracil (PTU), carbimazole (CMZ), and methimazole (MMI) are common medications for hyperthyroidism treatment. The literature regarding antithyroid medication use in pregnancy and breastfeeding is reviewed. Results Animal studies for PTU have suggested congenital anomalies while animal studies for MMI have only indicated adverse outcomes at higher doses than used in humans. Epidemiological studies have noted an increased risk of congenital anomalies for PTU less often than CMZ or MMI but the epidemiological evidence remains mixed. A pattern of anomalies has been described for CMZ and MMI, from both case and epidemiological studies, including choanal atresia, aplasia cutis congenita, and other facial, heart, gastrointestinal, and skin anomalies. Closer examination of cases indicates that a few cases of the anomalies have occurred without exposure to CMZ or MMI and outside of the proposed critical period. PTU has a small risk of hepatotoxicity which rarely results in liver transplantation and death. Some authors have suggested that PTU be prescribed in early pregnancy and switched to MMI in late pregnancy. Untreated hyperthyroidism, from either a lack of medications or switching medications during the first trimester, may also increase the chance of congenital anomalies. Multiple case studies and larger epidemiological studies have failed to provide clear, consistent outcomes for the use of PTU, CMZ, and MMI in pregnancy. MMI and PTU both enter the breastmilk in small amounts. Conclusion Additional research is needed to assist in the medical management and exposure counseling of pregnant and breastfeeding women with hyperthyroidism.

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Section: Propylthioruacilmentioning

confidence: 95%

Section: Propylthioruacilmentioning

confidence: 99%

Section: Propylthioruacilmentioning

confidence: 99%

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Teratogen update: Antithyroid medications

Romeo

Običan

2020

Birth Defects Research

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“…Some of the comorbidities that pose a teratogenic risk include gestational diabetes mellitus which is associated with higher risk of congenital malformation,[ 6 7 8 ] thyroid related diseases and medications[ 9 10 ] and epilepsy medications. [ 11 12 13 ] Awareness of women showed insufficient knowledge regarding the teratogenicity of gestational diabetes mellitus,[ 14 ] thyroid diseases and medications[ 15 ] and epileptic medications.…”

Section: Introductionmentioning

confidence: 99%

Knowledge regarding teratogens among women of childbearing age at a large tertiary care center in Saudi Arabia

Alhamdan

Moukaddem

AlOtaibi

et al. 2020

J Family Med Prim Care

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Aim: To investigate the knowledge of Saudi women regarding the teratogenic effects of environmental agents such as fever, some chronic conditions and medications and its association with certain socio-demographic factors. Materials and Methods: A survey based cross-sectional study was conducted on 315 Saudi women of childbearing age visiting OB/GYN clinics at a large tertiary care centre in Riyadh, Saudi Arabia. Knowledge of subjects on teratogenic risk of common entities was measured and nonparametric Mann–Whitney and Kruskal–Wallis tests were used to associate knowledge score with various predictors. Results: The response rate was 75%. Most of the participants were between 28 and 37 years. Knowledge on teratogenic risk was generally poor with specifically higher knowledge regarding insulin intake and isotretinoin. Older age, higher education, being employed, and having a high monthly income were significantly associated with a higher knowledge score ( P < 0.05). Conclusion: Women's knowledge regarding teratogenic risks is crucial in ensuring a safe pregnancy and a healthy fetus. Our study revealed inadequate knowledge of teratogens among the participants which implies an urgent need to increase awareness of mothers regarding the harmful effects of common teratogens.

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“…Thyroid disorders are prevalent conditions in women of reproductive age1–4 and may affect female fertility in various ways, including anovulatory cycles, luteal phase defect, high prolactin levels, and sex hormone imbalances,5–7 which may cause both infertility and adverse pregnancy outcomes 8–12. Assisted reproductive technology (ART) treatment is a relevant intervention in women who cannot conceive naturally, and recent studies have shown that women with ulcerative colitis, Crohn’s disease, and rheumatoid arthritis have a decreased chance of giving birth to a live-born child after ART treatment compared to other women undergoing ART treatment 13–15.…”

Section: Introductionmentioning

confidence: 99%

<p>The chance of a live birth after assisted reproduction in women with thyroid disorders</p>

Jølving

Larsen

Fedder

et al. 2019

CLEP

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Purpose Women with thyroid disorders may have increased infertility and poor reproductive outcomes, but it is unclear if assisted reproductive technology (ART) is effective in this population. The aim of this study was to examine the chance of a pregnancy (biochemical and clinical), and a live birth after ART, in women with thyroid disorders undergoing ART treatment, compared to women without thyroid disorders. Among live-born children, we assessed the risk of congenital malformations. Patients and methods In a nationwide cohort study of all women undergoing ART treatments in Denmark from 1 January 1994 throughout June 2017, we calculated the chance of a pregnancy and a live birth after embryo transfer. Women with thyroid disorders were stratified into two groups: those diagnosed with hypothyroid or hyperthyroid disorders. The adjusted OR (aOR) of a biochemical and a clinical pregnancy, a live born child and a congenital malformation was computed using multilevel logistic regression models. Results In total, 199,674 embryo transfers were included in 2,101 women with thyroid disorders and in 65,526 women without thyroid disorders. The chance of a biochemical pregnancy was significantly reduced in women with hyperthyroidism (aOR=0.80, 95% CI 0.69–0.93), and the aOR of a live birth was 0.86, 95% CI 0.76–0.98. The aOR for a live birth in women with hypothyroidism was 1.03 (95% CI 0.94–1.12). Children of women with hypothyroidism, who were conceived after ART treatment, had a significantly increased risk of any congenital malformation (aOR=1.46 [95% CI 1.07–2.00]). Conclusion Women with hyperthyroidism receiving ART treatment had a decreased chance of a live birth per embryo transfer compared to women without thyroid disorders. Women with hypothyroidism did not have a decreased chance of a live birth but their offspring had an increased risk of congenital malformation.

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Thyroid Medication Use and Birth Defects in the National Birth Defects Prevention Study

Cited by 11 publications

References 59 publications

Teratogen update: Antithyroid medications

Teratogen update: Antithyroid medications

Knowledge regarding teratogens among women of childbearing age at a large tertiary care center in Saudi Arabia

<p>The chance of a live birth after assisted reproduction in women with thyroid disorders</p>

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