Abstract
SummaryBackgroundIn the last 2 decades, several studies have examined the association between maternal thyroid hormone insufficiency during pregnancy and neurodevelopmental disorders in children and shown conflicting results.AimThis systematic review aimed to assess the evidence for an association between maternal thyroid hormone insufficiency during pregnancy and neurodevelopmental disorders in children. We also sought to assess whether levothyroxine treatment for maternal thyroid hormone insufficiency improves child neurodevelopment outcomes.MethodsWe performed systematic literature searches in MEDLINE, EMBASE, PSYCinfo, CINAHL, AMED, BNI, Cochrane, Scopus, Web of Science, GreyLit, Grey Source and Open Grey (latest search: March 2017). We also conducted targeted web searching and performed forwards and backwards citation chasing. Meta‐analyses of eligible studies were carried out using the random‐effects model.ResultsWe identified 39 eligible articles (37 observational studies and 2 randomized controlled trials [RCT]). Meta‐analysis showed that maternal subclinical hypothyroidism and hypothyroxinaemia are associated with indicators of intellectual disability in offspring (odds ratio [OR] 2.14, 95% confidence interval [CI] 1.20 to 3.83, P = .01, and OR 1.63, 95% CI 1.03 to 2.56, P = .04, respectively). Maternal subclinical hypothyroidism and hypothyroxinaemia were not associated with attention deficit hyperactivity disorder, and their effect on the risk of autism in offspring was unclear. Meta‐analysis of RCTs showed no evidence that levothyroxine treatment for maternal hypothyroxinaemia or subclinical hypothyroidism reduces the incidence of low intelligence quotient in offspring.LimitationsAlthough studies were generally of good quality, there was evidence of heterogeneity between the included observational studies (I 2 72%‐79%).ConclusionMaternal hypothyroxinaemia and subclinical hypothyroidism may be associated with intellectual disability in offspring. Currently, there is no evidence that levothyroxine treatment, when initiated 8‐ to 20‐week gestation (mostly between 12 and 17 weeks), for mild maternal thyroid hormone insufficiency during pregnancy reduces intellectual disability in offspring.
Highlights
Thyroid hormone is essential for optimum neurological development of the foetus
In recent years, several studies have shown that even mild maternal thyroid hormone insufficiency during pregnancy is associated with various types of neurodevelopmental disorders in children, including reduced intelligence quotient (IQ) scores,[2] autism[3] and attention deficit hyperactivity disorder (ADHD).[4]
We identified 2 randomized controlled trials (RCTs) that reported the effects of treatment of maternal thyroid hormone insufficiency with levothyroxine on the incidence of low IQ
Summary
Thyroid hormone is essential for optimum neurological development of the foetus. The foetal thyroid gland is not functional until the 12-14th week of gestation,[1] and during that period, the foetus is solely dependent on thyroxine from the mother. It is plausible that maternal thyroid hormone insufficiency, in early pregnancy, could impair foetal neurodevelopment. In recent years, several studies have shown that even mild maternal thyroid hormone insufficiency (including subclinical hypothyroidism and isolated hypothyroxinaemia) during pregnancy is associated with various types of neurodevelopmental disorders in children, including reduced intelligence quotient (IQ) scores,[2] autism[3] and attention deficit hyperactivity disorder (ADHD).[4] other studies have shown conflicting results,[5,6] and there remains an uncertainty whether levothyroxine treatment in mild maternal thyroid hormone insufficiency improves neurodevelopmental outcomes in children.[7] These observations have led to an ongoing debate about whether all pregnant women should be screened and treated for thyroid dysfunction
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