Abstract
BackgroundThyroid dysfunction during pregnancy is associated with multiple adverse outcomes, but whether all women should be screened for thyroid disorders during pregnancy remains controversial.ObjectiveTo evaluate the effectiveness of the targeted high risk case-finding approach for identifying women with thyroid dysfunction during the first and second trimesters of pregnancy.MethodsLevels of thyroid stimulating hormone (TSH), free thyroxine (FT4), and thyroid peroxidase antibodies (TPOAb) were measured in 3882 Chinese women during the first and second trimester of pregnancy. All tested women were divided into the high risk or non-high risk groups, based on their history, findings from physical examination, or other clinical features suggestive of a thyroid disorder. Diagnosis of thyroid disorders was made according to the standard trimester-specific reference intervals. The prevalence of thyroid disorders in each group was determined, and the feasibility of a screening approach focusing exclusively on high risk women was evaluated to estimate the ability of finding women with thyroid dysfunction.ResultsThe prevalence of overt hypothyroidism or hyperthyroidism in the high risk group was higher than in the non-high risk group during the first trimester (0.8% vs 0, χ2 = 7.10, p = 0.008; 1.6% vs 0.2%, χ2 = 7.02, p = 0.008, respectively). The prevalence of hypothyroxinemia or TPOAb positivity was significantly higher in the high risk group than in the non-high risk group during the second trimester (1.3% vs 0.5%, χ2 = 4.49, p = 0.034; 11.6% vs 8.4%, χ2 = 6.396, p = 0.011, respectively). The total prevalence of hypothyroidism or hyperthyroidism and the prevalence of subclinical hypothyroidism or hyperthyroidism were not statistically different between the high risk and non-high risk groups, for either the first or second trimester.ConclusionThe high risk screening strategy failed to detect the majority of pregnant women with thyroid disorders. Therefore, we recommend universal screening of sTSH, FT4, and TPOAb during the first trimester and second trimester of pregnancy.
Highlights
Thyroid disease during pregnancy is associated with an increase in maternal and fetal risk for a number of adverse effects [1]
Maternal thyroid dysfunction is linked to premature birth, low birth weight, fetal anomaly, fetal death, gestational hypertension, and other pregnancy complications [2,3]
According to the Endocrine Society guidelines in 2012, some members advocated for thyroid stimulating hormone (TSH) testing of all women during the first trimester of pregnancy [9]
Summary
Thyroid disease during pregnancy is associated with an increase in maternal and fetal risk for a number of adverse effects [1]. Despite the prevalence and risk associated with thyroid disease, controversy regarding universal versus high risk screening strategies remains. Both the Endocrine Society Clinical Practice (ESCP, 2007) [7] and the American Thyroid Association (ATA) guidelines (2011) recommended screening of high risk patients only for thyroid disease in pregnancy [8]. According to the Endocrine Society guidelines in 2012, some members advocated for thyroid stimulating hormone (TSH) testing of all women during the first trimester of pregnancy [9]. Thyroid dysfunction during pregnancy is associated with multiple adverse outcomes, but whether all women should be screened for thyroid disorders during pregnancy remains controversial
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