Thyroid Dysfunction In Pregnant Women Research Articles

Variability in screening thyroid dysfunction in pregnant women: A pilot study

Variability in screening thyroid dysfunction in pregnant women: A pilot study

Screening for Thyroid Dysfunction in Pregnancy With Targeted High-Risk Case Finding: Can It Be Improved?

Targeted screening is proposed for the detection of thyroid dysfunction in pregnant women rather than universal screening (US). We aimed to determine the detection rate of subclinical hypothyroidism (SCH) and overt hypothyroidism (OH) based on American Thyroid Association guidelines (ATA-GL) and whether it could be improved. Cross-sectional study of 1832 pregnant women in a single center. Thyroid function (TSH and free T4) and iron status were determined. The high-risk group (HRG) included women with one or more ATA-GL risk factors and the low-risk group (LRG) included women without. Participants with other risk factors [body mass index (BMI) 30 to 39.9 kg/m2, Caucasian background] were classified as HRG+ and those with iron deficiency as HRG++. The HRG included 64% of women and the LRG included 36% (P < 0.001). Of all participants, 4.5% had SCH and 0.5% OH. The detection rate of SCH and OH was comparable between the LRG and HRG (46% vs 54% and 25% vs 75%; P = 0.560 and 0.157, respectively). In the HRG, the detection rate of SCH was lower than that of US (54% vs 100%; P < 0.001), but that of OH was comparable (75%; P = 0.596). The detection rate of SCH in the HRG+ and HRG++ was comparable to that in the US group (81% and 88% vs 100%; P = 0.220 and 0.439, respectively). Targeted high-risk case finding screening was not effective for the detection of SCH but performed better for OH. When obesity in the range BMI 30 to 39.9 kg/m2 and a Caucasian background were included as risk factors, the detection rate of SCH became comparable with that of US.

Clinical study of thyroid dysfunction in pregnant women and it’s effect on maternal and fetal outcome

Clinical study of thyroid dysfunction in pregnant women and it’s effect on maternal and fetal outcome

Influencia del informe de laboratorio en el diagnóstico de la disfunción tiroidea en la gestante: más allá del asterisco

IntroductionThyroid physiology undergoes adaptive changes during pregnancy, making it necessary to know the reference ranges of thyroid hormones according to gestational age for a correct interpretation, especially in subclinical thyroid disease. Laboratory information systems (LIS) have difficulty in reporting reference ranges (RR) in different pathophysiological situations. The work of the laboratory physician is important in developing and designing tools to identify these situations, and to make an appropriate interpretation of the results. ObjectiveTo determine whether the change in the LIS in our department and the issue of the laboratory report with the interpretation of the results, had an impact on the identification and monitoring of thyroid dysfunction in pregnant women in our area. Material and methodsA retrospective cross-sectional study was carried out by analysing the results of all first-trimester pregnant women and those on whom thyroid tests had been requested in the following six months. The pregnant women were divided into two groups, before and after the change of the LIS. ResultsFollow-up percentages were similar in the two groups, except when TSH was abnormal for pregnant women and normal for the general population, that is, when there was no asterisk. ConclusionsThe RRs established for the normal population do not identify sub-clinical thyroid disease in pregnant women. The active intervention of the laboratory physician is essential in the evaluation of these results. In our study, more than 50% of the pregnant women with sub-clinical hypothyroidism benefited from the strategy introduced.

Selective screening for thyroid dysfunction in pregnant women: How often do low-risk women cease to be treated following the new guidelines of the American Thyroid Association?

Universal screening for thyroid dysfunction in pregnant women is not recommended by the American Thyroid Association (ATA) or the American Association of Clinical Endocrinologists (AACE). This study evaluated the frequency of pregnant women that would have an indication for levothyroxine (L-T4) according to the new ATA/AACE guidelines among low-risk women without an indication for screening with TSH. The sample consisted of 412 pregnant women ranging in age from 18 to 30 years. These women were considered to be at low risk for thyroid dysfunction according to ATA/AACE and would not be candidates for screening with TSH. Anti-thyroid peroxidase antibodies (TPOAb) and TSH were measured. Women who had TSH > 2.5 mIU/L or TPOAb in the first trimester were submitted to subsequent evaluations in the second and third trimester. In the first trimester, none of the pregnant women would have L-T4 therapy "recommended" and treatment would be "considered" in only two. In the second trimester, pregnant women with positive TPOAb or TSH > 2.5 mIU/L in the first trimester (n = 30) were reevaluated. L-T4 treatment would be "recommended" in only one woman and would be "considered" in two others. The 28 women that were not treated in the second trimester were reevaluated in the third trimester, but none of them would have L-T4 "recommended". The findings of the study suggest that selective screening, recommended by ATA/AACE does not result in a significant loss of pregnant women with an indication for L-T4 treatment.

The prevalence of thyroid dysfunction and its relationship with perinatal outcomes in pregnant women in the third trimester.

OBJECTIVE:In this study, we aimed to investigate the prevalence of thyroid dysfunction in pregnant women in their third trimester and assess its relationship with perinatal outcomes.METHODS:A total of 796 women who delivered babies at the Haydarpaşa Numune Training and Research Hospital between January 2014 and January 2015 were evaluated retrospectively. Women with complete data and relevant results from thyroid functions tests were included in the study (n=573). Serum levels of thyroid stimulating hormone (TSH), free triiodothyronine (T3), free thyroxine (T4) were studied for all patients. Patients were classified according to thyroid function test results as having hypothyroidism, subclinical hypothyroidism, hyperthyroidism, or euthyroid state. The perinatal outcomes (Apgar score, birth type and birth weight) were compared.RESULTS:A total of 86.7% of pregnant woman (492/573) showed normal thyroid function tests. Out of the remaining participants,0.5% had hypothyroidism, 8.9% had subclinical hypothyroidism, and 2.8% had hyperthyroidism. TSH levels correlated with maternal age. The perinatal outcomes were insignificant between groups.CONCLUSION:The prevalence of thyroid dysfunction was 13.2% in our population. Subclinical hypothyroidism and hyperthyroidism had no adverse effects on birth weight, cesarean section rates, and Apgar scores.

Thyroid function testing in women who had a stillbirth.

Thyroid dysfunction is thought to be associated with stillbirth. Therefore, thyroid function is often recommended in the diagnostic investigations for stillbirth. We aimed to evaluate the added value of thyroid function testing in the diagnostic investigations for stillbirth. A nationwide multicentre prospective cohort study in 1025 women who suffered stillbirth >20 weeks of gestation performed between 2002 and 2008. In each woman, an extensive diagnostic work-up was performed, including placental examination and autopsy. TSH and FT4 values below the 2·5th percentile or above the 97·5th percentile according local laboratory reference values were regarded as abnormal. Women with a history of thyroid disease were evaluated separately. Thyroid function abnormalities in women with stillbirth. Of 1025 included women, 21 had a history of thyroid disease (2%). In the 875 with TSH and FT4 results and no history of thyroid disease, 10% had hypothyroxinemia, 4·6% subclinical hypothyroidism, 1·6% overt hypothyroidism and 1·5% subclinical hyperthyroidism. Women with a subclinical hyperthyroidism more often had a foetal death caused by foetal hydrops: 23% vs 2·9% (adjusted OR 10·3, 95% CI 2·5-42). Women with a stillbirth had a slightly higher prevalence of overt hypothyroidism, subclinical hypothyroidism and hypothyroxinaemia compared to previous studies on thyroid dysfunction in pregnant women. Given the absence of a strong associations with the cause of stillbirth, and no demonstrated beneficial effects of treating thyroid dysfunction in these women, routine screening after stillbirth is not justified.

The incidence of thyroid dysfunction in pregnant women

The incidence of thyroid dysfunction in pregnant women

Gebelerde tiroid fonksiyon bozukluğu sıklığı

Gebelerde tiroid fonksiyon bozukluğu sıklığı

Prevalence of thyroid dysfunction among women during the first trimester of pregnancy at a tertiary care hospital in Haryana.

Background:Undetected and untreated thyroid disorders are associated with adverse maternal and fetal outcomes. There are limited data on the prevalence of newly diagnosed thyroid disease during pregnancy from India. Therefore, this study was designed to evaluate the prevalence of thyroid dysfunction, especially hypothyroidism during the first trimester of pregnancy.Materials and Methods:The present cross-sectional study was conducted at Department of endocrinology and antenatal clinic in the Obstetrics and Gynecology Pt. B.D. Sharma PGIMS, Rohtak over a period of 1-year. The total sample population comprised of 461 pregnant women with uncomplicated intrauterine singleton pregnancies in the first trimester of gestation without any history of thyroid disease or intake of any thyroid medication. Morning blood samples from the participants were analyzed for thyroid function tests, which included FT3, FT4, thyroid-stimulating hormone (TSH) and anti-thyroid peroxidase antibodies (TPO).Results:A total of 461 women were enrolled for this study. Mean maternal age was 23.79 ± 3.47 years. Median gestational age was 8 weeks 5 days. The median FT3, FT4 and TSH were 3.3 pg/mL, 1.25 ng/dL, and 1.40 mIU/L, respectively. Anti-TPO was elevated in 128 (27.8%) pregnant women. 99 (21.5%) women had sub-clinical hypothyroidism and 39 (39.4%) among them were positive for anti-TPO (P ≤ 0.001). 2 (0.4%) of women had overt hyperthyroidism, whereas 15 (3.3%) of the women had sub-clinical hyperthyroidism.Conclusion:Considering the immense impact that maternal thyroid dysfunction has on maternal and fetal outcomes, prompt identification of thyroid dysfunction and its timely treatment is essential. Thus, universal screening of pregnant women for thyroid dysfunction should be considered especially in a country like India due to the high prevalence of thyroid dysfunction.

Reference values and universal screening of thyroid dysfunction in pregnant women

Reference values and universal screening of thyroid dysfunction in pregnant women

Comparison of universal and targeted screening for thyroid dysfunction in pregnant Egyptian women.

To compare universal vs targeted screening for thyroid dysfunction and to estimate the prevalence of hypothyroidism in pregnant Egyptian women. A total of 168 of pregnant women who attended the outpatient obstetric clinic at Ain Shams University Hospital (Cairo, Egypt) for antenatal care between September 2011 and December 2011 were enrolled. Based on the detailed data collection and results of laboratory testing, they were subdivided into the high- and low-risk group for thyroid disease according to the most recent Endocrine Society clinical practice guidelines, as well as into groups by trimester for application of American Thyroid Association guidelines. The group values were subjected to statistical analysis for estimating the prevalence of clinical and subclinical hypothyroidism and for identifying significant differences. Of the 168 patients, 104 were classified into the low-risk group and 64 into the high-risk group. Using the trimesteric and normal population cutoff values for thyroid functions, the prevalence of hypothyroidism was found to be 56% (n=94) and 44.6% (n=75) respectively. No statistically significant differences were found between the high- and low-risk group regarding prevalence of either clinical or subclinical hypothyroidism, and no significant differences were found regarding the prevalence of hypothyroidism in the first, second, or third trimester. Use of the most recent Endocrine Society clinical practice guidelines led to missed detection of clinical or subclinical hypothyroidism in 34.5% of pregnant women. Universal screening of pregnant women for thyroid dysfunction should thus be adopted throughout Egypt.

Screening and management of hypothyroidism in pregnancy: results of an Asian survey.

Maternal hypothyroidism in pregnancy is associated with several adverse outcomes. The American Thyroid Association and the Endocrine Society Guidelines for the management of thyroid diseases in pregnancy were published in 2011 and 2012, respectively; however, impact of the guidelines in routine clinical practice is unknown. We therefore carried out a survey to study current practices in the screening and management of hypothyroidism in pregnancy. We collected completed questionnaire survey based on clinical case scenarios from 321 members of the Asia-Oceania Thyrpid Association (AOTA). Responses from 310 clinician members (from 21 Asian countries) were analyzed. For a woman with hypothyroidism planning pregnancy, 54% favored testing thyroid function before adjusting the dose, whilst 32% recommended increasing the dose of L-thyroxine (L-T₄) as soon as pregnancy is confirmed. For a pregnant woman with newly diagnosed overt hypothyroidism, most responders initiated a full dose of L-T₄. One half of responders used serum TSH and free T₄ to monitor the dose of L-T₄. Although the target of thyroid function tests that responders aimed to achieve with L-T₄ was inconsistent, but a majority aim to keep TSH within recommended trimester specific range. Twenty-one % responders or their institutions screened all pregnant women for thyroid dysfunction, 66% performed targeted screening of only the high-risk group, whilst 13% did not carry out systemic screening. Majority of responders practices within recommendations of major professional societies; however, there is wide variation in the clinical practice in the treatment and screening of hypothyroidism during pregnancy in Asia.

Reference values and variability study of thyroid hormones in pregnant women from El Bierzo

Abstract Background and objectives El Bierzo area is characterized by low urinary iodine levels in the pregnant population. Guidelines recommend that local reference values are established for the diagnosis of thyroid dysfunction in pregnancy. Our objectives were to establish reference values for thyroid-stimulating hormone (TSH), free thyroxine (FT4) and free triiodothyronine (FT3) in women in the first trimester of pregnancy and to explore the factors influencing variability in these hormones. Patients and methods A retrospective study of 412 women in the first trimester of pregnancy who were measured serum levels of TSH, FT4, and FT3; 163 women with conditions with a potential influence on thyroid function were excluded. Thirty smoking pregnant women were also excluded from the study of reference values. Factors examined in the variability study included age, body mass index (BMI), and smoking. A multifactorial analysis of covariance was performed. Results Reference values in first-trimester pregnant women were: TSH: 0.497–3.595 mIU/L; FT4: 0.90–1.42 ng/dL; FT3: 2.49–3.56 pg/mL. TSH levels depended on mother age and on interaction between age and smoking. FT3 levels depended on the mother's BMI and smoking, and there was also an interaction between both factors. Conclusion The reference values found may be used to assess thyroid dysfunction in pregnant women from El Bierzo. TSH and FT3 levels are influenced by age and BMI of the mother and by smoking, in addition to the interaction of these factors.

High Prevalence of Thyroid Dysfunction Among Pregnant Women in Lubumbashi, Democratic Republic of Congo

Despite notable progress in the fight against iodine deficiency disorders in the Democratic Republic of Congo, a recent study has shown that pregnant women in Lubumbashi were still iodine deficient. Our objective was to assess thyroid function in this population. In a cross-sectional study conducted in maternity units from three different socioeconomic areas in Lubumbashi, serum thyrotropin, free thyroxine, thyroglobulin, and thyroperoxidase antibodies were measured in 225 pregnant women attending antenatal visits, in 75 women who recently delivered, and in 75 nonpregnant controls. The outcome was the prevalence of thyroid dysfunction. Median values in pregnant women, women who recently delivered, and nonpregnant women were 1.80, 2.80, and 1.54 mIU/L for thyrotropin (p<0.001); 0.85, 1.11, and 1.16 ng/dL for free thyroxine (p<0.001); and 13.3, 9.5, and 10.4 ng/mL for thyroglobulin (p=0.01), respectively. The prevalence of thyroid dysfunction in pregnant women, in women who recently delivered, and in nonpregnant women was 31%, 8%, and 20% for isolated hypothyroxinemia (p<0.001); 12%, 24%, and 5% for subclinical hypothyroidism (p=0.002); 8%, 3%, and 3%, for overt hypothyroidism (p=0.09); and 5%, 13%, and 4%, for positive thyroperoxidase antibodies (p=0.03), respectively. In multiple logistic regression, women who were pregnant or who recently delivered, who lived in a poor socioeconomic area, and who had low urinary iodine concentration were more likely to have an increased serum thyrotropin: odds ratio (OR)=3.43 (95% confidence interval [CI] 1.23-9.53) for pregnancy, OR=4.49 [CI 1.66-15.01] for postpartum period, OR=3.68 [CI 1.85-7.35] for semiurban area, and OR=0.44 [CI 0.19-0.96] for urinary iodine concentration ≥ 250 μg/L. Our results show that there is a high prevalence of thyroid dysfunction in pregnant women of Lubumbashi, and this high prevalence is associated with iodine deficiency. To prevent obstetrical adverse outcomes and neurological damage in children, iodine supplementation is needed before conception or in early pregnancy in Lubumbashi.

Subclinical hypothyroidism in pregnancy: to treat or not to treat.

The published study [1] aimed to observe the pattern of thyroid function in pregnant women with subclinical hypothyroidism treated with levothyroxine (LT4) throughout pregnancy and to obtain the optimal dosages of LT4 for pregnant women with subclinical hypothyroidism. The authors screened 4,102 pregnant women from 10 hospitals of the Shenyang region, northeast China, and enrolled 89 women among 938 with subclinical hypothyroidism defined by serum thyrotropin [2.5 mU/L and ‘‘normal’’ free thyroxine (T4), but ended by including 56 compliant women. They were divided in three groups based on different serum TSH concentrations, given three different dosages of LT4 and followed with 4-week intervals by measuring thyroid function tests until week 36 of gestation. Ten of the patients had to be dose adjusted to remain within target, the others stayed on the same dose. The authors conclude that different LT4 doses can be chosen according to the baseline TSH levels of pregnant women, and maintain serum TSH levels of 79.3–90 % patients in the ideal range. 20 % need adjustment of therapy during second and third trimester. Careful monitoring of serum TSH and free T4 each month is, therefore, advocated. The study is thus a small descriptive contribution to demonstrating the biochemical pattern during different LT4 dosages during pregnancy of women with subclinical hypothyroidism. However, the study leaves a lot of caveats and unanswered questions. In 2011, the ATA guidelines [2] mentioned that subclinical hypothyroidism has been associated with adverse maternal and fetal outcomes, and recommended that women with positive antibodies against thyroid peroxidase or thyroglobulin and subclinical hypothyroidism should be treated with LT4. The same guidelines also recommended LT4 replacement in women with antibody negative subclinical hypothyroidism, although the evidence levels were very low both for obstetrical and neonatal neurological outcome. The current study [1] does not mention any measurement of thyroid antibodies, and the etiology of subclinical hypothyroidism is, therefore, quite unclear; the study does not include an untreated control group, which would have been advantageous for comparison of the biochemical evolution of the thyroid function tests, considering in particular that serum TSH is very often lowered in early pregnancy due to an effect from human chorionic gonadotropin [3]; the study does mention the use of trimester-specific reference concentrations for serum TSH and free T4, but do not take into account the high degree of intraindividual variation of the concentrations, even in pregnancy [4]; the strict cut-off concentrations necessary for conducting the study are very dependent on method and laboratory [5], which should have been discussed in the paper. Even though the study mentions cut-off concentrations for TSH and free T4, the authors do not mention, how many were outside target in each method, which would have been useful information for the clinician. One of the important points for discussion within this topic has been whether to screen all pregnant women for thyroid dysfunction and autoimmunity, but up to now guidelines have advocated for case-finding although more groups of women with predisposition for hypothyroidism are included in the new guidelines [2]. The presented study does not add to this discussion, since the data are not suitable for answering this question. The study can only U. Feldt-Rasmussen (&) Department of Medical Endocrinology PE 2132, National University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark e-mail: ufeldt@rh.dk

Overweight increases risk of first trimester hypothyroxinaemia in iodine‐deficient pregnant women

Hypothyroxinaemia early in pregnancy may impair fetal brain development. Increased body weight has been associated with low thyroxine concentrations in non-pregnant women. In pregnant women, morbid maternal obesity is a risk factor for thyroid dysfunction. But whether lesser degrees of overweight that are much more common could be a risk factor for hypothyroxinaemia in pregnancy is unclear. The objective of this study was to investigate if overweight increases risk for thyroid dysfunction, and specifically hypothyroxinaemia, in iodine-deficient pregnant women. We performed a cross-sectional study at first hospital visit among healthy Thai pregnant women. We measured weight and height, urinary iodine concentration (UIC), serum thyroid hormones and thyroglobulin. Pre-pregnancy weight and relevant dietary factors were determined by questionnaire, and body mass index (BMI) was used to classify weight status. Among 514 women (mean gestational age, 11 weeks) with a median UIC of 111 μg dL(-1) , indicating mild iodine deficiency, 12% had low free thyroxine (fT4) concentrations: 3% had overt hypothyroidism; 7% had subclinical hypothyroidism; and 8% had isolated hypothyroxinaemia. Based on pre-pregnancy BMI, 26% of women were overweight or obese. In a multiple regression model, BMI was a negative predictor of fT4 (β = -0.20, P < 0.001). Compared to normal weight women, the prevalence ratio (95% CI) of a low fT4 in overweight women was 3.64 (2.08-6.37) (P < 0.01). Iodine-deficient pregnant Thai women who are overweight have a 3.6-fold higher risk of hypothyroxinaemia in the first trimester compared to normal weight women. Targeted screening should consider overweight a potential risk factor for thyroid dysfunction in pregnant women in iodine-deficient areas.

Some considerations about the consensus document “Detection of thyroid dysfunction in pregnant women: Universal screening is justified”

Cocoa extracts rich in polyphenols are used as potential agent for treating diabetes. Cocoa polyphenols have been proved to ameliorate important hallmarks of type-2 diabetes (T2D). They can regulate glucose levels by increasing insulin secretion, promoting β-cell proliferation and a reduction of insulin resistance. In addition, epidemiological evidence indicates that consumption of flavonoid decreases the incidence of T2D.T2D is preceded by a prediabetic state in which the endocrine-metabolic changes described in T2D are already present. Since epidemiological evidence indicates that consumption of flavonoid decreases its incidence, we evaluated possible preventive effects of polyphenol-enriched cocoa extract on a model of prediabetes induced by sucrose.We determined circulating parameters and insulin sensitivity indexes, liver protein carbonyl groups and reduced glutathione, liver mRNA expression levels of lipogenic enzymes, expression of different pro-inflammatory mediators, fructokinase activity and liver glycogen content. For that, radioimmunoassay, real-time polymerase chain reaction, Western blot, spectrophotometry, and immunohistochemistry were used.We demonstrated that sucrose administration triggered hypertriglyceridemia, insulin-resistance, and liver increased oxidative stress and inflammation markers compared to control rats. Additionally, we found an increase in glycogen deposit, fructokinase activity, and lipogenic genes expression (SREBP-1c, FAS and GPAT) together with a decrease in P-Akt and P-eNOS protein content (P < 0.05). Sucrose-induced insulin resistance, hepatic carbohydrate and lipid dysmetabolism, oxidative stress, and inflammation were effectively disrupted by polyphenol-enriched cocoa extract (PECE) co-administration (P < 0.05).Dietary administration of cocoa flavanols may be an effective and complementary tool for preventing or reverting T2D at an early stage of its development (prediabetes).

Valores de referencia y estudio de la variabilidad de hormonas tiroideas en gestantes de El Bierzo

Background and objectivesEl Bierzo area is characterized by low urinary iodine levels in the pregnant population. Guidelines recommend that local reference values are established for the diagnosis of thyroid dysfunction in pregnancy. Our objectives were to establish reference values for thyroid-stimulating hormone (TSH), free thyroxine (FT4) and free triiodothyronine (FT3) in women in the first trimester of pregnancy and to explore the factors influencing variability in these hormones. Patients and methodsA retrospective study of 412 women in the first trimester of pregnancy who were measured serum levels of TSH, FT4, and FT3; 163 women with conditions with a potential influence on thyroid function were excluded. Thirty smoking pregnant women were also excluded from the study of reference values. Factors examined in the variability study included age, body mass index (BMI), and smoking. A multifactorial analysis of covariance was performed. ResultsReference values in first-trimester pregnant women were: TSH: 0.497-3.595mIU/L; FT4: 0.90–1.42ng/dL; FT3: 2.49–3.56pg/mL. TSH levels depended on mother age and on interaction between age and smoking. FT3 levels depended on the mother's BMI and smoking, and there was also an interaction between both factors. ConclusionThe reference values found may be used to assess thyroid dysfunction in pregnant women from El Bierzo. TSH and FT3 levels are influenced by age and BMI of the mother and by smoking, in addition to the interaction of these factors.

PRM28 - Prevalence of thyroid disorders and need for universal screening of thyroid dysfunction in pregnant women: A meta-analysis

Thyroid dysfunction is the second most common endocrinopathy affecting women of childbearing age. Many studies have recommended that thyroid function screening should be routinely performed in all pregnant women. The aim of the present study was to determine the prevalence of thyroid disorders during pregnancy and to evaluate efficiency of the universal screening strategy versus case-finding strategy for diagnosing thyroid dysfunctions. Comprehensive literature search was done in PubMed and EMBASE databases till July 2012 for studies related to prevalence and screening of thyroid dysfunction. For prevalence, the primary estimate was weighed mean pooled prevalence (%) with 95% CI. For screening, the primary estimate was pooled odds ratio (OR) with 95% CI. Heterogeneity was assessed by I2 statistics. Publication bias was assessed using Begg and Egger test. Sensitivity analysis was also performed. A total of 33 studies (1988- 2012) for prevalence and 5 (2007- 2011) for screening were found to be pertinent. Because of significant heterogeneity, a random effects model was chosen. Combined analysis of weighed pooled prevalence of 19 studies of Thyroid Auto Immunity found 9.7% (9.5-10), 21 studies of hypothyroidism found 3.7% (2.2-6.1) and 10 studies of hyperthyroidism found 2.2% (1.0-4.5), 7 studies of overt/ clinical hypothyroidism found 2% (0.8-5.1), 13 studies of subclinical hypothyroidism found 3.7% (3-4.7), 6 studies of hypothyroxinemia found 3.4% (1.2-9.8), 4 studies of overt/ clinical hyperthyroidism found 0.6% (0.3-1.4) and 5 studies of subclinical hyperthyroidism found 0.022 (1.6-2.9). For the effectiveness of universal screening pooled OR was found to be 2.87 (1.60-4.94, P-<0.001). Our analysis supports the hypothesis of higher prevalence of thyroid dysfunction in pregnancy especially, hypothyroidism. The universal screening strategy is found to be more effective as the case-finding strategy fails to detect the majority of pregnant women with thyroid dysfunction.