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Thyroid function in neonates of women with subclinical hypothyroidism or hypothyroxinemia

Journal of Perinatology volume 38, pages 1490–1495 (2018)Cite this article

Subjects

Abstract

Objective

To assess whether treatment of pregnant women with subclinical hypothyroidism or hypothyroxinemia alters neonatal TSH results.

Study design

A planned secondary analysis of data from two multi-center randomized, double-masked, placebo-controlled thyroxine replacement trials in pregnant women with either subclinical hypothyroidism or hypothyroxinemia. Infant heel-stick specimens were obtained before discharge. We compared TSH levels between neonates born to mothers allocated to treatment or placebo within each trial and between neonates in the placebo groups. Multiples of means were generated for day-of-life-specific data.

Results

Neonatal TSH values were available for 573/677 (84.6%) newborns from the subclinical hypothyroidism trial and 461/526 (87.6%) newborns from the hypothyroxinemia trial. Neonatal TSH values did not differ in either trial by treatment group or between placebo groups (P > 0.05 for all comparisons).

Conclusions

Neonatal TSH values did not differ with thyroid hormone replacement in pregnancies diagnosed with subclinical hypothyroidism or hypothyroxinemia.

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References

  1. Taylor PN, Minassian C, Rehman A, Iqubal A, Draman MS, Hamilton W, et al. TSH levels and risk of miscarriage in women on long-term levothyroxine: a community-based study. J Clin Endocrinol Metab. 2014;99:3895–902.

    Article  CAS  Google Scholar 

  2. Alijotas-Reig J, Garrido-Gimenez C. Current concepts and new trends in the diagnosis and management of recurrent miscarriage. Obstet Gynecol Surv. 2013;68:455–66.

    Article  Google Scholar 

  3. Sheehan PM, Nankervis A, Araujo Junior E, Da Silva Costa F. Maternal thyroid disease and preterm birth: Systematic review and meta-analysis. J Clin Endocrinol Metab. 2015;100:4325–31.

    Article  CAS  Google Scholar 

  4. Vissenberg R, van den Boogaard E, van Wely M, van der Post JA, Fliers E, Bisschop PH, et al. Treatment of thyroid disorders before conception and in early pregnancy: a systematic review. Hum Reprod Update. 2012;18:360–73.

    Article  CAS  Google Scholar 

  5. Davis LE, Leveno KJ, Cunningham FG. Hypothyroidism complicating pregnancy. Obstet Gynecol. 1988;72:108–12.

    CAS  PubMed  Google Scholar 

  6. Andersen SL, Olsen J, Wu CS, Laurberg P. Low birth weight in children born to mothers with hyperthyroidism and high birth weight in hypothyroidism, whereas preterm birth is common in both conditions: a Danish national hospital register study. Eur Thyroid J. 2013;2:135–44.

    CAS  PubMed  PubMed Central  Google Scholar 

  7. Hou J, Yu P, Zhu H, Pan H, Li N, Yang H, et al. The impact of maternal hypothyroidism during pregnancy on neonatal outcomes: a systematic review and meta-analysis. Gynecol Endocrinol. 2016;32:9–13.

    Article  Google Scholar 

  8. Haddow JE, Palomaki GE, Allan WC, Williams JR, Knight GJ, Gagnon J, et al. Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child. N Engl J Med. 1999;3341:549–55.

    Article  Google Scholar 

  9. Ajmani SN, Aggarwal D, Bhatia P, Sharma M, Sarabhai V, Paul M. Prevalence of overt and subclinical thyroid dysfunction among pregnant women and its effect on maternal and fetal outcome. J Obstet Gynaecol India. 2014;64:105–10.

    Article  CAS  Google Scholar 

  10. Mannisto T, Vaarasmaki M, Pouta A, Hartikainen AL, Ruokonen A, Surcel JM, et al. Perinatal outcome of children born to mothers with thyroid dysfunction or antibodies: a prospective population-based cohort study. J Clin Endocrinol Metab. 2009;94:772–9.

    Article  CAS  Google Scholar 

  11. Korevaar TI, Medici M, deRijke YB, Visser W, deMuinck Keizer-Schrama SM, Jaddoe VV, et al. Ethnic differences in maternal thyroid parameters during pregnancy: the generation R study. J Clin Endocrinol Metab. 2013;98:3678–86.

    Article  CAS  Google Scholar 

  12. Stagnaro-Green A. Overt hyperthyroidism and hypothyroidism during pregnancy. Clin Obstet Gynecol. 2011;54:478–87.

    Article  Google Scholar 

  13. Cleary-Goldman J, Malone FD, Lambert-Messerlian G, Sullivan L, Canick J, Porter TF, et al. Maternal thyroid hypofunction and pregnancy outcome. Obstet Gynecol. 2008;112:85–92.

    Article  Google Scholar 

  14. Klein RZ, Haddow JE, Faix JD, Brown RS, Hermos RJ, Pulkkinen A, et al. Prevalence of thyroid deficiency in pregnant women. Clin Endocrinol (Oxf). 1991;35:41–46.

    Article  CAS  Google Scholar 

  15. Casey BM, Dashe JS, Spong CY, McIntire DD, Leveno KJ, Cunningham GF. Perinatal significance of isolated maternal hypothyroxinemia identified in the first half of pregnancy. Obstet Gynecol. 2007;109:1129–35.

    Article  Google Scholar 

  16. Negro R, Soldin OP, Obregon M-J, Stagnaro-Green A. Hypothyroxinemia and pregnancy. Endocr Pract. 2011;17:422–9.

    Article  Google Scholar 

  17. Negro R, Schwartz A, Gismondi R, Tinelli A, Mangieri T, Stagnaro-Green A. Universal screening versus case finding for detection and treatment of thyroid hormonal dysfunction during pregnancy. J Clin Endocrinol Metab. 2010;95:1699–707.

    Article  CAS  Google Scholar 

  18. Su PY, Huang K, Hao JH, Xu YA, Yan SQ, Li T, et al. Maternal thyroid function in the first twenty weeks of pregnancy and subsequent fetal and infant development: a prospective population-based cohort study in China. J Clin Endocrinol Metab. 2011;96:3234–41.

    Article  CAS  Google Scholar 

  19. Schneuer FJ, Nassar N, Tasevski V, Morris JM, Roberts CL. Association and predictive accuracy of high TSH serum levels in first trimester and adverse pregnancy outcomes. J Clin Endocrinol Metabo. 2012;97:3115–22.

    Article  CAS  Google Scholar 

  20. Allan WC, Haddow JE, Palomaki GE, Williams JR, Mitchell ML, Hermos RJ, et al. Maternal thyroid deficiency and pregnancy complications: implications for population screening. J Med Screen. 2000;7:27–30.

    Article  Google Scholar 

  21. Casey BM, Dashe JS, Wells CE, McIntire DD, Byrd W, Leveno KJ, et al. Subclinical hypothyroidism and pregnancy outcomes. Obstet Gynecol. 2005;105:239–45.

    Article  Google Scholar 

  22. Sahu MT, Das V, Mittal S, Agarwal A, Sahu M. Overt and subclinical thyroid dysfunction among Indian pregnant women and its effect on maternal and fetal outcome. Arch Gynecol Obstet. 2010;281:215–20.

    Article  Google Scholar 

  23. Goel P, Kaur J, Saha PK, Tandon Rr, Devi L. Prevalence, associated risk factors and effects of hypothyroidism in pregnancy: a study from north India. Gynecol Obstet Invest. 2012;74:89–94.

    Article  Google Scholar 

  24. Karakosta P, Alegakis D, Georgiou V, Roumeliotaki T, Fthenou E, Vassilaki M, et al. Thyroid dysfunction and autoantibodies in early pregnancy are associated with increased risk of gestational diabetes and adverse birth outcomes. J Clin Endocrinol Metab. 2012;97:4464–72.

    Article  CAS  Google Scholar 

  25. Mannisto T, Vaarasmaki M, Pouta A, Hartikainen AL, Ruokonen A, Surcel HM, et al. Thyroid dysfunction and autoantibodies during pregnancy as predictive factors of pregnancy complications and maternal morbidity in later life. J Clin Endocrinol Metab. 2010;95:1084–94.

    Article  CAS  Google Scholar 

  26. Tudela CM, Casey BM, McIntire DD, Cunningham FG. Relationship of subclinical thyroid disease to the incidence of gestational diabetes mellitus. Obstet Gynecol. 2012;119:983–8.

    Article  CAS  Google Scholar 

  27. Leung AS, Millar LK, Koonings PP, Montoro M, Mestman JH. Perinatal outcome in hypothyroid women. Obstet Gynecol. 1993;81:349–53.

    CAS  PubMed  Google Scholar 

  28. Wilson KL, Casey BM, McIntire DD, Halvorson LM, Cunningham FG. Subclinical thyroid disease and the incidence of hypertension in pregnancy. Obstet Gynecol. 2012;119:315–20.

    Article  Google Scholar 

  29. Kuppens SM, Kooistra L, Wijnen HA, Vader HL, Hasaart TH, Oei SG, et al. Neonatal thyroid screening results are related to gestational maternal thyroid function. Clin Endocrinol (Oxf). 2011;75:382–7.

    Article  CAS  Google Scholar 

  30. Pakkila F, Mannisto T, Hartikainen AL, Ruokonen A, Surcel HM, Bloigu A, et al. Maternal and child’s thyroid function and child’s intellect and scholastic performance. Thyroid. 2015;25:1363–74.

    Article  Google Scholar 

  31. Lazarus JH, Bestwick JP, Channon S, Paradice R, Maina A, Rees R, et al. Antenatal thyroid screening and childhood cognitive function. N Engl J Med. 2012;366:493–501.

    Article  CAS  Google Scholar 

  32. Casey BM, Thom EA, Peaceman AM, Varner MW, Sorokin Y, Hirtz DG, et al. Treatment of subclinical hypothyroidism or hypothyroxinemia in pregnancy. N Engl J Med. 2017;376:815–25.

    Article  CAS  Google Scholar 

  33. Shields BM, Knight BA, Hill A, Hattersley AT, Vaidya B. Fetal thyroid hormone level at birth is associated with fetal growth. J Clin Endocrinol Metab. 2011;96:E934–E938.

    Article  CAS  Google Scholar 

  34. Eltom A, Eltom M, Idris M, Gebre-Medhin M. Thyroid function in the newborn in relation to maternal thyroid status during labour in a mild iodine deficiency endemic area in Sudan. Clin Endocrinol (Oxf). 2001;55:485–90.

    Article  CAS  Google Scholar 

  35. Oken E, Braverman LE, Platek D, Mitchell ML, Lee SL, Pearce EN. Neonatal thyroxine, maternal thyroid function, and child cognition. J Clin Endocrinol Metab. 2009;94:497–503.

    Article  CAS  Google Scholar 

  36. Lott JA, Sardovia-Iyer M, Speakman KS, Lee KK. Age-dependent cutoff values in screening newborns for hypothyroidism. Clin Biochem. 2004;37:791–7.

    Article  CAS  Google Scholar 

  37. Alexander GR, Kogan MD, Himes JH. 1994-1996 U.S. singleton birth weight percentiles for gestational age by race, Hispanic origin, and gender. Matern Child Health J. 1999;3:225–31.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We thank Lisa Moseley, R.N., B.S.N., and Gail Mallet, R.N., B.S.N., C.C.R.C., for protocol development and coordination between clinical research centers; Barbara Jones-Binns, J.D., M.P.H., for protocol and data management, overall coordination, and quality control; and Elizabeth A. Thom, Ph.D., Deborah G. Hirtz, M.D., and Catherine Y. Spong, M.D. for protocol development and oversight.

In addition to the authors, other members of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network are as follows:

The University of Utah Health Sciences Center, Salt Lake City, UT – K. Hill, A. Sowles, S. Timothy, P. Reed (Intermountain Healthcare), S. Esplin (Intermountain Healthcare).

University of Texas Southwestern Medical Center, Dallas, TX – L. Moseley, J. Price, C. Melton, M. Garcia, J. Gerald, M. Santillan.

University of Pittsburgh, Pittsburgh, PA – M. Cotroneo, D. DeAngelis, M. Luce, R. Kennedy, D. Nowinski.

University of Alabama at Birmingham, Birmingham, AL – S. Harris, F. Biasini, M. Parks, J. Grant, C. Lee, A. Todd, K. Domnanovich, W. Andrews.

Wayne State University, Detroit, MI – N. Hauff, L. Goldston, D. Driscoll.

The Ohio State University, Columbus, OH – F. Johnson, S. Wylie, R. Devlin, B. Selegue, C. Latimer, J. Bauer.

Brown University, Providence, Rhode Island – D. Allard, T. Leach, V. Watson, B. Hughes.

Columbia University, New York, NY – S. Bousleiman, V. Carmona, A. Zygmunt, Y. Williams (Drexel University), M. Grant (Drexel University), C. Kitto (Christiana Care Health Systems), B. Higley (Christiana Care Health Systems), M. Falk (St. Peter’s University Hospital); L. Padovano (St. Peter’s University Hospital).

University of Texas Medical Branch, Galveston, TX – A. Salazar, A. Acosta, K. Smith, G. Hankins, S. Jain, M. Munn, L. Pacheco.

MetroHealth Medical Center-Case Western Reserve University, Cleveland, OH – C. Milluzzi, B. Nielsen, W. Dalton, H. Cozart, E. Chien.

The University of Texas Health Science Center at Houston, McGovern Medical School-Children’s Memorial Hermann Hospital, Houston, TX – F. Ortiz, S. Blackwell, B. Rech, M. Hutchinson, P. Givens.

University of North Carolina at Chapel Hill, Chapel Hill, NC – K. Clark, S. Timlin, K. Dorman, E. Campos, H. Byers, S. Brody (WakeMed Health & Hospitals).

Northwestern University, Chicago, IL – G. Mallett, M. Ramos-Brinson, M. Weissbourd (Lurie Children’s Hospital), M. Dinsmoor (NorthShore University HealthSystem), K. Paychek (NorthShore University HealthSystem), P. Campbell.

Oregon Health & Science University, Portland, OR – M. Rincon, L. Pereira, P. Blasco, S. Saxton, K. Beach, J. Snyder.

George Washington University Biostatistics Center, Washington, DC – E.A. Thom, B. Jones-Binns.

National Institute of Neurological Disorders and Stroke, Bethesda, MD – D.G. Hirtz

Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD – C. Spong, S. Tolivaisa.

MFMU Network Steering Committee Chair (Medical University of South Carolina, Charleston, SC) – J. P. VanDorsten, M.D.

Funding

Supported by grants (HD34116, HD40512, HD27917, HD34208, HD40485, HD40560, HD53097, HD27869, HD40500, HD40545, HD27915, HD40544, HD53118, HD21410, and HD36801) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Institute of Neurological Disorders and Stroke.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology of the University of Utah Health Sciences Center, Salt Lake City, UT, USA

    Michael W. Varner

  2. The George Washington University Biostatistics Center, Washington, DC, USA

    Lisa Mele

  3. University of Texas - Southwestern, Dallas, TX, USA

    Brian M. Casey

  4. Northwestern University, Chicago, IL, USA

    Alan M. Peaceman

  5. Wayne State University, Detroit, MI, USA

    Yoram Sorokin

  6. The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA

    Uma M. Reddy

  7. Columbia University, New York, NY, USA

    Ronald J. Wapner

  8. University of North Carolina, Chapel Hill, NC, USA

    John M. Thorp

  9. University of Texas Medical Branch, Galveston, TX, USA

    George R. Saade

  10. University of Alabama at Birmingham, Birmingham, AL, USA

    Alan T. N. Tita

  11. Brown University, Providence, RI, USA

    Dwight J. Rouse

  12. University of Texas – Houston, Houston, TX, USA

    Baha Sibai

  13. The Ohio State University, Columbus, OH, USA

    Jay D. Iams

  14. Case Western Reserve University, Cleveland, OH, USA

    Brian M. Mercer

  15. Oregon Health Sciences University, Portland, OR, USA

    Jorge Tolosa

  16. University of Pittsburgh, Pittsburgh, PA, USA

    Steve N. Caritis

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for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network

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Correspondence to Michael W. Varner.

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The authors declare that they have no conflict of interest.

Additional information

The other members of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units Network are listed in the Acknowledgements.

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Varner, M.W., Mele, L., Casey, B.M. et al. Thyroid function in neonates of women with subclinical hypothyroidism or hypothyroxinemia. J Perinatol 38, 1490–1495 (2018). https://doi.org/10.1038/s41372-018-0213-9

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