Research evaluates treatment of thyroid disease in pregnancy
Observational studies over the past 30 years suggest that subclinical thyroid disease during pregnancy may be associated with adverse outcomes, including a lower-than-normal IQ in offspring. The results of these studies led several professional organizations to recommend routine prenatal screening for and treatment of subclinical hypothyroidism in pregnant women.
New research, however, indicates that universal screening for and subsequent treatment of subclinical hypothyroidism does not result in improved health outcomes for mothers or babies. The research was conducted through the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units (MFMU) Network and has been published this month in the New England Journal of Medicine.
The research team concluded that, compared to no treatment, treatment for subclinical hypothyroidism or hypothroxinemia during pregnancy did not result in significantly better cognitive outcomes in children through age five.
"The results of our study, the largest and most rigorous on this issue, do not support screening for subclinical hypothyroidism or hypothroxinemia during pregnancy," said Dwight Rouse, MD, one of the authors on the paper and the principal investigator for the MFMU at Brown University/Women & Infants Hospital of Rhode Island. "Our results do not apply to women with actual hypothyroidism during pregnancy – such women should be treated during pregnancy, as treatment benefits them and their babies."
The MFMU conducted two multi-center, randomized, placebo-controlled studies at its 15 centers, including at Women & Infants, a Care New England hospital. They screened women with singleton pregnancies before 20 weeks gestation for subclinical hypothyroidism, characterized by a mildly high thyroid-stimulating hormone (TSH) level and a normal thyroxine (T4) level, and for hypothyroxinemia, characterized by low maternal free thyroid hormone (fT4) concentrations with TSH in the normal range.
In separate trials, women were randomly assigned to receive levothyroxine, a commonly used medication to treat hypothyroidism, or placebo. Thyroid function was assessed monthly throughout the pregnancy, and children underwent developmental and behavioral testing for five years.
The research team found that treatment for subclinical hypothryoidism or hypothyroxinemia did not improve cognitive outcomes in children through five years and, moreover, did not improve obstetric or immediate neonatal outcomes.
The findings of the MFMU study support current American College of Obstetricians and Gynecologists (ACOG) recommendations against universal thyroid screening during pregnancy.
About Women & Infants Hospital
Women & Infants Hospital of Rhode Island, a Care New England hospital, is one of the nation's leading specialty hospitals for women and newborns. A major teaching affiliate of The Warren Alpert Medical School of Brown University for obstetrics, gynecology and newborn pediatrics, as well as a number of specialized programs in women's medicine, Women & Infants is the ninth largest stand-alone obstetrical service in the country and the largest in New England with approximately 8,500 deliveries per year. A Designated Baby-Friendly® USA hospital, U.S.News & World Report 2014-15 Best Children's Hospital in Neonatology and a 2014 Leapfrog Top Hospital, in 2009 Women & Infants opened what was at the time the country's largest, single-family room neonatal intensive care unit.
Women & Infants and Brown offer fellowship programs in gynecologic oncology, maternal-fetal medicine, urogynecology and reconstructive pelvic surgery, neonatal-perinatal medicine, pediatric and perinatal pathology, gynecologic pathology and cytopathology, and reproductive endocrinology and infertility. It is home to the nation's first mother-baby perinatal psychiatric partial hospital, as well as the nation's only fellowship program in obstetric medicine.
Women & Infants has been designated as a Breast Imaging Center of Excellence by the American College of Radiography; a Center of Excellence in Minimally Invasive Gynecology; a Center of Biomedical Research Excellence by the National Institutes of Health (NIH); and a Neonatal Resource Services Center of Excellence. It is one of the largest and most prestigious research facilities in high risk and normal obstetrics, gynecology and newborn pediatrics in the nation, and is a member of the National Cancer Institute's Gynecologic Oncology Group and the Pelvic Floor Disorders Network.