Antenatal Thyroid Screening and Childhood Cognitive Function

Queen Mary, University of London, Londinium, England, United Kingdom
New England Journal of Medicine (Impact Factor: 55.87). 02/2012; 366(6):493-501. DOI: 10.1056/NEJMoa1106104
Source: PubMed


Children born to women with low thyroid hormone levels have been reported to have decreased cognitive function.
We conducted a randomized trial in which pregnant women at a gestation of 15 weeks 6 days or less provided blood samples for measurement of thyrotropin and free thyroxine (T(4)). Women were assigned to a screening group (in which measurements were obtained immediately) or a control group (in which serum was stored and measurements were obtained shortly after delivery). Thyrotropin levels above the 97.5th percentile, free T(4) levels below the 2.5th percentile, or both were considered a positive screening result. Women with positive findings in the screening group were assigned to 150 μg of levothyroxine per day. The primary outcome was IQ at 3 years of age in children of women with positive results, as measured by psychologists who were unaware of the group assignments.
Of 21,846 women who provided blood samples (at a median gestational age of 12 weeks 3 days), 390 women in the screening group and 404 in the control group tested positive. The median gestational age at the start of levothyroxine treatment was 13 weeks 3 days; treatment was adjusted as needed to achieve a target thyrotropin level of 0.1 to 1.0 mIU per liter. Among the children of women with positive results, the mean IQ scores were 99.2 and 100.0 in the screening and control groups, respectively (difference, 0.8; 95% confidence interval [CI], -1.1 to 2.6; P=0.40 by intention-to-treat analysis); the proportions of children with an IQ of less than 85 were 12.1% in the screening group and 14.1% in the control group (difference, 2.1 percentage points; 95% CI, -2.6 to 6.7; P=0.39). An on-treatment analysis showed similar results.
Antenatal screening (at a median gestational age of 12 weeks 3 days) and maternal treatment for hypothyroidism did not result in improved cognitive function in children at 3 years of age. (Funded by the Wellcome Trust UK and Compagnia di San Paulo, Turin; Current Controlled Trials number, ISRCTN46178175.).

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    • "Since the ATA supports the use of assay-specific, trimester specific reference intervals to define thyroid dysfunction during pregnancy [8], according to the standard of the National Academy of Clinical Biochemistry (NACB) [10], we formulated independent trimester-specific normal reference intervals for thyroid function, and all pregnant women were diagnosed according to the reference values. In our study, the upper limit of TSH for diagnosis of hypothyroidism was 3.47 mU/L in the first trimester and 3.81 mlU/L in the second trimester, which was similar to the cutoff used by Lazarus et al. [20]. According to our results, 100% (2 of 2) of women with overt hypothyroidism and 66.7% (4 of 6) of women with overt hyperthyroidism would have been identified by high risk screening strategy in the first trimester. "
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