Hypothyroidism during pregnancy:Controversy over screening and intervention

• 作者: AbdelHameed Mirghani Dirar Atul Kalhan
• 来源期刊: 世界妇产科杂志
• 学科: 医学
• 关键词: Targeted SCREENING Thyroid peroxidase antibodies Isolated hypothyroxinaemia Spontaneous abortion Overt HYPOTHYROIDISM Placental ABRUPTION Universal SCREENING HYPOTHYROIDISM DURING PREGNANCY SUBCLINICAL HYPOTHYROIDISM Autoimmune HYPOTHYROIDISM
• 年，卷（期）: 2018,（1）
• 页码范围: 1-16
• 页数: 16页
• 分类号: R

摘要

Thyroid hormones are critical for foetal neurological development and maternal health.Maternal hypothyroidism during pregnancy is associated with adverse impact on health of the mother as well as the progeny.Reduced thyroid hormone levels predispose the child to develop mental retardation and cognitive delay in early life.In the mother,hypothyroidism during pregnancy is associated with spontaneous abortion,placental abruption,preterm delivery and hypertensive disorders.Therefore,screening and therapeutic intervention is justified to prevent foetal as well as maternal co-morbidities.In view of impact of such a large-scale screening and intervention program on limited healthcare resources,it is debatable if a targeted rather than universal screening program will result in comparable outcomes.In addition,there is an ongoing debate regarding best evidence-based practice for the management of isolated hypothyroxinaemia,subclinical hypothyroidism and euthyroid women with autoimmune hypothyroidism.We have carried out a review of the literature;firstly,to determine whether universal screening for asymptomatic women in early pregnancy would be cost-effective.Secondly,we have retrospectively reviewed the literature to analyse the evidence regarding the impact of therapeutic intervention in women with subclinical hypothyroidism.