Risk Factors for Thyroid Dysfunction in Pregnancy: An Individual Participant Data Meta-Analysis.

Autor: Osinga JAJ; Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.; Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands., Liu Y; Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.; Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands., Männistö T; Northern Finland Laboratory Center Nordlab and Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland., Vafeiadi M; Department of Social Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece., Tao FB; Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, Anhui, China., Vaidya B; Department of Endocrinology, Royal Devon and Exeter Hospital NHS Foundation Trust, University of Exeter Medical School, Exeter, United Kingdom., Vrijkotte TGM; Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands., Mosso L; Departments of Endocrinology, Pontificia Universidad Catolica de Chile, Santiago, Chile., Bassols J; Maternal-Fetal Metabolic Research Group, Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta Hospital, Girona, Spain., López-Bermejo A; Pediatric Endocrinology Research Group, Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta Hospital, Girona, Spain.; Departament de Ciències Mèdiques, Universitat de Girona, Girona, Spain., Boucai L; Division of Endocrinology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, Weill Cornell University, New York, New York, USA., Aminorroaya A; Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran., Feldt-Rasmussen U; Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Clinical Sciences, Copenhagen University, Copenhagen, Denmark., Hisada A; Center for Preventive Medical Sciences, Chiba University, Chiba, Japan., Yoshinaga J; Faculty of Life Sciences, Toyo University, Gunma, Japan., Broeren MAC; Laboratory of Clinical Chemistry and Haematology, Máxima Medical Centre, Veldhoven, The Netherlands., Itoh S; Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Japan., Kishi R; Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Japan., Ashoor G; Harris Birthright Research Center for Fetal Medicine, King's College Hospital, London, United Kingdom., Chen L; Department of Endocrinology and Rui'an Center of the Chinese-American Research Institute for Diabetic Complications, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China., Veltri F; Endocrine Unit, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium., Lu X; Department of Endocrinology and Rui'an Center of the Chinese-American Research Institute for Diabetic Complications, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China., Taylor PN; Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, United Kingdom., Brown SJ; Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia., Chatzi L; Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA., Popova PV; Institute of Endocrinology, Almazov National Medical Research Centre, Saint Petersburg, Russia., Grineva EN; Department of Endocrinology, First Medical University, Saint Petersburg, Russia., Ghafoor F; Department of Research and Innovation, Shalamar Institute of Health Sciences, Lahore, Pakistan., Pirzada A; Shifa College of Medicine, Islamabad, Pakistan., Kianpour M; Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran., Oken E; Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA., Suvanto E; Department of Obstetrics and Gynecology and Medical Research Center Oulu, University of Oulu, Oulu, Finland., Hattersley A; Department of Molecular Medicine, University of Exeter Medical School, Royal Devon and Exeter Hospital, Exeter, Devon, United Kingdom., Rebagliato M; Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I-Universitat de València, Valencia, Spain.; Predepartamental Unit of Medicine, Jaume I University, Castelló, Spain.; Spanish Consortium for Research on Epidemiology and Public Health, Instituto de Salud Carlos III, Madrid, Spain., Riaño-Galán I; Spanish Consortium for Research on Epidemiology and Public Health, Instituto de Salud Carlos III, Madrid, Spain.; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, Spain.; IUOPA-Department of Medicine, University of Oviedo, Oviedo, Asturias, Spain.; Servicio de Pediatría, Endocrinología Pediátrica, HUCA, Oviedo, Asturias, Spain., Irizar A; Spanish Consortium for Research on Epidemiology and Public Health, Instituto de Salud Carlos III, Madrid, Spain.; Biodonostia Health Research Institute, Group of Environmental Epidemiology and Child Development, San Sebastian, Spain.; Department of Preventive Medicine and Public Health, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain., Vrijheid M; Spanish Consortium for Research on Epidemiology and Public Health, Instituto de Salud Carlos III, Madrid, Spain.; ISGlobal, Barcelona, Spain.; Universitat Pompeu Fabra, Barcelona, Spain., Delgado-Saborit JM; Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I-Universitat de València, Valencia, Spain.; Department of Medicine, Faculty of Health Sciences, Universitat Jaume I, Castellón de la Plana, Spain., Fernández-Somoano A; Spanish Consortium for Research on Epidemiology and Public Health, Instituto de Salud Carlos III, Madrid, Spain.; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, Spain.; IUOPA-Department of Medicine, University of Oviedo, Oviedo, Asturias, Spain., Santa-Marina L; Spanish Consortium for Research on Epidemiology and Public Health, Instituto de Salud Carlos III, Madrid, Spain.; Biodonostia Health Research Institute, Group of Environmental Epidemiology and Child Development, San Sebastian, Spain.; Department of Health of the Basque Government, Subdirectorate of Public Health of Gipuzkoa, San Sebastian, Spain., Boelaert K; Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom., Brenta G; Department of Internal Medicine, Unidad Asistencial Dr. César Milstein, Buenos Aires, Argentina., Dhillon-Smith R; Tommys National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom., Dosiou C; Division of Endocrinology, Stanford University School of Medicine, Stanford, California, USA., Eaton JL; Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, and Women and Infants Hospital and Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA., Guan H; The First Hospital of China Medical University, Shenyang, China., Lee SY; Section of Endocrinology, Diabetes, and Nutrition, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA., Maraka S; Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.; Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.; Endocrine Section, Medicine Service, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, USA., Morris-Wiseman LF; Division of Endocrine Surgery, Johns Hopkins Department of Surgery, Baltimore, Maryland, USA., Nguyen CT; Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA., Shan Z; Department of Endocrinology and Metabolism, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, China., Guxens M; Spanish Consortium for Research on Epidemiology and Public Health, Instituto de Salud Carlos III, Madrid, Spain.; ISGlobal, Barcelona, Spain.; Universitat Pompeu Fabra, Barcelona, Spain.; Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, The Netherlands., Pop VJM; Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands., Walsh JP; Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.; Medical School, University of Western Australia, Crawley, Western Australia, Australia., Nicolaides KH; Department of Women and Children's Health, Faculty of Life Sciences and Medicine King's College London, London, United Kingdom., D'Alton ME; Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York, USA., Visser WE; Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.; Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands., Carty DM; Department of Diabetes, Endocrinology and Clinical Pharmacology, Glasgow Royal Infirmary, Glasgow, United Kingdom.; School of Cardiovascular and Metabolic Health, Dentistry and Nursing, University of Glasgow, Glasgow, United Kingdom., Delles C; School of Cardiovascular and Metabolic Health, Dentistry and Nursing, University of Glasgow, Glasgow, United Kingdom., Nelson SM; School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, United Kingdom., Alexander EK; Division of Endocrinology, Hypertension and Diabetes, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA., Chaker L; Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.; Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands.; Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands.; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA., Palomaki GE; Department of Pathology and Laboratory Medicine, Women and Infants Hospital and Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA., Peeters RP; Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.; Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands., Bliddal S; Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Clinical Sciences, Copenhagen University, Copenhagen, Denmark., Huang K; Department of Maternal, Child and Adolescent Health, Scientific Research Center in Preventive Medicine; School of Public Health; Anhui Medical University, Hefei, Anhui, China., Poppe KG; Endocrine Unit, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium., Pearce EN; Section of Endocrinology, Diabetes, and Nutrition, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA., Derakhshan A; Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.; Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands., Korevaar TIM; Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.; Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands.
Jazyk: angličtina
Zdroj: Thyroid : official journal of the American Thyroid Association [Thyroid] 2024 May; Vol. 34 (5), pp. 646-658. Date of Electronic Publication: 2024 Mar 28.
DOI: 10.1089/thy.2023.0646
Abstrakt: Background: International guidelines recommend targeted screening to identify gestational thyroid dysfunction. However, currently used risk factors have questionable discriminative ability. We quantified the risk for thyroid function test abnormalities for a subset of risk factors currently used in international guidelines. Methods: We included prospective cohort studies with data on gestational maternal thyroid function and potential risk factors (maternal age, body mass index [BMI], parity, smoking status, pregnancy through in vitro fertilization, twin pregnancy, gestational age, maternal education, and thyroid peroxidase antibody [TPOAb] or thyroglobulin antibody [TgAb] positivity). Exclusion criteria were pre-existing thyroid disease and use of thyroid interfering medication. We analyzed individual participant data using mixed-effects regression models. Primary outcomes were overt and subclinical hypothyroidism and a treatment indication (defined as overt hypothyroidism, subclinical hypothyroidism with thyrotropin >10 mU/L, or subclinical hypothyroidism with TPOAb positivity). Results: The study population comprised 65,559 participants in 25 cohorts. The screening rate in cohorts using risk factors currently recommended (age >30 years, parity ≥2, BMI ≥40) was 58%, with a detection rate for overt and subclinical hypothyroidism of 59%. The absolute risk for overt or subclinical hypothyroidism varied <2% over the full range of age and BMI and for any parity. Receiver operating characteristic curves, fitted using maternal age, BMI, smoking status, parity, and gestational age at blood sampling as explanatory variables, yielded areas under the curve ranging from 0.58 to 0.63 for the primary outcomes. TPOAbs/TgAbs positivity was associated with overt hypothyroidism (approximate risk for antibody negativity 0.1%, isolated TgAb positivity 2.4%, isolated TPOAb positivity 3.8%, combined antibody positivity 7.0%; p  < 0.001), subclinical hypothyroidism (risk for antibody negativity 2.2%, isolated TgAb positivity 8.1%, isolated TPOAb positivity 14.2%, combined antibody positivity 20.0%; p  < 0.001) and a treatment indication (risk for antibody negativity 0.2%, isolated TgAb positivity 2.2%, isolated TPOAb positivity 3.0%, and combined antibody positivity 5.1%; p  < 0.001). Twin pregnancy was associated with a higher risk of overt hyperthyroidism (5.6% vs. 0.7%; p  < 0.001). Conclusions: The risk factors assessed in this study had poor predictive ability for detecting thyroid function test abnormalities, questioning their clinical usability for targeted screening. As expected, TPOAb positivity (used as a benchmark) was a relevant risk factor for (subclinical) hypothyroidism. These results provide insights into different risk factors for gestational thyroid dysfunction.
Databáze: MEDLINE