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Developmental scores in offspring of women with subclinical hypothyroidism in pregnancy are affected by gender and thyrotropin cutoff

  • Julie Kristine Guldberg Stryhn EMAIL logo , Mette Skovgaard Væver , Anne Lisbeth Hoffmann and Peter Haulund Gæde
Published/Copyright: October 27, 2023
Journal of Pediatric Endocrinology and Metabolism
From the journal Journal of Pediatric Endocrinology and Metabolism Volume 36 Issue 11

Abstract

Objectives

Subclinical hypothyroidism (SCH) is defined by elevated thyrotropin (TSH) and normal level of thyroxine (T4). The definition of SCH and the cutoff for TSH normality in pregnancy are debated. In the present study, we assess offspring perinatal outcome, anthropometrics and early development in relation to different TSH levels.

Methods

An observational study with 77 singleton-pregnant women included by thyroid screening before a planned cesarean section. Two TSH-cutoffs (3.0 and 3.7 mIU/L) defined euthyroid and SCH groups, and were applied to evaluate offspring anthropometrics, complication rates (maternal blood loss, Apgar-score, cord arterial-pH, admission to neonatal intensive care unit, perinatal hypoglycemia) and offspring development. Development was evaluated by Bayley-III test in a subsample at age 6 months (n=27) and 15 months (n=22).

Results

Prevalence of SCH was 31.2 % at TSH-cutoff 3.0 mIU/L, and 16.9 % at TSH-cutoff 3.7 mIU/L. No differences in complications and anthropometrics were observed. In Bayley-III tests, cognitive score was decreased at 6 months (p=0.012) and at 15 months (p=0.056) by applying TSH-cutoff 3.0 mIU/L. At cutoff 3.7 mIU/L, motor score was decreased at 15 months (p=0.020). Male offspring had significantly lower cognitive scores at age 6 and 15 months (TSH-cutoff 3.0 mIU/L), and motor scores at age 15 months (TSH-cutoff 3.7 mIU/L).

Conclusions

The importance of the definition of thyroid normality in pregnancy is underlined. This study suggests that a gender-effect might be present in maternal thyroid disease, and that developmental differences exist if TSH-cutoff is low. Further research is needed.

Keywords: pregnancy; subclinical hypothyroidism; development; cognitive; anthropometrics; thyroid reference range
Corresponding author: Consultant Julie Kristine Guldberg Stryhn, Dept. Of Gynecology and Obstetrics, Slagelse Hospital, Fælledvej 13, 4200 Slagelse, Denmark; and Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark, E-mail:

Acknowledgments

The authors would like to thank retired professor and endocrinologist Jan Kvetny for inspiration and help in launching this project. Also, molecular biologists Palle Lyngsie Pedersen and Jacob Larsen should be acknowledged for their great help in the design and initiation of this study, and Jane Clements should be acknowledged for English proofreading of the manuscript. Finally, we would like to thank all the women and children for their participation, as spending time on child examinations for research is not easy to incorporate in a busy family life.

  1. Research ethics: The study was approved by the Regional Ethic Committee of Zealand (SJ-361) and the Danish Data Protection Agency. Adult participants received oral and written information. Both parents had to accept inclusion of the child to the study by written consent. The study conformed to the Declaration of Helsinki. The study was registered in Clinical Trials with identification number NCT02061111.

  2. Informed consent: Written and verbal informed consent were obtained from all individuals included in this study. Written and verbal informed consent on behalf of the children were always obtained from both parents.

  3. Author contributions: Julie Stryhn handled data collection and all child examinations. Mette Væver, Lisbeth Hoffmann and Peter Gæde supervised the process. Everyone contributed to the manuscript. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  4. Competing interests: Authors state no conflict of interest.

  5. Research funding: NSR Hospitals Research Foundation and Region Zealands Research Foundation have granted this study by sponsoring materials for the project and salary to the main investigator in the main study period. In respect of this paper, the Bayley-III test and items, scoring-booklets, seca 416 infantometer, seca 212 measuring tape, and a video camera were financed by the mentioned research foundations. The Dept. of Gynecology and Obstetrics at Naestved Hospital sponsored the seca 376 baby scale. The Dept. of Gynecology and Obstetrics at Slagelse Hospital has also supported the project by granting leave of absence for writing, to the main investigator. The funding organizations played no role in the study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

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Supplementary Material

This article contains supplementary material (https://doi.org/10.1515/jpem-2023-0197).

Received: 2023-04-30
Accepted: 2023-09-01
Published Online: 2023-10-27
Published in Print: 2023-11-27

© 2023 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/jpem-2023-0197
Keywords for this article
pregnancy; subclinical hypothyroidism; development; cognitive; anthropometrics; thyroid reference range

Articles in the same Issue

  1. Frontmatter
  2. Review
  3. Clinical heterogeneity and therapeutic options for idiopathic infantile hypercalcemia caused by CYP24A1 pathogenic variant
  4. Original Articles
  5. Growth hormone use in pediatric inflammatory bowel disease
  6. Extremely and very preterm children who were born appropriate for gestational age show no differences in cortisol concentrations or diurnal rhythms compared to full-term children
  7. A prospective comparison study of subcutaneous and intramuscular testosterone injections in transgender male adolescents
  8. Excess body weight and dyslipidemia at well-child visit
  9. Body mass index evolution and ovarian function in adolescent girls who received GnRH agonist treatment for central precocious puberty or early and fast puberty
  10. Assessment of pubertal onset and disorders of puberty in Indian children and youth with type-1 diabetes
  11. A different approach to the evaluation of the genotype-phenotype relationship in biotinidase deficiency: repeated measurement of biotinidase enzyme activity
  12. Expected vs. perceived effects of gender-affirming hormone therapy among transmasculine adolescents
  13. Developmental scores in offspring of women with subclinical hypothyroidism in pregnancy are affected by gender and thyrotropin cutoff
  14. Assessment of the diagnosis, treatment, and follow-up of a group of Turkish pediatric glycogen storage disease type 1b patients with varying clinical presentations and a novel mutation
  15. IGAm: A novel index predicting long-term survival in patients with early-diagnosed inherited metabolic disorders
  16. Case Report
  17. Persistent hypercalcemia mimicking hypophosphatasia after discontinuation of a ketogenic diet: a case report
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