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Fang Y, Yao L, Sun J, Zhang J, Li Y, Yang R, Yang K, Tian L. Appraisal of clinical practice guidelines on the management of hypothyroidism in pregnancy using the Appraisal of Guidelines for Research and Evaluation II instrument. Endocrine 2018; 60:4-14. [PMID: 29445919 DOI: 10.1007/s12020-018-1535-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 01/15/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE This study aimed to systematically evaluate the quality of guidelines for the management of hypothyroidism in pregnancy. METHOD Systematic searches were conducted to identify hypothyroidism in pregnancy guidelines published in electronic databases and developers' websites. Four reviewers independently evaluated eligible guidelines using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. Agreement among reviewers was measured using the intraclass correlation coefficient (ICC). The number of recommendations, strength of recommendations, and levels of evidence were determined. The software used for analysis was SPSS version 12.0. RESULTS Nine guidelines met the inclusion criteria and were appraised. The scope and purpose (65%) and clarity of presentation (70%) domains achieved relatively high scores, whereas the stakeholder involvement (41%), rigor of development (33%), applicability (36%), and editorial independence (31%) domains yielded low scores. The American Thyroid Association (ATA) guideline ranked the highest, whereas the 2012 Chinese Society of Endocrinology (CSE) guideline ranked the lowest among all the guidelines. The British Thyroid Association (BTA) and ATA guidelines were strongly recommended as dependable and helpful references to aid clinical decisions for medical providers, whereas the CSE guideline was not recommended. Most recommendations of the guidelines were relatively consistent. However, the nine guidelines varied with respect to their recommendations on thyroid scanning, dose of levothyroxine (L-T4) treatment, and target thyroid-stimulating hormone(TSH) level of L-T4 therapy. CONCLUSIONS The quality of the guidelines on the management of hypothyroidism in pregnancy is highly variable. Additionally, these guidelines need significant improvement, especially in the rigor of development and applicability domains. Some improvements should be made to promote the development and implementation of guidelines, for example, conducting a comprehensive search strategy to include more potential evidence and establishing a standard grading system to evaluate the quality of evidence.
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Affiliation(s)
- Yuan Fang
- Department of Endocrinology, Gansu Provincial Hospital, Dong gang West Road, Lanzhou, 730000, Gansu, People's Republic of China
| | - Liang Yao
- Clinical Evidence based medicine center, Gansu Provincial Hospital, Dong gang West Road, Lanzhou, 730000, Gansu, People's Republic of China
| | - Jing Sun
- Department of Clinical Medicine, Ningxia Medical University, Yinchuan, 750004, Ningxia, People's Republic of China
| | - Jian Zhang
- Department of Clinical Medicine, Ningxia Medical University, Yinchuan, 750004, Ningxia, People's Republic of China
| | - Yanxia Li
- Department of Ultrasonography, Hebei Province Veterans Hospital, Lianchi South Street, Baoding, 071000, Hebei, People's Republic of China
| | - Ruifei Yang
- Department of Endocrinology, Gansu Provincial Hospital, Dong gang West Road, Lanzhou, 730000, Gansu, People's Republic of China
| | - Kehu Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, People's Republic of China.
| | - Limin Tian
- Department of Endocrinology, Gansu Provincial Hospital, Dong gang West Road, Lanzhou, 730000, Gansu, People's Republic of China.
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Thompson W, Russell G, Baragwanath G, Matthews J, Vaidya B, Thompson‐Coon J. Maternal thyroid hormone insufficiency during pregnancy and risk of neurodevelopmental disorders in offspring: A systematic review and meta-analysis. Clin Endocrinol (Oxf) 2018; 88:575-584. [PMID: 29325223 PMCID: PMC5888183 DOI: 10.1111/cen.13550] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 12/27/2017] [Accepted: 01/07/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND In the last 2 decades, several studies have examined the association between maternal thyroid hormone insufficiency during pregnancy and neurodevelopmental disorders in children and shown conflicting results. AIM This systematic review aimed to assess the evidence for an association between maternal thyroid hormone insufficiency during pregnancy and neurodevelopmental disorders in children. We also sought to assess whether levothyroxine treatment for maternal thyroid hormone insufficiency improves child neurodevelopment outcomes. METHODS We performed systematic literature searches in MEDLINE, EMBASE, PSYCinfo, CINAHL, AMED, BNI, Cochrane, Scopus, Web of Science, GreyLit, Grey Source and Open Grey (latest search: March 2017). We also conducted targeted web searching and performed forwards and backwards citation chasing. Meta-analyses of eligible studies were carried out using the random-effects model. RESULTS We identified 39 eligible articles (37 observational studies and 2 randomized controlled trials [RCT]). Meta-analysis showed that maternal subclinical hypothyroidism and hypothyroxinaemia are associated with indicators of intellectual disability in offspring (odds ratio [OR] 2.14, 95% confidence interval [CI] 1.20 to 3.83, P = .01, and OR 1.63, 95% CI 1.03 to 2.56, P = .04, respectively). Maternal subclinical hypothyroidism and hypothyroxinaemia were not associated with attention deficit hyperactivity disorder, and their effect on the risk of autism in offspring was unclear. Meta-analysis of RCTs showed no evidence that levothyroxine treatment for maternal hypothyroxinaemia or subclinical hypothyroidism reduces the incidence of low intelligence quotient in offspring. LIMITATIONS Although studies were generally of good quality, there was evidence of heterogeneity between the included observational studies (I2 72%-79%). CONCLUSION Maternal hypothyroxinaemia and subclinical hypothyroidism may be associated with intellectual disability in offspring. Currently, there is no evidence that levothyroxine treatment, when initiated 8- to 20-week gestation (mostly between 12 and 17 weeks), for mild maternal thyroid hormone insufficiency during pregnancy reduces intellectual disability in offspring.
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Affiliation(s)
- William Thompson
- NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula (PenCLAHRC)University of Exeter Medical SchoolUniversity of ExeterExeterUK
| | - Ginny Russell
- Centre for Study of the Life SciencesUniversity of Exeter Medical SchoolUniversity of ExeterExeterUK
- Institute of Health ResearchUniversity of Exeter Medical SchoolUniversity of ExeterExeterUK
| | | | - Justin Matthews
- NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula (PenCLAHRC)University of Exeter Medical SchoolUniversity of ExeterExeterUK
- Institute of Health ResearchUniversity of Exeter Medical SchoolUniversity of ExeterExeterUK
| | - Bijay Vaidya
- Department of EndocrinologyRoyal Devon & Exeter Hospital NHS TrustExeterUK
- Department of EndocrinologyUniversity of Exeter Medical SchoolUniversity of ExeterExeterUK
| | - Jo Thompson‐Coon
- NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula (PenCLAHRC)University of Exeter Medical SchoolUniversity of ExeterExeterUK
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103
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Hales C, Taylor PN, Channon S, Paradice R, McEwan K, Zhang L, Gyedu M, Bakhsh A, Okosieme O, Muller I, Draman MS, Gregory JW, Dayan C, Lazarus JH, Rees DA, Ludgate M. Controlled Antenatal Thyroid Screening II: Effect of Treating Maternal Suboptimal Thyroid Function on Child Cognition. J Clin Endocrinol Metab 2018; 103:1583-1591. [PMID: 29346569 DOI: 10.1210/jc.2017-02378] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 01/10/2018] [Indexed: 02/05/2023]
Abstract
CONTEXT AND OBJECTIVE The Controlled Antenatal Thyroid Screening (CATS) study investigated treatment of suboptimal gestational thyroid function (SGTF) on childhood cognition and found no difference in intelligence quotient (IQ) at 3 years between children of treated and untreated SGTF mothers. We have measured IQ in the same children at age 9.5 years and included children from normal gestational thyroid function (normal-GTF) mothers. DESIGN, SETTING, AND PARTICIPANTS One examiner, blinded to participant group, assessed children's IQ (Wechsler Intelligence Scale for Children, Fourth Edition UK), long-term memory, and motor function (Developmental Neuropsychological Assessment II) from children of 119 treated and 98 untreated SGTF mothers plus children of 232 mothers with normal-GTF. Logistic regression explored the odds and percentages of an IQ < 85 in the groups. RESULTS There was no difference in IQ < 85 between children of mothers with normal-GTF and combined SGTF, i.e., treated and untreated (fully adjusted odds ratio [OR] = 1.15 [95% confidence interval (CI) 0.52, 2.51]; P = 0.731). Furthermore, there was no significant effect of treatment [untreated OR = 1.33 (95% CI 0.53, 3.34); treated OR = 0.75 (95% CI 0.27, 2.06) P = 0.576]. IQ < 85 was 6.03% in normal-GTF, 7.56% in treated, and 11.22% in untreated groups. Analyses accounting for treated-SGTF women with free thyroxine > 97.5th percentile of the entire CATS-I cohort revealed no significant effect on a child's IQ < 85 in CATS-II. IQ at age 3 predicted IQ at age 9.5 (P < 0.0001) and accounted for 45% of the variation. CONCLUSIONS Maternal thyroxine during pregnancy did not improve child cognition at age 9.5 years. Our findings confirmed CATS-I and suggest that the lack of treatment effect may be a result of the similar proportion of IQ < 85 in children of women with normal-GTF and SGTF.
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Affiliation(s)
- Charlotte Hales
- School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | - Peter N Taylor
- School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | - Sue Channon
- Centre for Trials Research, Cardiff University, Cardiff, Wales, United Kingdom
| | - Ruth Paradice
- St David's Hospital, Cardiff and Vale University Health Board, Cardiff, Wales, United Kingdom
| | - Kirsten McEwan
- Centre for Trials Research, Cardiff University, Cardiff, Wales, United Kingdom
| | - Lei Zhang
- School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | - Michael Gyedu
- School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | - Ameen Bakhsh
- School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | | | - Ilaria Muller
- School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | - Mohd S Draman
- School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | - John W Gregory
- School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | - Colin Dayan
- School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | - John H Lazarus
- School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | - D Aled Rees
- Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, Wales, United Kingdom
| | - Marian Ludgate
- School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
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104
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Mughal BB, Fini JB, Demeneix BA. Thyroid-disrupting chemicals and brain development: an update. Endocr Connect 2018; 7:R160-R186. [PMID: 29572405 PMCID: PMC5890081 DOI: 10.1530/ec-18-0029] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 03/14/2018] [Indexed: 12/12/2022]
Abstract
This review covers recent findings on the main categories of thyroid hormone-disrupting chemicals and their effects on brain development. We draw mostly on epidemiological and experimental data published in the last decade. For each chemical class considered, we deal with not only the thyroid hormone-disrupting effects but also briefly mention the main mechanisms by which the same chemicals could modify estrogen and/or androgen signalling, thereby exacerbating adverse effects on endocrine-dependent developmental programmes. Further, we emphasize recent data showing how maternal thyroid hormone signalling during early pregnancy affects not only offspring IQ, but also neurodevelopmental disease risk. These recent findings add to established knowledge on the crucial importance of iodine and thyroid hormone for optimal brain development. We propose that prenatal exposure to mixtures of thyroid hormone-disrupting chemicals provides a plausible biological mechanism contributing to current increases in the incidence of neurodevelopmental disease and IQ loss.
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Affiliation(s)
- Bilal B Mughal
- CNRS/UMR7221Muséum National d'Histoire Naturelle, Sorbonne Universités, Paris, France
| | - Jean-Baptiste Fini
- CNRS/UMR7221Muséum National d'Histoire Naturelle, Sorbonne Universités, Paris, France
| | - Barbara A Demeneix
- CNRS/UMR7221Muséum National d'Histoire Naturelle, Sorbonne Universités, Paris, France
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105
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Dieb A, Salam R, Shaheen D, Shaeer E. Evaluation of foetal neurological behaviour in hypothyroid pregnant females – a pilot study. J Matern Fetal Neonatal Med 2018; 32:2617-2621. [DOI: 10.1080/14767058.2018.1442428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Amira Dieb
- Faculty of Medicine, Cairo University, Kasr Alainy, Cairo, Egypt
| | - Randa Salam
- Faculty of Medicine, Cairo University, Kasr Alainy, Cairo, Egypt
| | - Dina Shaheen
- Faculty of Medicine, Cairo University, Kasr Alainy, Cairo, Egypt
| | - Eman Shaeer
- Faculty of Medicine, Cairo University, Kasr Alainy, Cairo, Egypt
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106
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Kawahori K, Hashimoto K, Yuan X, Tsujimoto K, Hanzawa N, Hamaguchi M, Kase S, Fujita K, Tagawa K, Okazawa H, Nakajima Y, Shibusawa N, Yamada M, Ogawa Y. Mild Maternal Hypothyroxinemia During Pregnancy Induces Persistent DNA Hypermethylation in the Hippocampal Brain-Derived Neurotrophic Factor Gene in Mouse Offspring. Thyroid 2018; 28:395-406. [PMID: 29415629 DOI: 10.1089/thy.2017.0331] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Thyroid hormones are essential for normal development of the central nervous system (CNS). Experimental rodents have shown that even a subtle thyroid hormone insufficiency in circulating maternal thyroid hormones during pregnancy may adversely affect neurodevelopment in offspring, resulting in irreversible cognitive deficits. This may be due to the persistent reduced expression of the hippocampal brain-derived neurotrophic factor gene Bdnf, which plays a crucial role in CNS development. However, the underlying molecular mechanisms remain unclear. METHODS Thiamazole (MMI; 0.025% [w/v]) was administered to dams from two weeks prior to conception until delivery, which succeeded in inducing mild maternal hypothyroxinemia during pregnancy. Serum thyroid hormone and thyrotropin levels of the offspring derived from dams with mild maternal hypothyroxinemia (M offspring) and the control offspring (C offspring) were measured. At 70 days after birth, several behavior tests were performed on the offspring. Gene expression and DNA methylation status were also evaluated in the promoter region of Bdnf exon IV, which is largely responsible for neural activity-dependent Bdnf gene expression, in the hippocampus of the offspring at day 28 and day 70. RESULTS No significant differences in serum thyroid hormone or thyrotropin levels were found between M and C offspring at day 28 and day 70. M offspring showed an impaired learning capacity in the behavior tests. Hippocampal steady-state Bdnf exon IV expression was significantly weaker in M offspring than it was in C offspring at day 28. At day 70, hippocampal Bdnf exon IV expression at the basal level was comparable between M and C offspring. However, it was significantly weaker in M offspring than in C offspring after the behavior tests. Persistent DNA hypermethylation was also found in the promoter region of Bdnf exon IV in the hippocampus of M offspring compared to that of C offspring, which may cause the attenuation of Bdnf exon IV expression in M offspring. CONCLUSIONS Mild maternal hypothyroxinemia induces persistent DNA hypermethylation in Bdnf exon IV in offspring as epigenetic memory, which may result in long-term cognitive disorders.
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Affiliation(s)
- Kenichi Kawahori
- 1 Department of Molecular Endocrinology and Metabolism, Tokyo Medical and Dental University , Tokyo, Japan
| | - Koshi Hashimoto
- 2 Department of Preemptive Medicine and Metabolism, Tokyo Medical and Dental University , Tokyo, Japan
| | - Xunmei Yuan
- 3 Department of Molecular and Cellular Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University , Tokyo, Japan
| | - Kazutaka Tsujimoto
- 1 Department of Molecular Endocrinology and Metabolism, Tokyo Medical and Dental University , Tokyo, Japan
| | - Nozomi Hanzawa
- 1 Department of Molecular Endocrinology and Metabolism, Tokyo Medical and Dental University , Tokyo, Japan
| | - Miho Hamaguchi
- 3 Department of Molecular and Cellular Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University , Tokyo, Japan
| | - Saori Kase
- 1 Department of Molecular Endocrinology and Metabolism, Tokyo Medical and Dental University , Tokyo, Japan
| | - Kyota Fujita
- 4 Department of Neuropathology, Medical Research Institute and Center for Brain Integration Research, Tokyo Medical and Dental University , Tokyo, Japan
| | - Kazuhiko Tagawa
- 4 Department of Neuropathology, Medical Research Institute and Center for Brain Integration Research, Tokyo Medical and Dental University , Tokyo, Japan
| | - Hitoshi Okazawa
- 4 Department of Neuropathology, Medical Research Institute and Center for Brain Integration Research, Tokyo Medical and Dental University , Tokyo, Japan
| | - Yasuyo Nakajima
- 5 Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine , Gunma, Japan
| | - Nobuyuki Shibusawa
- 5 Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine , Gunma, Japan
| | - Masanobu Yamada
- 5 Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine , Gunma, Japan
| | - Yoshihiro Ogawa
- 3 Department of Molecular and Cellular Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University , Tokyo, Japan
- 6 Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University , Fukuoka, Japan
- 7 Japan Agency for Medical Research and Development , CREST, Tokyo, Japan
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107
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Bal-Price A, Hogberg HT, Crofton KM, Daneshian M, FitzGerald RE, Fritsche E, Heinonen T, Hougaard Bennekou S, Klima S, Piersma AH, Sachana M, Shafer TJ, Terron A, Monnet-Tschudi F, Viviani B, Waldmann T, Westerink RHS, Wilks MF, Witters H, Zurich MG, Leist M. Recommendation on test readiness criteria for new approach methods in toxicology: Exemplified for developmental neurotoxicity. ALTEX-ALTERNATIVES TO ANIMAL EXPERIMENTATION 2018; 35:306-352. [PMID: 29485663 DOI: 10.14573/altex.1712081] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 01/29/2018] [Indexed: 01/06/2023]
Abstract
Multiple non-animal-based test methods have never been formally validated. In order to use such new approach methods (NAMs) in a regulatory context, criteria to define their readiness are necessary. The field of developmental neurotoxicity (DNT) testing is used to exemplify the application of readiness criteria. The costs and number of untested chemicals are overwhelming for in vivo DNT testing. Thus, there is a need for inexpensive, high-throughput NAMs, to obtain initial information on potential hazards, and to allow prioritization for further testing. A background on the regulatory and scientific status of DNT testing is provided showing different types of test readiness levels, depending on the intended use of data from NAMs. Readiness criteria, compiled during a stakeholder workshop, uniting scientists from academia, industry and regulatory authorities are presented. An important step beyond the listing of criteria, was the suggestion for a preliminary scoring scheme. On this basis a (semi)-quantitative analysis process was assembled on test readiness of 17 NAMs with respect to various uses (e.g. prioritization/screening, risk assessment). The scoring results suggest that several assays are currently at high readiness levels. Therefore, suggestions are made on how DNT NAMs may be assembled into an integrated approach to testing and assessment (IATA). In parallel, the testing state in these assays was compiled for more than 1000 compounds. Finally, a vision is presented on how further NAM development may be guided by knowledge of signaling pathways necessary for brain development, DNT pathophysiology, and relevant adverse outcome pathways (AOP).
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Affiliation(s)
- Anna Bal-Price
- European Commission, Joint Research Centre (EC JRC), Ispra (VA), Italy
| | - Helena T Hogberg
- Center for Alternatives to Animal Testing (CAAT), Johns Hopkins University, Baltimore, MD, USA
| | - Kevin M Crofton
- National Centre for Computational Toxicology, US EPA, RTP, Washington, NC, USA
| | - Mardas Daneshian
- Center for Alternatives to Animal Testing, CAAT-Europe, University of Konstanz, Konstanz, Germany
| | - Rex E FitzGerald
- Swiss Centre for Human Applied Toxicology, SCAHT, University of Basle, Switzerland
| | - Ellen Fritsche
- IUF - Leibniz Research Institute for Environmental Medicine & Heinrich-Heine-University, Düsseldorf, Germany
| | - Tuula Heinonen
- Finnish Centre for Alternative Methods (FICAM), University of Tampere, Tampere, Finland
| | | | - Stefanie Klima
- In vitro Toxicology and Biomedicine, Department of Biology, University of Konstanz, Konstanz, Germany
| | - Aldert H Piersma
- RIVM, National Institute for Public Health and the Environment, Bilthoven, and Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Magdalini Sachana
- Organisation for Economic Co-operation and Development (OECD), Paris, France
| | - Timothy J Shafer
- National Centre for Computational Toxicology, US EPA, RTP, Washington, NC, USA
| | | | - Florianne Monnet-Tschudi
- Swiss Centre for Human Applied Toxicology, SCAHT, University of Basle, Switzerland.,Department of Physiology, University of Lausanne, Lausanne, Switzerland
| | - Barbara Viviani
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Italy
| | - Tanja Waldmann
- In vitro Toxicology and Biomedicine, Department of Biology, University of Konstanz, Konstanz, Germany
| | - Remco H S Westerink
- Neurotoxicology Research Group, Institute for Risk Assessment Sciences (IRAS), Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Martin F Wilks
- Swiss Centre for Human Applied Toxicology, SCAHT, University of Basle, Switzerland
| | - Hilda Witters
- VITO, Flemish Institute for Technological Research, Unit Environmental Risk and Health, Mol, Belgium
| | - Marie-Gabrielle Zurich
- Swiss Centre for Human Applied Toxicology, SCAHT, University of Basle, Switzerland.,Department of Physiology, University of Lausanne, Lausanne, Switzerland
| | - Marcel Leist
- Center for Alternatives to Animal Testing, CAAT-Europe, University of Konstanz, Konstanz, Germany.,In vitro Toxicology and Biomedicine, Department of Biology, University of Konstanz, Konstanz, Germany
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108
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Nelson SM, Haig C, McConnachie A, Sattar N, Ring SM, Smith GD, Lawlor DA, Lindsay RS. Maternal thyroid function and child educational attainment: prospective cohort study. BMJ 2018; 360:k452. [PMID: 29463525 PMCID: PMC5819484 DOI: 10.1136/bmj.k452] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine if first trimester maternal thyroid dysfunction is a critical determinant of child scholastic performance and overall educational attainment. DESIGN Prospective cohort study. SETTING Avon Longitudinal Study of Parents and Children cohort in the UK. PARTICIPANTS 4615 mother-child pairs with an available first trimester sample (median 10 weeks gestation, interquartile range 8-12). EXPOSURES Free thyroxine, thyroid stimulating hormone, and thyroid peroxidase antibodies assessed as continuous measures and the seven clinical categories of maternal thyroid function. MAIN OUTCOME MEASURES Five age-specific national curriculum assessments in 3580 children at entry stage assessment at 54 months, increasing up to 4461 children at their final school assessment at age 15. RESULTS No strong evidence of clinically meaningful associations of first trimester free thyroxine and thyroid stimulating hormone levels with entry stage assessment score or Standard Assessment Test scores at any of the key stages was found. Associations of maternal free thyroxine or thyroid stimulating hormone with the total number of General Certificates of Secondary Education (GCSEs) passed (range 0-16) were all close to the null: free thyroxine, rate ratio per pmol/L 1.00 (95% confidence interval 1.00 to 1.01); and thyroid stimulating hormone, rate ratio 0.98 (0.94 to 1.02). No important relationship was observed when more detailed capped scores of GCSEs allowing for both the number and grade of pass or when language, mathematics, and science performance were examined individually or when all educational assessments undertaken by an individual from school entry to leaving were considered. 200 (4.3%) mothers were newly identified as having hypothyroidism or subclinical hypothyroidism and 97 (2.1%) subclinical hyperthyroidism or hyperthyroidism. Children of mothers with thyroid dysfunction attained an equivalent number of GCSEs and equivalent grades as children of mothers with euthyroidism. CONCLUSIONS Maternal thyroid dysfunction in early pregnancy does not have a clinically important association with impaired child performance at school or educational achievement.
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Affiliation(s)
- Scott M Nelson
- School of Medicine, University of Glasgow, Room 2.52 Level 2, New Lister Building, Glasgow Royal Infirmary, Glasgow G31 2ER, UK
- National Institute for Health Research, Bristol Biomedical Research Centre, Bristol, UK
| | - Caroline Haig
- Robertson Centre for Biostatistics, University of Glasgow, Level 11, Boyd Orr Building, Glasgow, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, University of Glasgow, Level 11, Boyd Orr Building, Glasgow, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Susan M Ring
- The Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Bristol, UK
- Population Health Science, Bristol Medical School, University of Bristol, Oakfield House, Bristol, UK
| | - George D Smith
- The Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Bristol, UK
- Population Health Science, Bristol Medical School, University of Bristol, Oakfield House, Bristol, UK
| | - Debbie A Lawlor
- National Institute for Health Research, Bristol Biomedical Research Centre, Bristol, UK
- The Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Bristol, UK
- Population Health Science, Bristol Medical School, University of Bristol, Oakfield House, Bristol, UK
| | - Robert S Lindsay
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
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109
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Zhu YD, Han Y, Huang K, Zhu BB, Yan SQ, Ge X, Zhou SS, Xu YY, Ren LI, Sheng J, Pan WJ, Hao JH, Zhu P, Tao FB. The impact of isolated maternal hypothyroxinaemia on the incidence of large-for-gestational-age infants: the Ma'anshan Birth Cohort study. BJOG 2018; 125:1118-1125. [PMID: 29266657 DOI: 10.1111/1471-0528.15107] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2017] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate whether isolated maternal hypothyroxinaemia (IMH) is associated with risks of small/large-for-gestational-age (SGA/LGA) infants. DESIGN Population-based prospective cohort study. SETTING Ma'anshan Maternal and Child Health (MCH) clinics, China. POPULATION Pregnant women with singleton births (n = 3178). METHODS Descriptive statistics were calculated for the demographic characteristics of the mothers and their newborns. Linear regression was applied to estimate the association between thyroid hormone levels and birthweight. Logistic regression was performed to calculate the association between IMH and SGA/LGA. MAIN OUTCOME MEASURES Outcomes included SGA/LGA. RESULTS The prevalence of IMH, defined as a free thyroxine value (FT4) lower than the 2.5th percentile with normal thyroid stimulating hormone, was 2.5% (78/3080) and 2.5% (74/2999) in the first and second trimesters, respectively. Additionally, 306 (9.6%) and 524 (16.5%) infants were defined as SGA and LGA, respectively. No evidence supported the notion that IMH is associated with an increased risk for SGA in either the first [odds ratio (OR): 1.762, 95% confidence interval (CI): 0.759-4.089] or the second (OR: 0.763, 95% CI: 0.231-2.516) trimester. However, an increased risk of LGA was observed among IMH women in the second trimester (OR: 2.088, 95% CI: 1.193-3.654). Maternal TPO-Ab positivity in the second trimester increased the risk of SGA (OR: 2.094, 95% CI: 1.333-3.290). CONCLUSION This study provides evidence that IMH is associated with LGA. FUNDING This work was supported by the National Natural Science Foundation of China (No. 81330068). TWEETABLE ABSTRACT Isolated maternal hypothyroxinaemia may increase the risk of large-for-gestational-age infants.
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Affiliation(s)
- Y-D Zhu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Y Han
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - K Huang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China.,Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, China
| | - B-B Zhu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China.,Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, China
| | - S-Q Yan
- Ma'anshan Maternal and Child Health (MCH) Clinic, Ma'anshan, China
| | - X Ge
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - S-S Zhou
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Y-Y Xu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China.,Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, China
| | - L-I Ren
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, China
| | - J Sheng
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, China
| | - W-J Pan
- Ma'anshan Maternal and Child Health (MCH) Clinic, Ma'anshan, China
| | - J-H Hao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China.,Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, China
| | - P Zhu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China.,Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, China
| | - F-B Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China.,Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, China
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110
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Hypothyroidism during pregnancy and its association to perinatal and obstetric morbidity: a review. ENDOCRINOLOGÍA, DIABETES Y NUTRICIÓN (ENGLISH ED.) 2018. [DOI: 10.1016/j.endien.2017.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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111
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Miranda A, Sousa N. Maternal hormonal milieu influence on fetal brain development. Brain Behav 2018; 8:e00920. [PMID: 29484271 PMCID: PMC5822586 DOI: 10.1002/brb3.920] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 11/15/2017] [Accepted: 12/06/2017] [Indexed: 12/23/2022] Open
Abstract
An adverse maternal hormonal environment during pregnancy can be associated with abnormal brain growth. Subtle changes in fetal brain development have been observed even for maternal hormone levels within the currently accepted physiologic ranges. In this review, we provide an update of the research data on maternal hormonal impact on fetal neurodevelopment, giving particular emphasis to thyroid hormones and glucocorticoids. Thyroid hormones are required for normal brain development. Despite serum TSH appearing to be the most accurate indicator of thyroid function in pregnancy, maternal serum free T4 levels in the first trimester of pregnancy are the major determinant of postnatal psychomotor development. Even a transient period of maternal hypothyroxinemia at the beginning of neurogenesis can confer a higher risk of expressive language and nonverbal cognitive delays in offspring. Nevertheless, most recent clinical guidelines advocate for targeted high-risk case finding during first trimester of pregnancy despite universal thyroid function screening. Corticosteroids are determinant in suppressing cell proliferation and stimulating terminal differentiation, a fundamental switch for the maturation of fetal organs. Not surprisingly, intrauterine exposure to stress or high levels of glucocorticoids, endogenous or synthetic, has a molecular and structural impact on brain development and appears to impair cognition and increase anxiety and reactivity to stress. Limbic regions, such as hippocampus and amygdala, are particularly sensitive. Repeated doses of prenatal corticosteroids seem to have short-term benefits of less respiratory distress and fewer serious health problems in offspring. Nevertheless, neurodevelopmental growth in later childhood and adulthood needs further clarification. Future studies should address the relevance of monitoring the level of thyroid hormones and corticosteroids during pregnancy in the risk stratification for impaired postnatal neurodevelopment.
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Affiliation(s)
- Alexandra Miranda
- Life and Health Sciences Research Institute (ICVS)School of MedicineUniversity of MinhoBragaPortugal
- ICVS/3B's ‐ PT Government Associate LaboratoryBraga/GuimarãesPortugal
- Department of Obstetrics and GynecologyHospital de BragaBragaPortugal
| | - Nuno Sousa
- Life and Health Sciences Research Institute (ICVS)School of MedicineUniversity of MinhoBragaPortugal
- ICVS/3B's ‐ PT Government Associate LaboratoryBraga/GuimarãesPortugal
- Clinic Academic Center ‐ 2CABragaPortugal
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112
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Krause M, Frederiksen H, Sundberg K, Jørgensen FS, Jensen LN, Nørgaard P, Jørgensen C, Ertberg P, Petersen JH, Feldt-Rasmussen U, Juul A, Drzewiecki KT, Skakkebaek NE, Andersson AM. Maternal exposure to UV filters: associations with maternal thyroid hormones, IGF-I/IGFBP3 and birth outcomes. Endocr Connect 2018; 7:334-346. [PMID: 29362228 PMCID: PMC5820990 DOI: 10.1530/ec-17-0375] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 01/23/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Several chemical UV filters/absorbers ('UV filters' hereafter) have endocrine-disrupting properties in vitro and in vivo. Exposure to these chemicals, especially during prenatal development, is of concern. OBJECTIVES To examine maternal exposure to UV filters, associations with maternal thyroid hormone, with growth factor concentrations as well as to birth outcomes. METHODS Prospective study of 183 pregnant women with 2nd trimester serum and urine samples available. Maternal concentrations of the chemical UV filters benzophenone-1 (BP-1) and benzophenone-3 (BP-3) in urine and 4-hydroxy-benzophenone (4-HBP) in serum were measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS). The relationships between 2nd trimester maternal concentrations of the three chemical UV filters and maternal serum concentrations of thyroid hormones and growth factors, as well as birth outcomes (weight, height, and head and abdominal circumferences) were examined. RESULTS Positive associations between maternal serum concentrations of 4-HBP and triiodothyronine (T3), thyroxine (T4), insulin-like growth factor I (IGF-I) and its binding protein IGFBP3 were observed in mothers carrying male fetuses. Male infants of mothers in the middle 4-HBP exposure group had statistically significantly lower weight and shorter head and abdominal circumferences at birth compared to the low exposure group. CONCLUSIONS Widespread exposure of pregnant women to chemical UV filters and the possible impact on maternal thyroid hormones and growth factors, and on fetal growth, calls for further studies on possible long-term consequences of the exposure to UV filters on fetal development and children's health.
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Affiliation(s)
- M Krause
- Department of Growth and Reproduction & International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC)Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - H Frederiksen
- Department of Growth and Reproduction & International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC)Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - K Sundberg
- Center of Fetal Medicine and PregnancyDepartment of Obstetrics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - F S Jørgensen
- Fetal Medicine UnitDepartment of Obstetrics and Gynecology, Copenhagen University Hospital, Hvidovre, Denmark
| | - L N Jensen
- Center of Fetal Medicine and PregnancyDepartment of Obstetrics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - P Nørgaard
- Fetal Medicine UnitDepartment of Obstetrics and Gynecology, Copenhagen University Hospital, Hvidovre, Denmark
| | - C Jørgensen
- Center of Fetal Medicine and PregnancyDepartment of Obstetrics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - P Ertberg
- Fetal Medicine UnitDepartment of Obstetrics and Gynecology, Copenhagen University Hospital, Hvidovre, Denmark
| | - J H Petersen
- Department of Growth and Reproduction & International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC)Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Section of BiostatisticsFaculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - U Feldt-Rasmussen
- Department of EndocrinologyRigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - A Juul
- Department of Growth and Reproduction & International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC)Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - K T Drzewiecki
- Department of Plastic SurgeryBreast Surgery and Burns Treatment, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - N E Skakkebaek
- Department of Growth and Reproduction & International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC)Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - A M Andersson
- Department of Growth and Reproduction & International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC)Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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113
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Richard S, Flamant F. Regulation of T3 Availability in the Developing Brain: The Mouse Genetics Contribution. Front Endocrinol (Lausanne) 2018; 9:265. [PMID: 29892264 PMCID: PMC5985302 DOI: 10.3389/fendo.2018.00265] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 05/07/2018] [Indexed: 12/11/2022] Open
Abstract
Alterations in maternal thyroid physiology may have deleterious consequences on the development of the fetal brain, but the underlying mechanisms remain elusive, hampering the development of appropriate therapeutic strategies. The present review sums up the contribution of genetically modified mouse models to this field. In particular, knocking out genes involved in thyroid hormone (TH) deiodination, transport, and storage has significantly improved the picture that we have of the economy of TH in the fetal brain and the underlying genetic program. These data pave the way for future studies to bridge the gap in knowledge between thyroid physiology and brain development.
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114
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Päkkilä F, Männistö T, Hartikainen AL, Suvanto E. Maternal Thyroid Function During Pregnancy and the Child's Linguistic and Sensory Development in the Northern Finland Birth Cohort 1986. Front Endocrinol (Lausanne) 2018; 9:127. [PMID: 29632517 PMCID: PMC5879546 DOI: 10.3389/fendo.2018.00127] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 03/13/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Maternal hypothyroidism and hypothyroxinemia are associated with poor neuropsychological development in children. Previous research is lacking on whether maternal thyroid dysfunction affects sensory and linguistic development in childhood. METHODS The Northern Finland Birth Cohort 1986 included all births within a year (9,362 women, 9,479 children) from the two northernmost Finnish provinces. Maternal serum samples (n = 5,791) were obtained in early pregnancy and analyzed for TSH, free T4, and thyroid peroxidase antibodies (TPO-Abs). Five thousand three hundred and ninety-one parents evaluated their child's sensory and linguistic development at 7 years old via a questionnaire (excluding children with an intelligence quotient ≤85). The prevalence of sensory and linguistic impairments was compared between mothers with and without thyroid dysfunction. RESULTS There were no statistically significant differences in the prevalence of sensory or linguistic impairment between children of mothers with and without thyroid dysfunction. Children of hypothyroid and hypothyroxinemic mothers had an increased prevalence of vision impairment compared with those of euthyroid mothers (10.8 and 11.7%, respectively, versus 6.5%), but the difference was not significant. All results remained similar after excluding TPO-Ab-positive mothers and premature children. CONCLUSION We did not find an association between maternal thyroid dysfunction during pregnancy and sensory and linguistic development impairment in childhood. A somewhat higher prevalence of vision impairment was seen in children of hypothyroid and hypothyroxinemic mothers, which merits further research.
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Affiliation(s)
- Fanni Päkkilä
- Department of Obstetrics and Gynecology, University of Oulu, Oulu, Finland
- Clinic of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland
- Institute of Health Sciences, University of Oulu, Oulu, Finland
- Department of Children, Young People, and Families, National Institute for Health and Welfare, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
- *Correspondence: Fanni Päkkilä,
| | - Tuija Männistö
- Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Oulu, Finland
- Northern Finland Laboratory Center Nordlab, Oulu University Hospital, University of Oulu, Oulu, Finland
- Department of Clinical Chemistry, University of Oulu, Oulu, Finland
| | - Anna-Liisa Hartikainen
- Department of Obstetrics and Gynecology, University of Oulu, Oulu, Finland
- Clinic of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Eila Suvanto
- Department of Obstetrics and Gynecology, University of Oulu, Oulu, Finland
- Clinic of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
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115
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Mughal BB, Demeneix BA, Fini JB. Evaluating Thyroid Disrupting Chemicals In Vivo Using Xenopus laevis. Methods Mol Biol 2018; 1801:183-192. [PMID: 29892825 DOI: 10.1007/978-1-4939-7902-8_15] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Using in vivo animal model systems for chemical screening can permit evaluation of the signaling pathways implicated. Xenopus laevis is an ideal model organism to test thyroid axis disruption as thyroid hormones are highly conserved across vertebrates. Here, we describe a high-throughput assay using non-feeding embryonic stage transgenic X. laevis (TH/bZip) to screen for thyroid disrupting chemicals using a 3 day exposure protocol. We further describe a protocol to detect endocrine disruption of thyroid axis by the analysis of gene expression using wild-type X. laevis.
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Affiliation(s)
- Bilal B Mughal
- Evolution des Régulations Endocriniennes, Département "Adaptation du Vivant", UMR 7221 Muséum National d'Histoire Naturelle /CNRS, 7 rue Cuvier, Paris, 75005, France
| | - Barbara A Demeneix
- Evolution des Régulations Endocriniennes, Département "Adaptation du Vivant", UMR 7221 Muséum National d'Histoire Naturelle /CNRS, 7 rue Cuvier, Paris, 75005, France.
| | - Jean-Baptiste Fini
- Evolution des Régulations Endocriniennes, Département "Adaptation du Vivant", UMR 7221 Muséum National d'Histoire Naturelle /CNRS, 7 rue Cuvier, Paris, 75005, France
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116
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Donald KA, Wedderburn CJ, Barnett W, Hoffman N, Zar HJ, Redei EE, Stein DJ. Thyroid Function in Pregnant Women With Moderate to Severe Alcohol Consumption Is Related to Infant Developmental Outcomes. Front Endocrinol (Lausanne) 2018; 9:294. [PMID: 29951034 PMCID: PMC6008549 DOI: 10.3389/fendo.2018.00294] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 05/17/2018] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Fetal alcohol spectrum disorders (FASD) have an estimated global prevalence of 2-5% of births, but prevalence is reported to be as high as 15.5% for FASD in certain high-risk communities in South Africa. Preclinical studies demonstrate that alcohol consumption during pregnancy interferes with thyroid hormone availability and function and negatively impacts exposed offspring. Very little is currently reported on this phenomenon in humans. METHODS This pilot study was embedded in the Drakenstein Child Health Study, a multi-disciplinary longitudinal birth cohort study investigating the early biological and psychosocial determinants of child health in South Africa. Twenty one mothers and their children with moderate-severe prenatal alcohol exposure (PAE) and 19 mothers and their children with no alcohol exposure were investigated. Maternal exposure history and blood samples were collected in mid-pregnancy and analyzed for serum-free thyroxin (FT4), free triiodothyronine (FT3), and thyroid stimulating hormone (TSH). Children were assessed with formally measured growth parameters and development was evaluated using the Bayley III Scales of Infant and Toddler Development (BSID III) at 6 and 24 months of age. RESULTS While there were no significant differences in serum TSH and FT4 between groups, FT3 levels were significantly higher in mothers with moderate-severe prenatal alcohol use. In abstinent pregnant women, levels of FT4 were significantly correlated with infants' scores on cognitive measures at 6 and 24 months of age and with levels of gross motor skills at 24 months. However, in mothers with alcohol use, FT4 levels were not correlated with any cognitive or motor skills, but FT3 levels were significantly associated with scores on children's social-emotional development at 24 months of age. DISCUSSION Thyroid function in PAE is sufficiently disrupted to lead to alterations in serum FT3 levels. The contrast in findings between PAE and abstinent dyads in their association of maternal thyroid function and infant development further suggests that such disruption is present and may contribute to adverse neurodevelopment. Further work is needed to determine the relationship between peripheral thyroid indices during pregnancy and neurodevelopmental outcomes in the context of PAE.
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Affiliation(s)
- Kirsten A. Donald
- Division of Developmental Paediatrics, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa
- *Correspondence: Kirsten A. Donald,
| | - Catherine J. Wedderburn
- Division of Developmental Paediatrics, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Whitney Barnett
- Unit on Child and Adolescent Health, South African Medical Research Council (SAMRC), Cape Town, South Africa
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa
| | - Nadia Hoffman
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Heather J. Zar
- Unit on Child and Adolescent Health, South African Medical Research Council (SAMRC), Cape Town, South Africa
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa
| | - Eva E. Redei
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Dan J. Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Unit on Risk and Resilience in Mental Disorders, South African Medical Research Council (SAMRC), Cape Town, South Africa
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117
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Aakre I, Strand TA, Moubarek K, Barikmo I, Henjum S. Associations between thyroid dysfunction and developmental status in children with excessive iodine status. PLoS One 2017; 12:e0187241. [PMID: 29166388 PMCID: PMC5699829 DOI: 10.1371/journal.pone.0187241] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Accepted: 10/08/2017] [Indexed: 01/01/2023] Open
Abstract
Background and objective Adequate iodine status and normal thyroid hormone synthesis are important for optimal child development. In this study, we explored whether young children’s developmental status is associated with thyroid dysfunction in an area of chronic excessive iodine exposure. Methods We included 298 children between 18 and 48 months of age residing in Algerian refugee camps. Early child development was measured using the Ages and Stages Questionnaires, third edition (ASQ-3), consisting of five domains: Communication, Gross Motor, Fine Motor, Problem Solving and Personal-Social. Due to poor discriminatory ability in the Gross Motor domain, the total ASQ-3 scores were calculated both including and excluding this domain. Urinary iodine concentration (UIC), thyroid hormones (TSH, FT3 and FT4), thyroid antibodies and serum thyroglobulin (Tg) were measured. Results The median UIC was 451.6 μg/L, and approximately 72% of the children had a UIC above 300 μg/L. Furthermore, 14% had thyroid disturbances, of whom 10% had TSH outside the reference range. Children with thyroid disturbances and TSH outside the reference ranges had lower odds of being among the 66% highest total ASQ scores, with adjusted odds ratios (95% CI) of 0.46 (0.23, 0.93) and 0.42 (0.19, 0.94), respectively. Conclusion We found an association between thyroid dysfunction and poorer developmental status among children with excessive iodine intake. The high iodine intake may have caused the thyroid dysfunction and hence the delayed developmental status; however, other influential factors cannot be excluded. Optimal child development is important for a sustainable future. With iodine excess being an increasing problem globally, this subject should be further explored.
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Affiliation(s)
- Inger Aakre
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College, Oslo, Norway
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
- * E-mail:
| | - Tor A. Strand
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
- Research Department, Innlandet Hospital Trust, Lillehammer, Norway
| | | | - Ingrid Barikmo
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College, Oslo, Norway
| | - Sigrun Henjum
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College, Oslo, Norway
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118
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Kocevska D, Rijlaarsdam J, Ghassabian A, Jaddoe VW, Franco OH, Verhulst FC, Tiemeier H. Early Childhood Sleep Patterns and Cognitive Development at Age 6 Years: The Generation R Study. J Pediatr Psychol 2017; 42:260-268. [PMID: 26803843 DOI: 10.1093/jpepsy/jsv168] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 12/10/2015] [Indexed: 12/30/2022] Open
Abstract
Objective To explore the association of sleep duration and awakening frequency with cognitive outcomes in young children. Methods Mothers of 2,800 children from the Generation R cohort reported sleep duration and awakenings at children's age 24 months. At age 6 years, validated Dutch measures were used to assess children's nonverbal intelligence and language comprehension. Results We found a nonlinear association of total sleep time at 24 months with nonverbal intelligence ( p = 0.03) and language comprehension ( p = 0.04) at 6 years. Toddlers sleeping within the recommended 11-14 hr had more favorable cognitive development compared with both extremes. Frequent awakenings were negatively associated with nonverbal intelligence, but not with verbal comprehension. Conclusion Sleep duration in toddlerhood has an inverted-U-shaped relation with childhood cognitive measures. Frequent awakenings are associated with lower nonverbal intelligence. Given the marked decline in sleep duration and awakenings in toddlerhood, developmental changes of sleep patterns might be important for cognitive development.
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Affiliation(s)
- Desana Kocevska
- Generation R Study Group, Erasmus University Medical Center, Rotterdam, Netherlands.,Department of Child and Adolescent Psychiatry, Erasmus Medical Center, Rotterdam, Netherlands
| | - Jolien Rijlaarsdam
- Generation R Study Group, Erasmus University Medical Center, Rotterdam, Netherlands.,Department of Child and Adolescent Psychiatry, Erasmus Medical Center, Rotterdam, Netherlands
| | - Akhgar Ghassabian
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center, Rotterdam, Netherlands
| | - Vincent W Jaddoe
- Generation R Study Group, Erasmus University Medical Center, Rotterdam, Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands,Department of Pediatrics, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Oscar H Franco
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Frank C Verhulst
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center, Rotterdam, Netherlands
| | - Henning Tiemeier
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands,Department of Child and Adolescent Psychiatry, Erasmus Medical Center, Rotterdam, Netherlands.,Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
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119
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Fetene DM, Betts KS, Alati R. MECHANISMS IN ENDOCRINOLOGY: Maternal thyroid dysfunction during pregnancy and behavioural and psychiatric disorders of children: a systematic review. Eur J Endocrinol 2017; 177:R261-R273. [PMID: 28982961 DOI: 10.1530/eje-16-0860] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 05/09/2017] [Accepted: 07/04/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND Maternal thyroid dysfunction during pregnancy may lead to persistent neurodevelopmental disorders in the offspring appearing in later life. This study aimed to review the available evidence concerning the relationship between maternal thyroid status during pregnancy and offspring behavioural and psychiatric disorders. METHODS Systematic electronic database searches were conducted using PubMed, Embase, PsycNET, Scopus, Google Scholar and Cochrane library. Studies including gestational thyroid dysfunction as the exposure and offspring behavioural and psychiatric disorders as the outcome were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed and, after thorough screening by two independent reviewers, 13 articles remained eligible for inclusion in this study. RESULTS Indicators of maternal thyroid dysfunction, including low and high thyroid hormone level and autoimmune thyroiditis, during early pregnancy, were found to be associated with several offspring behavioural and psychiatric disorders such as attention deficit hyperactivity disorder (ADHD), autism, pervasive developmental problems, externalising behaviour, in addition to epilepsy and seizure. The majority of associations were found with low maternal thyroid hormone level. CONCLUSION Maternal thyroid function during pregnancy, particularly hypothyroidism, is associated with behavioural and psychiatric disorders in children. Further studies are needed with a capacity to adjust for a fuller range of confounding factors.
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Affiliation(s)
- Dagnachew Muluye Fetene
- School of Public Health, University of Queensland, Brisbane, Australia
- College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kim S Betts
- Institute for Social Science Research, University of Queensland, Brisbane, Australia
| | - Rosa Alati
- Institute for Social Science Research, University of Queensland, Brisbane, Australia
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120
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Korevaar TIM, Medici M, Visser TJ, Peeters RP. Thyroid disease in pregnancy: new insights in diagnosis and clinical management. Nat Rev Endocrinol 2017; 13:610-622. [PMID: 28776582 DOI: 10.1038/nrendo.2017.93] [Citation(s) in RCA: 209] [Impact Index Per Article: 29.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Adequate thyroid hormone availability is important for an uncomplicated pregnancy and optimal fetal growth and development. Overt thyroid disease is associated with a wide range of adverse obstetric and child development outcomes. An increasing number of studies now indicate that milder forms of thyroid dysfunction are also associated with these adverse pregnancy outcomes. The definitions of both overt and subclinical thyroid dysfunction have changed considerably over the past few years, as new data indicate that the commonly used fixed upper limits of 2.5 mU/l or 3.0 mU/l for thyroid-stimulating hormone (TSH) are too low to define an abnormal thyroid function. Furthermore, some studies now show that the reference ranges are not necessarily the best cut-off for identifying pregnancies at high risk of adverse outcomes. In addition, data suggest that thyroid peroxidase autoantibody positivity and high or low concentrations of human chorionic gonadotropin seem to have a more prominent role in the interpretation of thyroid dysfunction than previously thought. Data on the effects of thyroid disease treatment are lacking, but some studies indicate that clinicians should be aware of the potential for overtreatment with levothyroxine. Here, we put studies from the past decade on reference ranges for TSH, determinants of thyroid dysfunction, risks of adverse outcomes and options for treatment into perspective. In addition, we provide an overview of the current views on thyroid physiology during pregnancy and discuss strategies to identify high-risk individuals who might benefit from levothyroxine treatment.
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Affiliation(s)
- Tim I M Korevaar
- Department of Internal Medicine, Erasmus Medical Center, Postbus 2040, 3000 CA, Rotterdam, The Netherlands
- Academic Center for Thyroid Diseases, Erasmus Medical Center, Postbus 2040, 3000 CA, Rotterdam, The Netherlands
| | - Marco Medici
- Department of Internal Medicine, Erasmus Medical Center, Postbus 2040, 3000 CA, Rotterdam, The Netherlands
- Academic Center for Thyroid Diseases, Erasmus Medical Center, Postbus 2040, 3000 CA, Rotterdam, The Netherlands
| | - Theo J Visser
- Department of Internal Medicine, Erasmus Medical Center, Postbus 2040, 3000 CA, Rotterdam, The Netherlands
- Academic Center for Thyroid Diseases, Erasmus Medical Center, Postbus 2040, 3000 CA, Rotterdam, The Netherlands
| | - Robin P Peeters
- Department of Internal Medicine, Erasmus Medical Center, Postbus 2040, 3000 CA, Rotterdam, The Netherlands
- Academic Center for Thyroid Diseases, Erasmus Medical Center, Postbus 2040, 3000 CA, Rotterdam, The Netherlands
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121
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Neelaveni K, Kumar KVSH, Sahay R, Ramesh J. Postpartum Follow-up in Women Diagnosed with Subclinical Hypothyroidism during Pregnancy. Indian J Endocrinol Metab 2017; 21:699-702. [PMID: 28989877 PMCID: PMC5628539 DOI: 10.4103/ijem.ijem_452_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Management guidelines about the thyroid disease in pregnancy are silent about the postpartum course of new onset subclinical hypothyroidism (SCH). Hence, we analyzed the 2 years outcome of SCH diagnosed during pregnancy. MATERIALS AND METHODS We conducted this retrospective study using the medical records of patients with new onset SCH during pregnancy between 2010 and 2013 (n = 718). Patients who stopped their levothyroxine after delivery with a 2-year follow-up record were included. We excluded patients with known thyroid disorders and continuous use of drugs that affect the thyroid results. The patients were divided into two groups (Group 1 - euthyroid and Group 2 - hypothyroid) based on the final outcome after 2 years. The data were analyzed using appropriate statistical methods and a P < 0.05 was considered statically significant. RESULTS A total of 559 (77.8%) women stopped levothyroxine after delivery, and the final follow-up data were available for 467 patients only. At the end of 2 years, 384 (82.2%) remained euthyroid, and the remaining 83 (17.8%) developed hypothyroidism. SCH and overt hypothyroidism were seen in 22 and 61 patients, respectively. Group 2 patients had higher mean age (25.5 vs. 23.6 years), goiter (51 vs. 2%), initial thyroid stimulating hormone (7.9 vs. 5.1 μIU/mL), and thyroid antibody positivity (76 vs. 13%) (P < 0.001). CONCLUSION The majority of patients with SCH during pregnancy remain euthyroid after delivery. Advanced age, goiter, positive family history, and thyroid autoimmunity increase the future risk of hypothyroidism in patients with SCH diagnosed during pregnancy.
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Affiliation(s)
- K. Neelaveni
- Department of Endocrinology, Osmania Medical College, Hyderabad, Telangana, India
| | | | - Rakesh Sahay
- Department of Endocrinology, Osmania Medical College, Hyderabad, Telangana, India
| | - Jayanthy Ramesh
- Department of Endocrinology, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India
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122
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Endendijk JJ, Wijnen HAA, Pop VJM, van Baar AL. Maternal thyroid hormone trajectories during pregnancy and child behavioral problems. Horm Behav 2017; 94:84-92. [PMID: 28668344 DOI: 10.1016/j.yhbeh.2017.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 06/15/2017] [Accepted: 06/25/2017] [Indexed: 12/11/2022]
Abstract
There is ample evidence demonstrating the importance of maternal thyroid hormones, assessed at single trimesters in pregnancy, for child cognition. Less is known, however, about the course of maternal thyroid hormone concentrations during pregnancy in relation to child behavioral development. Child sex might be an important moderator, because there are sex differences in externalizing and internalizing behavioral problems. The current study examined the associations between maternal thyroid hormone trajectories versus thyroid assessments at separate trimesters of pregnancy and child behavioral problems, as well as sex differences in these associations. In 442 pregnant mothers, serum levels of TSH and free T4 (fT4) were measured at 12, 24, and 36weeks gestation. Both mothers and fathers reported on their children's behavioral problems, between 23 and 60months of age. Latent growth mixture modeling was used to determine the number of different thyroid hormone trajectories. Three trajectory groups were discerned: 1) highest and non-increasing TSH with lowest fT4 that decreased least of the three trajectories; 2) increasing TSH and decreasing fT4 at intermediate levels; 3) lowest and increasing TSH with highest and decreasing fT4. Children of mothers with the most flattened thyroid hormone trajectories (trajectory 1) showed the most anxiety/depression symptoms. The following trimester-specific associations were found: 1) lower first-trimester fT4 was associated with more child anxiety/depression, 2) higher first-trimester TSH levels were related to more attention problems in boys only. A flattened course of maternal thyroid hormone concentrations during pregnancy was a better predictor of child anxiety/depression than first-trimester fT4 levels.
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Affiliation(s)
- Joyce J Endendijk
- Child and Adolescent Studies, Utrecht University, P.O. Box 80140, 3508 TC Utrecht, The Netherlands.
| | - Hennie A A Wijnen
- Department Midwifery Sciences, AVM, University of Midwifery Education & Studies Maastricht, Universiteitssingel 60, 6229 ER Maastricht, The Netherlands
| | - Victor J M Pop
- Department of Medical Health Psychology, Tilburg University, P.O. Box 90153, 5000 LE Tilburg, The Netherlands
| | - Anneloes L van Baar
- Child and Adolescent Studies, Utrecht University, P.O. Box 80140, 3508 TC Utrecht, The Netherlands
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123
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Torres MT, Francés L, Vila L, Manresa JM, Falguera G, Prieto G, Casamitjana R, Toran P. Iodine nutritional status of women in their first trimester of pregnancy in Catalonia. BMC Pregnancy Childbirth 2017; 17:249. [PMID: 28747228 PMCID: PMC5530553 DOI: 10.1186/s12884-017-1423-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 07/18/2017] [Indexed: 01/28/2023] Open
Abstract
Background Sufficient iodine intake is needed during pregnancy to ensure proper fetal development. The iodine levels of women in their first trimester of pregnancy in Catalonia are currently unknown. This data would help to determine whether our public health services should establish recommendations or interventions in this line. The aim of this study was to investigate the iodine nutritional status, prevalence of urinary iodine <150 μg/L, and tobacco use in the first trimester of pregnancy in our setting. Methods Cross-sectional study. Data were collected during 2008–2009 from women in their first trimester at the primary care centers of the province of Barcelona (Spain). Pregnant women included in the study completed a questionnaire on eating habits and underwent urinary iodine concentration (UIC) assessment. Results Nine hundred forty five women completed the dietary questionnaire and urinary iodine testing. Median UIC was 172 μg/L, with 407 participants (43.1%) showing levels <150 μg/L. On multivariate logistic regression analysis, intake of 1–2 glasses of milk per day, OR = 0.636 95% CI (0.45–0.90) or >2 glasses, OR = 0.593 95% CI (0.37–0.95); iodized salt consumption, OR = 0.678 95% CI (0.51–0. 90); and use of iodine supplementation, OR = 0.410 95% CI (0.31–0.54), protected against the risk of UIC <150 μg/L. Simultaneous consumption of iodized salt and milk (≥1 glass/day) showed a larger protective effect: OR = 0.427, 95% CI (0.31–0.54). Conclusion The median UIC of the pregnant women surveyed indicated an acceptable iodine nutritional status according to the criteria established by the WHO and ICCIDD. The risk of urinary iodine <150 μg/L decreased with simultaneous consumption of milk and iodized salt, similar to the decrease seen with iodine supplementation. Electronic supplementary material The online version of this article (doi:10.1186/s12884-017-1423-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maria Teresa Torres
- Atenció a la Salut Sexual i Reproductiva (ASSIR), CAP Antoni Creus i Querol, Institut Català de la Salut, Terrassa, Barcelona, Spain. .,Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Sabadell, Barcelona, Spain. .,GRASSIR research group, IDIAP Jordi Gol, Generalitat de Catalunya, Barcelona, Spain. .,Departament d'Infermeria, Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain.
| | - Lidia Francés
- Departament d'Infermeria, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Lluis Vila
- Servicio de Endocrinología y Nutrición, Hospital de Sant Joan Despí 'Moisès Broggi', Sant Joan Despí, Barcelona, Spain
| | - Josep María Manresa
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Sabadell, Barcelona, Spain.,GRASSIR research group, IDIAP Jordi Gol, Generalitat de Catalunya, Barcelona, Spain.,Departament d'Infermeria, Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
| | - Gemma Falguera
- GRASSIR research group, IDIAP Jordi Gol, Generalitat de Catalunya, Barcelona, Spain.,Atenció a la Salut Sexual i Reproductiva (ASSIR) Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Sabadell, Barcelona, Spain
| | | | - Roser Casamitjana
- Centro de Diagnóstico Biomédico - Bioquímica y Genética Molecular, Hospital Clínic, Barcelona, Spain
| | - Pere Toran
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Sabadell, Barcelona, Spain
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124
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Noda M. Thyroid Hormone in the CNS: Contribution of Neuron-Glia Interaction. VITAMINS AND HORMONES 2017; 106:313-331. [PMID: 29407440 DOI: 10.1016/bs.vh.2017.05.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The endocrine system and the central nervous system (CNS) are intimately linked. Among hormones closely related to the nervous system, thyroid hormones (THs) are critical for the regulation of development and differentiation of neurons and neuroglia and hence for development and function of the CNS. T3 (3,3',5-triiodothyronine), an active form of TH, is important not only for neuronal development but also for differentiation of astrocytes and oligodendrocytes, and for microglial development. In adult brain, T3 affects glial morphology with sex- and age-dependent manner and therefore may affect their function, leading to influence on neuron-glia interaction. T3 is an important signaling factor that affects microglial functions such as migration and phagocytosis via complex mechanisms. Therefore, dysfunction of THs may impair glial function as well as neuronal function and thus disturb the brain, which may cause mental disorders. Investigations on molecular and cellular basis of hyperthyroidism and hypothyroidism will help us to understand changes in neuron-glia interaction and therefore consequent psychiatric symptoms.
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Affiliation(s)
- Mami Noda
- Laboratory of Pathophysiology, Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan.
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125
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Oostenbroek MHW, Kersten RHJ, Tros B, Kunst AE, Vrijkotte TGM, Finken MJJ. Maternal hypothyroxinaemia in early pregnancy and problem behavior in 5-year-old offspring. Psychoneuroendocrinology 2017; 81:29-35. [PMID: 28411411 DOI: 10.1016/j.psyneuen.2017.03.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 03/04/2017] [Accepted: 03/22/2017] [Indexed: 12/25/2022]
Abstract
INTRODUCTION There is evidence, though not consistent, that offspring born to mothers with subtle decreases in thyroid function early in their pregnancies may be at risk of cognitive impairments and attention problems. However, other types of problem behavior have not been addressed thus far. We tested whether maternal thyroid function in early pregnancy is associated with several types of problem behavior in offspring at age 5-6 years. METHODS This was a longitudinal study that included the data of 2000 mother-child pairs from the Amsterdam Born Children and their Development study. At a median gestational age of 12.9 (interquartile range: 11.9-14.1) weeks, maternal blood was sampled for assessment of free T4 and TSH. Overall problem behavior, hyperactivity/inattention, conduct problems, emotional problems, peer relationship problems and prosocial behavior were measured at age 5-6 years using the Strengths and Difficulties Questionnaire, which was filled out by both parents and teachers. RESULTS Maternal hypothyroxinaemia <5th percentile was associated with a 1.70 (95% confidence interval (CI): 1.01-2.86) increased odds of teacher-reported hyperactivity/inattention after adjustment for confounders. By increasing the cut-off level to <10th percentile, the odds ratio became 1.47 (95% CI: 0.99-2.20). There were no associations between maternal thyroid function parameters and hyperactivity/inattention as reported by parents, nor with teacher or parent reports of other types of problem behavior. CONCLUSIONS Our results partially confirm previous observations, showing that early disruptions in the maternal thyroid hormone supply may be associated with ADHD symptoms in offspring. Our study adds that there is no evidence for an effect on other types of problem behavior.
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Affiliation(s)
- Maurits H W Oostenbroek
- Department of Public Health, Academic Medical Centre, University of Amsterdam, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands.
| | - Remco H J Kersten
- Department of Public Health, Academic Medical Centre, University of Amsterdam, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands.
| | - Benjamin Tros
- Department of Public Health, Academic Medical Centre, University of Amsterdam, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands.
| | - Anton E Kunst
- Department of Public Health, Academic Medical Centre, University of Amsterdam, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands.
| | - Tanja G M Vrijkotte
- Department of Public Health, Academic Medical Centre, University of Amsterdam, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands.
| | - Martijn J J Finken
- Department of Pediatric Endocrinology, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
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Chen S, Zhou X, Zhu H, Yang H, Gong F, Wang L, Zhang M, Jiang Y, Yan C, Li J, Wang Q, Zhang S, Pan H. Preconception TSH and pregnancy outcomes: a population-based cohort study in 184 611 women. Clin Endocrinol (Oxf) 2017; 86:816-824. [PMID: 28295470 DOI: 10.1111/cen.13329] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 03/06/2017] [Accepted: 03/09/2017] [Indexed: 01/29/2023]
Abstract
BACKGROUND Whether subclinical hypothyroidism adversely impacts pregnancy outcomes is inconclusive, and limited data are available on the optimal TSH range in women planning pregnancy. OBJECTIVE To investigate the association between maternal preconception TSH levels and pregnancy outcomes. DESIGN Population-based cohort study. METHODS From 2010 to 2012, the free National Pre-pregnancy Checkups Project recruited 248 501 pairs of volunteer couples across China, of which 184 611 women, who subsequently became pregnant, were studied. Maternal TSH was measured within 6 months prior to conception. Participants were grouped according to TSH: 0·48-2·49 mIU/l (n = 133 232, 72%), 2·50-4·28 mIU/l (n = 44 239, 24%) and 4·29-10·0 mIU/l (n = 7140, 4%). Multivariable logistic regression models were used to study the association between TSH and pregnancy outcomes. MAIN OUTCOMES Pregnancy loss, gestational age (GA), delivery modes and birthweight. RESULTS The overall incidence of adverse pregnancy outcomes was 28·6%. Compared with TSH 0·48-2·50 mIU/l, TSH 2·50-4·29 mIU/l was associated with spontaneous abortion [aOR: 1·10, 95% confidence interval (CI): 1·03-1·18], preterm birth (aOR: 1·09, 95% CI: 1·04-1·15) and operative vaginal delivery (aOR: 1·15, 95% CI: 1·09-1·21), while TSH 4·29-10 mIU/l was correlated with spontaneous abortion (aOR: 1·15, 95% CI: 1·10-1·22), stillbirth (aOR: 1·58, 95% CI: 1·10-2·28), preterm birth (aOR: 1·20, 95% CI: 1·08-1·34), caesarean section (aOR: 1·15, 95% CI: 1·10-1·22) and large for gestational age (LGA) infants (aOR: 1·12, 95% CI: 1·04-1·21). CONCLUSION Preconception TSH elevation was associated with increased risk of adverse pregnancy outcomes, even within the normal nonpregnant range.
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Affiliation(s)
- Shi Chen
- Department of Endocrinology, Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiang Zhou
- Department of Endocrinology, Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Huijuan Zhu
- Department of Endocrinology, Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Hongbo Yang
- Department of Endocrinology, Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Fengying Gong
- Department of Endocrinology, Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Linjie Wang
- Department of Endocrinology, Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Man Zhang
- Department of Clinical Laboratory, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Yu Jiang
- School of Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Chengsheng Yan
- Department of pediatric health care, Hebei Center for Women and Children's Health, Shijiazhuang, China
| | - Jianqiang Li
- School of Software Engineering, University of Science and Technology Beijing, Beijing, China
| | - Qing Wang
- Tsinghua National Laboratory for Information Science and Technology, Tsinghua University, Beijing, China
| | - Shikun Zhang
- Research Association for Women and Children's Health, Secretariat, Beijing, China
| | - Hui Pan
- Department of Endocrinology, Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Furnica RM, Gruson D, Lazarus JH, Maiter D, Bernard P, Daumerie C. First trimester isolated maternal hypothyroxinaemia: adverse maternal metabolic profile and impact on the obstetrical outcome. Clin Endocrinol (Oxf) 2017; 86:576-583. [PMID: 28039875 DOI: 10.1111/cen.13301] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 11/10/2016] [Accepted: 12/28/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Isolated maternal hypothyroxinaemia (IH) is defined as low maternal FT4 (<5th percentile) and normal thyroid-stimulating hormone. There is concern on its potential negative effects on the mother and offspring. OBJECTIVE We aimed to evaluate the prevalence of IH and to assess the consequences of hypothyroxinaemia on the maternal and foetal outcomes. SUBJECTS AND METHODS From a total of 1300 consecutive pregnant women recruited during the prenatal screen (mean gestational age, 11·8 weeks), thyroid function parameters were assessed in 879 women. After exclusion of women with T4 supplements, with twin pregnancies and with diabetes, data from 783 women were included. Maternal and neonatal outcomes in 55 selected women with IH and negative thyroid auto-antibodies without thyroid disorders or pregnancy achieved through assisted reproductive techniques were compared with a selected euthyroid control group (N = 165). RESULTS Among the 783 non diabetic singleton pregnant women, 68 women (8·7%) were identified with IH. When compared to the selected euthyroid controls, selected women with hypothyroxinaemia had significantly increased body mass index (BMI) in preconception (P = 0·003), in the first trimester (P = 0·004) and at the time of delivery (P = 0·001). At term, foetal breech presentation and caesarean section rate were significantly higher (P = 0·006 and P = 0·026, respectively) than in the euthyroid controls. A significant increase in macrosomia was also noted (P = 0·026). CONCLUSION The prevalence of hypothyroxinaemia in early pregnancy was of 8·7%. IH is associated with an increased maternal BMI and is related with a risk of breech presentation, a significant increase in macrosomia and caesarean sections. Screening should consider overweight as risk factor for hypothyroxinaemia.
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Affiliation(s)
- Raluca M Furnica
- Department of Endocrinology, Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Damien Gruson
- Department of Clinical Biology, Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - John H Lazarus
- Institute of Molecular and Experimental Medicine, University Hospital of Wales, Cardiff University, Cardiff, UK
| | - Dominique Maiter
- Department of Endocrinology, Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Pierre Bernard
- Department of Obstetrics, Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Chantal Daumerie
- Department of Endocrinology, Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Redman K, Ruffman T, Fitzgerald P, Skeaff S. Iodine Deficiency and the Brain: Effects and Mechanisms. Crit Rev Food Sci Nutr 2017; 56:2695-713. [PMID: 25880137 DOI: 10.1080/10408398.2014.922042] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Iodine is an essential micronutrient needed in human diets. As iodine is an integral component of thyroid hormone, it mediates the effects of thyroid hormone on brain development. Iodine deficiency is the most prevalent and preventable cause of mental impairment in the world. The exact mechanism through which iodine influences the brain is unclear, but is generally thought to begin with genetic expression. Many brain structures and systems appear to be affected with iodine deficiency, including areas such as the hippocampus, microstructures such as myelin, and neurotransmitters. The clearest evidence comes from the studies examining cognition in the cases of iodine deprivation or interventions involving iodine supplementation. Nevertheless, there are many inconsistencies and gaps in the literature of iodine deficiency, especially over the lifespan. This paper summarizes the literature on this topic, suggests a causal mechanism for iodine's effect on the brain, and indicates areas for the future research (e.g., using magnetic resonance imaging (MRI) and functional MRI to examine how iodine supplementation facilitates cognitive functioning).
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Affiliation(s)
- Kahla Redman
- a Department of Psychology , University of Otago , Dunedin , New Zealand
| | - Ted Ruffman
- a Department of Psychology , University of Otago , Dunedin , New Zealand
| | - Penelope Fitzgerald
- b Department of Human Nutrition , University of Otago , Dunedin , New Zealand
| | - Sheila Skeaff
- b Department of Human Nutrition , University of Otago , Dunedin , New Zealand
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Opazo MC, Haensgen H, Bohmwald K, Venegas LF, Boudin H, Elorza AA, Simon F, Fardella C, Bueno SM, Kalergis AM, Riedel CA. Imprinting of maternal thyroid hormones in the offspring. Int Rev Immunol 2017; 36:240-255. [DOI: 10.1080/08830185.2016.1277216] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- María Cecilia Opazo
- Departamento de Ciencias Biológicas, Millennium Institute on Immunology and Immunotherapy, Facultad de Ciencias Biológicas y Facultad de Medicina, Universidad Andres Bello, Santiago, Chile
| | - Henny Haensgen
- The Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Karen Bohmwald
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Luis F. Venegas
- Departamento de Ciencias Biológicas, Millennium Institute on Immunology and Immunotherapy, Facultad de Ciencias Biológicas y Facultad de Medicina, Universidad Andres Bello, Santiago, Chile
| | | | - Alvaro A. Elorza
- Centro de Investigaciones Biomedicas, Millenium Institute on Immunology and Immunotherapy, Facultad de Ciencias Biológicas y Faculta de Medicina, Universidad Andres Bello
| | - Felipe Simon
- Departamento de Ciencias Biológicas, Millennium Institute on Immunology and Immunotherapy, Facultad de Ciencias Biológicas y Facultad de Medicina, Universidad Andres Bello, Santiago, Chile
| | - Carlos Fardella
- Millenium Institute on Immunology and immunotherapy, Departamento de Endocrinología, Faculta de Medicina, Pontificia Universidad Católica de Chile; Santiago, Chile
| | - Susan M. Bueno
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas Pontificia Universidad Católica de Chile, Santiago, Chile
- INSERM UMR1064, Nantes, France
| | - Alexis M. Kalergis
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas Pontificia Universidad Católica de Chile, Santiago, Chile
- INSERM UMR1064, Nantes, France
| | - Claudia A. Riedel
- Departamento de Ciencias Biológicas, Millennium Institute on Immunology and Immunotherapy, Facultad de Ciencias Biológicas y Facultad de Medicina, Universidad Andres Bello, Santiago, Chile
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130
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Willemin ME, Lumen A. Thiocyanate: a review and evaluation of the kinetics and the modes of action for thyroid hormone perturbations. Crit Rev Toxicol 2017. [DOI: 10.1080/10408444.2017.1281590] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Marie-Emilie Willemin
- Division of Biochemical Toxicology, National Center for Toxicological Research, US Food and Drug Administration, Jefferson, AR, USA
| | - Annie Lumen
- Division of Biochemical Toxicology, National Center for Toxicological Research, US Food and Drug Administration, Jefferson, AR, USA
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Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, Grobman WA, Laurberg P, Lazarus JH, Mandel SJ, Peeters RP, Sullivan S. 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid 2017; 27:315-389. [PMID: 28056690 DOI: 10.1089/thy.2016.0457] [Citation(s) in RCA: 1303] [Impact Index Per Article: 186.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Thyroid disease in pregnancy is a common clinical problem. Since the guidelines for the management of these disorders by the American Thyroid Association (ATA) were first published in 2011, significant clinical and scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid disease in women during pregnancy, preconception, and the postpartum period. METHODS The specific clinical questions addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of task force members. Task force panel members were educated on knowledge synthesis methods, including electronic database searching, review and selection of relevant citations, and critical appraisal of selected studies. Published English language articles were eligible for inclusion. The American College of Physicians Guideline Grading System was used for critical appraisal of evidence and grading strength of recommendations. The guideline task force had complete editorial independence from the ATA. Competing interests of guideline task force members were regularly updated, managed, and communicated to the ATA and task force members. RESULTS The revised guidelines for the management of thyroid disease in pregnancy include recommendations regarding the interpretation of thyroid function tests in pregnancy, iodine nutrition, thyroid autoantibodies and pregnancy complications, thyroid considerations in infertile women, hypothyroidism in pregnancy, thyrotoxicosis in pregnancy, thyroid nodules and cancer in pregnant women, fetal and neonatal considerations, thyroid disease and lactation, screening for thyroid dysfunction in pregnancy, and directions for future research. CONCLUSIONS We have developed evidence-based recommendations to inform clinical decision-making in the management of thyroid disease in pregnant and postpartum women. While all care must be individualized, such recommendations provide, in our opinion, optimal care paradigms for patients with these disorders.
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Affiliation(s)
- Erik K Alexander
- 1 Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - Elizabeth N Pearce
- 2 Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine , Boston, Massachusetts
| | - Gregory A Brent
- 3 Department of Medicine, VA Greater Los Angeles Healthcare System and David Geffen School of Medicine at UCLA , Los Angeles, California
| | - Rosalind S Brown
- 4 Division of Endocrinology, Boston Children's Hospital , Harvard Medical School, Boston, Massachusetts
| | - Herbert Chen
- 5 Department of Surgery, University of Alabama at Birmingham , Birmingham, Alabama
| | - Chrysoula Dosiou
- 6 Division of Endocrinology, Stanford University School of Medicine , Stanford, California
| | - William A Grobman
- 7 Department of Obstetrics and Gynecology, Northwestern University , Chicago, Illinois
| | - Peter Laurberg
- 8 Departments of Endocrinology & Clinical Medicine, Aalborg University Hospital , Aalborg, Denmark
| | - John H Lazarus
- 9 Institute of Molecular Medicine, Cardiff University , Cardiff, United Kingdom
| | - Susan J Mandel
- 10 Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Robin P Peeters
- 11 Department of Internal Medicine and Rotterdam Thyroid Center, Erasmus Medical Center , Rotterdam, The Netherlands
| | - Scott Sullivan
- 12 Department of Obstetrics and Gynecology, Medical University of South Carolina , Charleston, South Carolina
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132
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Moog NK, Entringer S, Heim C, Wadhwa PD, Kathmann N, Buss C. Influence of maternal thyroid hormones during gestation on fetal brain development. Neuroscience 2017; 342:68-100. [PMID: 26434624 PMCID: PMC4819012 DOI: 10.1016/j.neuroscience.2015.09.070] [Citation(s) in RCA: 221] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 09/22/2015] [Accepted: 09/25/2015] [Indexed: 01/09/2023]
Abstract
Thyroid hormones (THs) play an obligatory role in many fundamental processes underlying brain development and maturation. The developing embryo/fetus is dependent on maternal supply of TH. The fetal thyroid gland does not commence TH synthesis until mid gestation, and the adverse consequences of severe maternal TH deficiency on offspring neurodevelopment are well established. Recent evidence suggests that even more moderate forms of maternal thyroid dysfunction, particularly during early gestation, may have a long-lasting influence on child cognitive development and risk of neurodevelopmental disorders. Moreover, these observed alterations appear to be largely irreversible after birth. It is, therefore, important to gain a better understanding of the role of maternal thyroid dysfunction on offspring neurodevelopment in terms of the nature, magnitude, time-specificity, and context-specificity of its effects. With respect to the issue of context specificity, it is possible that maternal stress and stress-related biological processes during pregnancy may modulate maternal thyroid function. The possibility of an interaction between the thyroid and stress systems in the context of fetal brain development has, however, not been addressed to date. We begin this review with a brief overview of TH biology during pregnancy and a summary of the literature on its effect on the developing brain. Next, we consider and discuss whether and how processes related to maternal stress and stress biology may interact with and modify the effects of maternal thyroid function on offspring brain development. We synthesize several research areas and identify important knowledge gaps that may warrant further study. The scientific and public health relevance of this review relates to achieving a better understanding of the timing, mechanisms and contexts of thyroid programing of brain development, with implications for early identification of risk, primary prevention and intervention.
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Affiliation(s)
- N K Moog
- Department of Medical Psychology, Charité University Medicine Berlin, Luisenstrasse 57, 10117 Berlin, Germany
| | - S Entringer
- Department of Medical Psychology, Charité University Medicine Berlin, Luisenstrasse 57, 10117 Berlin, Germany; University of California, Irvine, Development, Health, and Disease Research Program, 333 The City Drive West, Suite 1200, Orange, CA 92868, USA; Department of Pediatrics, University of California, Irvine, School of Medicine, 505 South Main Street, Suite 525, Orange, CA 92868, USA
| | - C Heim
- Department of Medical Psychology, Charité University Medicine Berlin, Luisenstrasse 57, 10117 Berlin, Germany; Department of Biobehavioral Health, Pennsylvania State University, College of Health and Human Development, 219 Biobehavioral Health Building, University Park, PA 16802, USA
| | - P D Wadhwa
- University of California, Irvine, Development, Health, and Disease Research Program, 333 The City Drive West, Suite 1200, Orange, CA 92868, USA; Department of Pediatrics, University of California, Irvine, School of Medicine, 505 South Main Street, Suite 525, Orange, CA 92868, USA; Department of Psychiatry and Human Behavior, University of California, Irvine, School of Medicine, 3117 Gillespie Neuroscience Research Facility, 837 Health Sciences Drive, Irvine, CA 92697, USA; Department of Obstetrics and Gynecology, University of California, Irvine, School of Medicine, 3117 Gillespie Neuroscience Research Facility, 837 Health Sciences Drive, Irvine, CA 92697, USA; Department of Epidemiology, University of California, Irvine, School of Medicine, 3117 Gillespie Neuroscience Research Facility, 837 Health Sciences Drive, Irvine, CA 92697, USA
| | - N Kathmann
- Department of Clinical Psychology, Humboldt-Universität zu Berlin, Rudower Chaussee 18, 12489 Berlin, Germany
| | - C Buss
- Department of Medical Psychology, Charité University Medicine Berlin, Luisenstrasse 57, 10117 Berlin, Germany; University of California, Irvine, Development, Health, and Disease Research Program, 333 The City Drive West, Suite 1200, Orange, CA 92868, USA; Department of Pediatrics, University of California, Irvine, School of Medicine, 505 South Main Street, Suite 525, Orange, CA 92868, USA.
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133
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Springer D, Jiskra J, Limanova Z, Zima T, Potlukova E. Thyroid in pregnancy: From physiology to screening. Crit Rev Clin Lab Sci 2017; 54:102-116. [PMID: 28102101 DOI: 10.1080/10408363.2016.1269309] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Thyroid hormones are crucial for the growth and maturation of many target tissues, especially the brain and skeleton. During critical periods in the first trimester of pregnancy, maternal thyroxine is essential for fetal development as it supplies thyroid hormone-dependent tissues. The ontogeny of mature thyroid function involves organogenesis, and maturation of the hypothalamus, pituitary and the thyroid gland; and it is almost complete by the 12th-14th gestational week. In case of maternal hypothyroidism, substitution with levothyroxine must be started in early pregnancy. After the 14th gestational week, fetal brain development may already be irreversibly affected by lack of thyroid hormones. The prevalence of manifest hypothyroidism in pregnancy is about 0.3-0.5%. The prevalence of subclinical hypothyroidism varies between 4 and 17%, strongly depending on the definition of the upper TSH cutoff limit. Hyperthyroidism occurs in 0.1-1% of all pregnancies. Positivity for antibodies against thyroid peroxidase (TPOAb) is common in women of childbearing age with an incidence rate of 5.1-12.4%. TPOAb-positivity may be regarded as a manifestation of a general autoimmune state which may alter the fertilization and implantation processes or cause early missed abortions. Women positive for TPOAb are at a significant risk of developing hypothyroidism during pregnancy and postpartum. Laboratory diagnosis of thyroid dysfunction during pregnancy is based upon serum TSH concentration. TSH in pregnancy is physiologically lower than the non-pregnant population. Results of multiple international studies point toward creation of trimester-specific reference intervals for TSH in pregnancy. Screening for hypothyroidism in pregnancy is controversial and its implementation varies from country to country. Currently, the case-finding approach of screening high-risk women is preferred in most countries to universal screening. However, numerous studies have shown that one-third to one-half of women with thyroid disorders escape the case-finding approach. Moreover, the universal screening has been shown to be more cost-effective. Screening for thyroid disorders in pregnancy should include assessment of both TSH and TPOAb, regardless of the screening approach. This review summarizes the current knowledge on physiology of thyroid hormones in pregnancy, causes of maternal thyroid dysfunction and its effects on pregnancy course and fetal development. We discuss the question of case-finding versus universal screening strategies and we display an overview of the analytical methods and their reference intervals in the assessment of thyroid function and thyroid autoimmunity in pregnancy. Finally, we present our results supporting the implementation of universal screening.
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Affiliation(s)
- Drahomira Springer
- a Institute of Medical Biochemistry and Laboratory Medicine, 1st Faculty of Medicine, Charles University and General University Hospital , Prague , Czech Republic
| | - Jan Jiskra
- b 3rd Department of Medicine - Clinical Department of Endocrinology and Metabolism , 1st Faculty of Medicine, Charles University and General University Hospital , Prague , Czech Republic , and
| | - Zdenka Limanova
- b 3rd Department of Medicine - Clinical Department of Endocrinology and Metabolism , 1st Faculty of Medicine, Charles University and General University Hospital , Prague , Czech Republic , and
| | - Tomas Zima
- a Institute of Medical Biochemistry and Laboratory Medicine, 1st Faculty of Medicine, Charles University and General University Hospital , Prague , Czech Republic
| | - Eliska Potlukova
- c Division of Internal Medicine , University Hospital Basel , Basel , Switzerland
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134
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Bronchain OJ, Chesneau A, Monsoro-Burq AH, Jolivet P, Paillard E, Scanlan TS, Demeneix BA, Sachs LM, Pollet N. Implication of thyroid hormone signaling in neural crest cells migration: Evidence from thyroid hormone receptor beta knockdown and NH3 antagonist studies. Mol Cell Endocrinol 2017; 439:233-246. [PMID: 27619407 DOI: 10.1016/j.mce.2016.09.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 09/08/2016] [Accepted: 09/08/2016] [Indexed: 11/18/2022]
Abstract
Thyroid hormones (TH) have been mainly associated with post-embryonic development and adult homeostasis but few studies report direct experimental evidence for TH function at very early phases of embryogenesis. We assessed the outcome of altered TH signaling on early embryogenesis using the amphibian Xenopus as a model system. Precocious exposure to the TH antagonist NH-3 or impaired thyroid receptor beta function led to severe malformations related to neurocristopathies. These include pathologies with a broad spectrum of organ dysplasias arising from defects in embryonic neural crest cell (NCC) development. We identified a specific temporal window of sensitivity that encompasses the emergence of NCCs. Although the initial steps in NCC ontogenesis appeared unaffected, their migration properties were severely compromised both in vivo and in vitro. Our data describe a role for TH signaling in NCCs migration ability and suggest severe consequences of altered TH signaling during early phases of embryonic development.
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Affiliation(s)
- Odile J Bronchain
- Paris-Saclay Institute of Neuroscience, CNRS, Univ. Paris-Sud, Université Paris-Saclay, 91405, Orsay, France.
| | - Albert Chesneau
- Paris-Saclay Institute of Neuroscience, CNRS, Univ. Paris-Sud, Université Paris-Saclay, 91405, Orsay, France
| | - Anne-Hélène Monsoro-Burq
- Univ Paris Sud, Université Paris Saclay, Centre Universitaire, F-91405, Orsay, France; Institut Curie PSL Research University, Centre Universitaire, F-91405, Orsay, France; UMR 3347 CNRS, U1021 Inserm, Université Paris Saclay, Centre Universitaire, F-91405, Orsay, France
| | - Pascale Jolivet
- CNRS, Sorbonne Universités, UPMC University Paris 06, UMR8226, Laboratoire de Biologie Moléculaire et Cellulaire des Eucaryotes, Institut de Biologie Physico-Chimique, 75005, Paris, France; UMR 7221 CNRS, Muséum National d'histoire Naturelle, Dépt. Régulation, Développement et Diversité Moléculaire, Sorbonne Universités, 75005, Paris, France
| | - Elodie Paillard
- Watchfrog S.A., 1 Rue Pierre Fontaine, 91000, Evry, France; Institute of Systems and Synthetic Biology, CNRS, Université d'Evry Val d'Essonne, Bâtiment 3, Genopole(®) Campus 3, 1, Rue Pierre Fontaine, F-91058, Evry, France
| | - Thomas S Scanlan
- Department of Physiology & Pharmacology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, L334, Portland, OR, 97239-3098, USA
| | - Barbara A Demeneix
- UMR 7221 CNRS, Muséum National d'histoire Naturelle, Dépt. Régulation, Développement et Diversité Moléculaire, Sorbonne Universités, 75005, Paris, France
| | - Laurent M Sachs
- UMR 7221 CNRS, Muséum National d'histoire Naturelle, Dépt. Régulation, Développement et Diversité Moléculaire, Sorbonne Universités, 75005, Paris, France
| | - Nicolas Pollet
- Institute of Systems and Synthetic Biology, CNRS, Université d'Evry Val d'Essonne, Bâtiment 3, Genopole(®) Campus 3, 1, Rue Pierre Fontaine, F-91058, Evry, France; Evolution, Génomes, Comportement & Ecologie, CNRS, IRD, Univ. Paris-Sud, Université Paris-Saclay, 91198, Gif-sur-Yvette, France
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135
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Dosiou C, Medici M. MANAGEMENT OF ENDOCRINE DISEASE: Isolated maternal hypothyroxinemia during pregnancy: knowns and unknowns. Eur J Endocrinol 2017; 176:R21-R38. [PMID: 27528503 DOI: 10.1530/eje-16-0354] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 02/10/2016] [Accepted: 02/15/2016] [Indexed: 12/16/2022]
Abstract
Isolated maternal hypothyroxinemia (IMH) during pregnancy is defined as a low maternal T4 in the absence of TSH elevation. As IMH is common, with a prevalence of 1-2% in iodine-sufficient populations, and early research has suggested adverse effects on fetal neurodevelopment, it has been the focus of many studies in the last decade. In the current review, we first discuss the significance of IMH based on data from animal models and recent discoveries regarding the role of thyroid hormone on neurodevelopment. We address issues surrounding the definition and prevalence of this entity and discuss new insights into the etiologies, clinical consequences and management of IMH. A number of large cohort studies have investigated the effects of IMH on the risk of various pregnancy complications and child neurodevelopment. We review these studies in detail and describe their limitations. We discuss the available research on management of IMH, including two recent randomized controlled trials (RCTs). Finally, we delineate the remaining uncertainties in this field and emphasize the need for a sufficiently powered, placebo-controlled RCT on the treatment of IMH early in the first trimester of pregnancy.
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Affiliation(s)
- Chrysoula Dosiou
- Division of EndocrinologyStanford University School of Medicine, Stanford, California, USA
| | - Marco Medici
- Department of Endocrinology and Rotterdam Thyroid CenterErasmus Medical Center, Rotterdam, The Netherlands
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136
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Ruszkiewicz JA, Li S, Rodriguez MB, Aschner M. Is Triclosan a neurotoxic agent? JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART B, CRITICAL REVIEWS 2017; 20:104-117. [PMID: 28339349 DOI: 10.1080/10937404.2017.1281181] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Triclosan (TCS) is an antibacterial agent that has been used in many products since 1960s. Given its broad usage as an antiseptic TCS is present ubiquitously in the environment. Trace levels of TCS continue to be detected in many organisms, and it has been shown to be particularly toxic to aquatic species. The mechanisms underlying TCS-mediated toxicity include hormone dyshomeostasis, induction of oxidative stress, apoptosis and inflammation. Although TCS has been considered to be non-toxic to mammals, the adverse effects of continuous, long-term and low concentration exposure remain unknown. Epidemiological studies revealed that levels of TCS in human tissues, urine, plasma and breast milk correlate with the usage of this antimicrobial. This led to concerns regarding TCS safety and potential toxicity in humans, with special emphasis on early development. The Food and Drug Administration (FDA) recently issued a directive banning the use of TCS in consumer soaps, justifying the move attributed to data gaps on its effectiveness and safety, indicating the need for more studies addressing this chemical-mediated effects on various tissues including the central nervous system (CNS). The aim of this review was to (1) summarize the current findings on the neurotoxic effects of TCS and given the paucity of data, to (2) broaden the discussion to other effects of TCS, which might plausibly be related to neuronal functions.
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Affiliation(s)
- Joanna A Ruszkiewicz
- a Department of Molecular Pharmacology , Albert Einstein College of Medicine , Bronx , NY , United States
| | - Shaojun Li
- b Department of Toxicology, School of Public Health , Guangxi Medical University , Guangxi , China
| | - Maliya B Rodriguez
- a Department of Molecular Pharmacology , Albert Einstein College of Medicine , Bronx , NY , United States
| | - Michael Aschner
- a Department of Molecular Pharmacology , Albert Einstein College of Medicine , Bronx , NY , United States
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137
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Wei L, Qiao P, Shi Y, Ruan Y, Yin J, Wu Q, Shao B. Triclosan/triclocarban levels in maternal and umbilical blood samples and their association with fetal malformation. Clin Chim Acta 2016; 466:133-137. [PMID: 28025031 DOI: 10.1016/j.cca.2016.12.024] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 12/22/2016] [Accepted: 12/22/2016] [Indexed: 12/20/2022]
Abstract
Triclosan (TCS) and triclocarban (TCC) are widely used as antimicrobial compounds in consumer products. TCS and TCC are frequently found in waste water and sewage. In this study, we investigate the potential impact of exposure to triclosan (TCS) and triclocarban (TCC) on fetal abnormalities. We measured TCS and TCC levels in maternal and umbilical cord blood samples from 39 pregnant women diagnosed with fetal or post-birth abnormalities at Beijing Obstetrics and Gynecology Hospital. 52 pregnant women who gave birth to healthy neonates during the same period of time were included as controls. Applying ultra-performance liquid chromatography-tandem mass spectrometry, TCS and TCC concentrations were measured in maternal and fetal sera. Significantly increased levels of TCS were detected in maternal sera from mothers with abnormal births. Similar levels of TCS or TCC were found in maternal and cord sera in control group. The concentrations of TCS or TCC in maternal sera correlated with those in umbilical cord sera (r=0.649, P<0.01). These observations suggest that maternal blood test could be a useful assay for detecting fetal exposure to TCS and TCC, and high exposure to TCS may be potentially associated with increased risk for fetal malformations.
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Affiliation(s)
- Ling Wei
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Pengyun Qiao
- Clinical Center of Reproductive Medicine, Affiliated Hospital of Weifang Medical University, Weifang 261031, China
| | - Ying Shi
- Xiangheyuan Supervision Station, The Institute of Inspection and Supervision, National Health and Family Planning Commission in Chaoyang District of Beijing, China
| | - Yan Ruan
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Jie Yin
- Beijing Key Laboratory of Diagnostic and Traceability Technologies for Food Poisoning, Beijing Centre for Disease Control and Prevention, Beijing, China
| | - Qingqing Wu
- Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China.
| | - Bing Shao
- Beijing Key Laboratory of Diagnostic and Traceability Technologies for Food Poisoning, Beijing Centre for Disease Control and Prevention, Beijing, China.
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138
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Zhang X, Yao B, Li C, Mao J, Wang W, Xie X, Teng X, Han C, Zhou W, Li C, Xu B, Bi L, Meng T, Du J, Zhang S, Gao Z, Yang L, Fan C, Teng W, Shan Z. Reference Intervals of Thyroid Function During Pregnancy: Self-Sequential Longitudinal Study Versus Cross-Sectional Study. Thyroid 2016; 26:1786-1793. [PMID: 27733101 DOI: 10.1089/thy.2016.0002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND A self-sequential longitudinal reference interval may be expected to minimize the inter-individual variation of thyroid function. Comparison between the self-sequential longitudinal reference interval (SLRI) and cross-sectional reference interval (CSRI) in pregnancy has not been well investigated. The objectives of this study were to establish a stringent SLRI of thyroid function in pregnant women and to compare it with the conventional CSRI. METHODS Three cohorts were enrolled: group 1, pregnant women for an SLRI (n = 99); group 2, pregnant women for a CSRI (n = 1318); group 3, non-pregnant control women (NC) as a control group (n = 301) according to the criteria of the National Academy of Clinical Biochemistry. Thyrotropin (TSH), total thyroxine (TT4), free thyroxine (fT4), total triiodothyronine (TT3), free triiodothyronine (fT3), serum ferritin (SF), and urine iodine concentration (UIC) were measured in the three groups. RESULTS Compared with CSRI, the reference interval of the SLRI group had narrower reference intervals of fT4 in the first and second trimesters (p < 0.05). The median of TSH was at a low level during the first trimester, and then gradually elevated in the second and third trimesters. The median of fT4 persistently decreased from 12 weeks, and did not return to the level of the NC group until 12 months postpartum. The TT4 increased to 131.4 nmol/L at gestational week 8, and reached a peak (170.0 nmol/L) at gestational week 12. In the first trimester, the prevalence of hypothyroxinemia was 9.1%, 4.0%, and 2.0% with a fT4 value below the 10th, 5th, and 2.5th percentile, respectively. In contrast, 29.3% of TT4 values were below the lower non-pregnancy reference limit multiplied by 1.5. CONCLUSIONS No significant difference was found between a SLRI and a CSRI, even in a stringent self-sequential longitudinal reference interval of thyroid function in pregnant women. In addition, the limit of TT4 below the non-pregnant level multiplied by a factor 1.5 is not appropriate for diagnosing hypothyroxinemia in the first trimester.
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Affiliation(s)
- Xiaomei Zhang
- 1 Department of Endocrinology and Metabolism, Peking University International Hospital , Beijing, China
| | - Baoting Yao
- 2 Department of Endocrinology and Metabolism, The First Hospital of Dandong City , Dandong, China
| | - Chenyan Li
- 3 The Endocrine Institute and The Liaoning Provincial Key Laboratory of Endocrine Diseases, Department of Endocrinology and Metabolism, The First Hospital of China Medical University , Shenyang, China
| | - Jinyuan Mao
- 3 The Endocrine Institute and The Liaoning Provincial Key Laboratory of Endocrine Diseases, Department of Endocrinology and Metabolism, The First Hospital of China Medical University , Shenyang, China
| | - Weiwei Wang
- 3 The Endocrine Institute and The Liaoning Provincial Key Laboratory of Endocrine Diseases, Department of Endocrinology and Metabolism, The First Hospital of China Medical University , Shenyang, China
| | - Xiaochen Xie
- 3 The Endocrine Institute and The Liaoning Provincial Key Laboratory of Endocrine Diseases, Department of Endocrinology and Metabolism, The First Hospital of China Medical University , Shenyang, China
| | - Xiaochun Teng
- 3 The Endocrine Institute and The Liaoning Provincial Key Laboratory of Endocrine Diseases, Department of Endocrinology and Metabolism, The First Hospital of China Medical University , Shenyang, China
| | - Cheng Han
- 3 The Endocrine Institute and The Liaoning Provincial Key Laboratory of Endocrine Diseases, Department of Endocrinology and Metabolism, The First Hospital of China Medical University , Shenyang, China
| | - Weiwei Zhou
- 4 Department of Obstetrics and Gynecology, Shenyang Women's and Children's Hospital , Shenyang, China
| | - Chenyang Li
- 4 Department of Obstetrics and Gynecology, Shenyang Women's and Children's Hospital , Shenyang, China
| | - Bin Xu
- 5 Department of Obstetrics and Gynecology, No. 202 Hospital of People's Liberation Army , Shenyang, China
| | - Lihua Bi
- 6 Department of Obstetrics and Gynecology, Dalian Obstetrics and Gynecology Hospital , Dalian, China
| | - Tao Meng
- 7 Department of Obstetrics and Gynecology, The First Hospital of China Medical University , Shenyang, China
| | - Jianling Du
- 8 Department of Endocrinology, The First Affiliated Hospital of Dalian Medical University , Dalian, China
| | - Shaowei Zhang
- 9 Department of Endocrinology, No. 202 Hospital of People's Liberation Army , Shenyang, China
| | - Zhengnan Gao
- 10 Department of Endocrinology, Dalian Municipal Central Hospital Affiliated of Dalian Medical University , Dalian, China
| | - Liu Yang
- 11 Department of Obstetrics and Gynecology, Shenyang Women and Children Health Care Center , Shenyang, China
| | - Chenling Fan
- 3 The Endocrine Institute and The Liaoning Provincial Key Laboratory of Endocrine Diseases, Department of Endocrinology and Metabolism, The First Hospital of China Medical University , Shenyang, China
| | - Weiping Teng
- 3 The Endocrine Institute and The Liaoning Provincial Key Laboratory of Endocrine Diseases, Department of Endocrinology and Metabolism, The First Hospital of China Medical University , Shenyang, China
| | - Zhongyan Shan
- 3 The Endocrine Institute and The Liaoning Provincial Key Laboratory of Endocrine Diseases, Department of Endocrinology and Metabolism, The First Hospital of China Medical University , Shenyang, China
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139
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Tingi E, Syed AA, Kyriacou A, Mastorakos G, Kyriacou A. Benign thyroid disease in pregnancy: A state of the art review. J Clin Transl Endocrinol 2016; 6:37-49. [PMID: 29067240 PMCID: PMC5644429 DOI: 10.1016/j.jcte.2016.11.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 11/08/2016] [Accepted: 11/10/2016] [Indexed: 12/20/2022] Open
Abstract
Thyroid dysfunction is the commonest endocrine disorder in pregnancy apart from diabetes. Thyroid hormones are essential for fetal brain development in the embryonic phase. Maternal thyroid dysfunction during pregnancy may have significant adverse maternal and fetal outcomes such as preterm delivery, preeclampsia, miscarriage and low birth weight. In this review we discuss the effect of thyroid disease on pregnancy and the current evidence on the management of different thyroid conditions in pregnancy and postpartum to improve fetal and neonatal outcomes, with special reference to existing guidelines on the topic which we dissect, critique and compare with each other. Overt hypothyroidism and hyperthyroidism should be treated appropriately in pregnancy, aiming to maintain euthyroidism. Subclinical hypothyroidism is often pragmatically treated with levothyroxine, although it has not been definitively proven whether this alters maternal or fetal outcomes. Subclinical hyperthyroidism does not usually require treatment and the possibility of non-thyroidal illness or gestational thyrotoxicosis should be considered. Autoimmune thyroid diseases tend to improve during pregnancy but commonly flare-up or emerge in the post-partum period. Accordingly, thyroid auto-antibodies tend to decrease with pregnancy progression. Postpartum thyroiditis should be managed based on the clinical symptoms rather than abnormal biochemical results.
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Affiliation(s)
- Efterpi Tingi
- Obstetrics and Gynaecology, St Mary’s Hospital, Manchester, UK
| | - Akheel A. Syed
- Endocrinology and Diabetes, Salford Royal NHS Foundation Trust, Salford, Greater Manchester, UK
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Alexis Kyriacou
- School of Health Sciences, University of Stirling, Stirling, UK
- CEDM Centre of Endocrinology, Diabetes & Metabolism, Limassol, Cyprus
| | | | - Angelos Kyriacou
- Endocrinology and Diabetes, Salford Royal NHS Foundation Trust, Salford, Greater Manchester, UK
- CEDM Centre of Endocrinology, Diabetes & Metabolism, Limassol, Cyprus
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Santos R, Cliff DP, Howard SJ, Veldman SL, Wright IM, Sousa-Sá E, Pereira JR, Okely AD. "GET-UP" study rationale and protocol: a cluster randomised controlled trial to evaluate the effects of reduced sitting on toddlers' cognitive development. BMC Pediatr 2016; 16:182. [PMID: 27829405 PMCID: PMC5103395 DOI: 10.1186/s12887-016-0723-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 10/28/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The educational and cognitive differences associated with low socioeconomic status begin early in life and tend to persist throughout life. Coupled with the finding that levels of sedentary time are negatively associated with cognitive development, and time spent active tends to be lower in disadvantaged circumstances, this highlights the need for interventions that reduce the amount of time children spend sitting and sedentary during childcare. The proposed study aims to assess the effects of reducing sitting time during Early Childhood Education and Care (ECEC) services on cognitive development in toddlers from low socio-economic families. METHODS/DESIGN We will implement a 12-months 2-arm parallel group cluster randomised controlled trial (RCT) with Australian toddlers, aged 12 to 26 months at baseline. Educators from the ECEC services allocated to the intervention group will receive professional development on how to reduce sitting time while children attend ECEC. Participants' cognitive development will be assessed as a primary outcome, at baseline and post-intervention, using the cognitive sub-test from the Bayley Scales of Infant and Toddler Development. DISCUSSION This trial has the potential to inform programs and policies designed to optimize developmental and health outcomes in toddlers, specifically in those from disadvantaged backgrounds. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry: ACTRN12616000471482 , 11/04/2016, retrospectively registered.
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Affiliation(s)
- Rute Santos
- Early Start Research Institute, School of Education, Faculty of Social Sciences, University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia. .,Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Porto, Portugal.
| | - Dylan P Cliff
- Early Start Research Institute, School of Education, Faculty of Social Sciences, University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia
| | - Steven J Howard
- Early Start Research Institute, School of Education, Faculty of Social Sciences, University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia
| | - Sanne L Veldman
- Early Start Research Institute, School of Education, Faculty of Social Sciences, University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia
| | - Ian M Wright
- Early Start Research Institute, School of Education, Faculty of Social Sciences, University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Eduarda Sousa-Sá
- Early Start Research Institute, School of Education, Faculty of Social Sciences, University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia
| | - João R Pereira
- Early Start Research Institute, School of Education, Faculty of Social Sciences, University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia
| | - Anthony D Okely
- Early Start Research Institute, School of Education, Faculty of Social Sciences, University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia
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Relationship between the LHPP Gene Polymorphism and Resting-State Brain Activity in Major Depressive Disorder. Neural Plast 2016; 2016:9162590. [PMID: 27843651 PMCID: PMC5097818 DOI: 10.1155/2016/9162590] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 08/22/2016] [Accepted: 09/06/2016] [Indexed: 11/18/2022] Open
Abstract
A single-nucleotide polymorphism at the LHPP gene (rs35936514) has been reported in genome-wide association studies to be associated with major depressive disorder (MDD). However, the neural system effects of rs35936514 that mediate the association are unknown. The present work explores whether the LHPP rs35936514 polymorphism moderates brain regional activity in MDD. A total of 160 subjects were studied: a CC group homozygous for the C allele (23 individuals with MDD and 57 controls) and a T-carrier group carrying the high risk T allele (CT/TT genotypes; 22 MDD and 58 controls). All participants underwent resting-state functional magnetic resonance imaging (rs-fMRI) scanning. Brain activity was assessed using the amplitudes of low-frequency fluctuations (ALFF). MDD patients showed a significant increased ALFF in the left middle temporal gyrus and occipital cortex. The T-carrier group showed increased ALFF in the left superior temporal gyrus. Significant diagnosis × genotype interaction was noted in the bilateral lingual gyri, bilateral dorsal lateral prefrontal cortex (dlPFC), and left medial prefrontal cortex (mPFC) (P < 0.05, corrected). Results demonstrated that MDD patients with LHPP rs35936514 CT/TT genotype may influence the regional brain activity. These findings implicate the effects of the rs35936514 variation on the neural system in MDD.
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142
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Yim CH. Update on the Management of Thyroid Disease during Pregnancy. Endocrinol Metab (Seoul) 2016; 31:386-391. [PMID: 27546871 PMCID: PMC5053049 DOI: 10.3803/enm.2016.31.3.386] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 07/22/2016] [Accepted: 07/27/2016] [Indexed: 01/26/2023] Open
Abstract
Thyroid dysfunction during pregnancy can result in serious complications for both the mother and infant; however, these complications can be prevented by optimal treatment of maternal overt thyroid dysfunction. Although several studies have demonstrated that maternal subclinical hypothyroidism is associated with obstetric complications and neurocognitive impairments in offspring, there is limited evidence that levothyroxine treatment can improve these complications. Therefore, most professional societies do not recommend universal screening for thyroid dysfunction during pregnancy, and instead recommend a case-finding approach in which only high-risk women are tested. However, recent studies have estimated that targeted thyroid function testing misses approximately 30% to 55% of hypothyroidism cases in pregnant women, and some associations and researchers have recommended universal screening of pregnant women to facilitate the early detection and treatment of overt hypothyroidism. This review summarizes recent data on thyroid function test changes, thyroid functional disorder management, and thyroid screening during pregnancy.
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Affiliation(s)
- Chang Hoon Yim
- Department of Internal Medicine, Cheil General Hospital & Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea.
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143
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Pearce EN, Lazarus JH, Moreno-Reyes R, Zimmermann MB. Consequences of iodine deficiency and excess in pregnant women: an overview of current knowns and unknowns. Am J Clin Nutr 2016; 104 Suppl 3:918S-23S. [PMID: 27534632 PMCID: PMC5004501 DOI: 10.3945/ajcn.115.110429] [Citation(s) in RCA: 183] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Severe iodine deficiency during development results in maternal and fetal hypothyroidism and associated serious adverse health effects, including cretinism and growth retardation. Universal salt iodization is the first-line strategy for the elimination of severe iodine deficiency. Iodine supplementation is recommended for vulnerable groups in severely iodine-deficient regions where salt iodization is infeasible or insufficient. A recent clinical trial has informed best practices for iodine supplementation of severely iodine-deficient lactating mothers. Because of successful programs of universal salt iodization in formerly severely iodine-deficient regions around the world, public health concern has shifted toward mild to moderate iodine deficiency, which remains prevalent in many regions, especially among pregnant women. Observational studies have shown associations between both mild maternal iodine deficiency and mild maternal thyroid hypofunction and decreased child cognition. Iodine supplementation has been shown to improve indexes of maternal thyroid function, even in marginally iodine-deficient areas. However, no data are yet available from randomized controlled trials in regions of mild to moderate iodine insufficiency on the relation between maternal iodine supplementation and neurobehavioral development in the offspring; thus, the long-term benefits and safety of such supplementation are uncertain. Although it is clear that excessive iodine intake can cause alterations in thyroid function in susceptible individuals, safe upper limits for iodine intake in pregnancy have not been well defined. Well-designed, prospective, randomized controlled trials that examine the effects of iodine supplementation on maternal thyroid function and infant neurobehavioral development in mildly to moderately iodine-deficient pregnant women are urgently needed. In addition, clinical data on the effects of iodine excess in pregnant and lactating women are needed to inform current recommendations for safe upper limits on chronic iodine ingestion in general and on iodine supplementation in particular.
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Affiliation(s)
- Elizabeth N Pearce
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, MA;
| | - John H Lazarus
- Thyroid Research Group, Institute of Molecular and Experimental Medicine, Cardiff University, University Hospital of Wales, Cardiff, United Kingdom
| | - Rodrigo Moreno-Reyes
- Department of Nuclear Medicine, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium; and
| | - Michael B Zimmermann
- Human Nutrition Laboratory, Institute of Food, Nutrition, and Health, ETH Zurich, Zurich, Switzerland
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Johnson PI, Koustas E, Vesterinen HM, Sutton P, Atchley DS, Kim AN, Campbell M, Donald JM, Sen S, Bero L, Zeise L, Woodruff TJ. Application of the Navigation Guide systematic review methodology to the evidence for developmental and reproductive toxicity of triclosan. ENVIRONMENT INTERNATIONAL 2016; 92-93:716-28. [PMID: 27156197 PMCID: PMC4951161 DOI: 10.1016/j.envint.2016.03.009] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 03/08/2016] [Accepted: 03/09/2016] [Indexed: 05/19/2023]
Abstract
BACKGROUND There are reports of developmental and reproductive health effects associated with the widely used biocide triclosan. OBJECTIVE Apply the Navigation Guide systematic review methodology to answer the question: Does exposure to triclosan have adverse effects on human development or reproduction? METHODS We applied the first 3 steps of the Navigation Guide methodology: 1) Specify a study question, 2) Select the evidence, and 3) Rate quality and strength of the evidence. We developed a protocol, conducted a comprehensive search of the literature, and identified relevant studies using pre-specified criteria. We assessed the number and type of all relevant studies. We evaluated each included study for risk of bias and rated the quality and strength of the evidence for the selected outcomes. We conducted a meta-analysis on a subset of suitable data. RESULTS We found 4282 potentially relevant records, and 81 records met our inclusion criteria. Of the more than 100 endpoints identified by our search, we focused our evaluation on hormone concentration outcomes, which had the largest human and non-human mammalian data set. Three human studies and 8 studies conducted in rats reported thyroxine levels as outcomes. The rat data were amenable to meta-analysis. Because only one of the human thyroxine studies quantified exposure, we did not conduct a meta-analysis of the human data. Through meta-analysis of the data for rats, we estimated for prenatal exposure a 0.09% (95% CI: -0.20, 0.02) reduction in thyroxine concentration per mg triclosan/kg-bw in fetal and young rats compared to control. For postnatal exposure we estimated a 0.31% (95% CI: -0.38, -0.23) reduction in thyroxine per mg triclosan/kg-bw, also compared to control. Overall, we found low to moderate risk of bias across the human studies and moderate to high risk of bias across the non-human studies, and assigned a "moderate/low" quality rating to the body of evidence for human thyroid hormone alterations and a "moderate" quality rating to the body of evidence for non-human thyroid hormone alterations. CONCLUSION Based on this application of the Navigation Guide systematic review methodology, we concluded that there was "sufficient" non-human evidence and "inadequate" human evidence of an association between triclosan exposure and thyroxine concentrations, and consequently, triclosan is "possibly toxic" to reproductive and developmental health. Thyroid hormone disruption is an upstream indicator of developmental toxicity. Additional endpoints may be identified as being of equal or greater concern as other data are developed or evaluated.
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Affiliation(s)
- Paula I Johnson
- University of California San Francisco, Program on Reproductive Health and the Environment, Oakland, CA, USA.
| | - Erica Koustas
- ORISE Post-doctoral Fellowship, U.S. Environmental Protection Agency, Office of Policy, National Center for Environmental Economics, Washington, D.C., USA
| | - Hanna M Vesterinen
- University of California San Francisco, Program on Reproductive Health and the Environment, Oakland, CA, USA
| | - Patrice Sutton
- University of California San Francisco, Program on Reproductive Health and the Environment, Oakland, CA, USA
| | - Dylan S Atchley
- University of California San Francisco, Program on Reproductive Health and the Environment, Oakland, CA, USA
| | - Allegra N Kim
- Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, CA, USA
| | - Marlissa Campbell
- Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, CA, USA
| | - James M Donald
- Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, CA, USA
| | - Saunak Sen
- University of California San Francisco, Department of Epidemiology and Biostatistics, San Francisco, CA, USA
| | - Lisa Bero
- University of California San Francisco, Department of Clinical Pharmacy, San Francisco, CA, USA
| | - Lauren Zeise
- Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, CA, USA
| | - Tracey J Woodruff
- University of California San Francisco, Program on Reproductive Health and the Environment, Oakland, CA, USA
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Maternal thyroid function in pregnancy may program offspring blood pressure, but not adiposity at 20 y of age. Pediatr Res 2016; 80:7-13. [PMID: 26991263 DOI: 10.1038/pr.2016.56] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 01/08/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Experimental evidence exists indicating that maternal thyroid hormones during pregnancy may affect the metabolic set point and cardio-vascular function in the offspring. The objective of this study was to investigate the association between maternal thyroid function in week 30 of gestation and offspring adiposity and blood pressure at 20 y. METHODS The study was based on the follow up of a Danish birth cohort from 1988 to 1989 (n = 965). A blood sample was drawn from the pregnant women in week 30 of gestation (N = 877). In 2008-2009, the offspring were followed up with self-reported anthropometrics (N = 645) and a clinically measured blood pressure (N = 425). Multiple linear regressions were used to estimate the association between maternal thyroid function and offspring BMI, waist circumference, and blood pressure. RESULTS Offspring of subclinical hypothyroid women had higher systolic blood pressure (adjusted difference = 3.6, 95% confidence interval: 0.2, 7.0 mmHg) and a tendency toward higher diastolic blood pressure (adjusted difference = 2.3, 95% confidence interval: -0.2, 4.9 mmHg) compared to offspring of euthyroid women. No association was found with offspring BMI and waist circumference. CONCLUSION Maternal thyroid function during third trimester of pregnancy may affect long-term blood pressure in the offspring.
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Gyllenberg D, Sourander A, Surcel HM, Hinkka-Yli-Salomäki S, McKeague IW, Brown AS. Hypothyroxinemia During Gestation and Offspring Schizophrenia in a National Birth Cohort. Biol Psychiatry 2016; 79:962-70. [PMID: 26194598 PMCID: PMC4684794 DOI: 10.1016/j.biopsych.2015.06.014] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 05/07/2015] [Accepted: 06/11/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Evidence from animal and human studies indicates that thyroid hormone deficiency during early gestation alters brain development. As schizophrenia is associated with prenatal brain insults and premorbid cognitive deficits, we tested the a priori hypothesis that serologically defined maternal thyroid deficiency during early gestation to mid-gestation is associated with schizophrenia in offspring. METHODS The investigation is based on the Finnish Prenatal Study of Schizophrenia, a nested case-control study that included archived maternal sera from virtually all pregnancies since 1983 (N = >1 million). We identified all offspring in the cohort with a diagnosis of schizophrenia based on the national inpatient and outpatient register and matched them on sex, date of birth, and residence in Finland at time of onset of the case to comparison subjects (1:1) from the cohort. Maternal sera of 1010 case-control pairs were assessed for free thyroxine, and sera of 948 case-control pairs were assessed for thyroid-stimulating hormone. RESULTS Maternal hypothyroxinemia (free thyroxine ≤10th percentile, normal thyroid-stimulating hormone) was associated with an increased odds of schizophrenia (odds ratio = 1.75, 95% confidence interval = 1.22-2.50, p = .002). When adjusted for maternal psychiatric history, province of birth, and maternal smoking during pregnancy, the association remained significant (odds ratio = 1.70, 95% confidence interval = 1.13-2.55, p = .010). CONCLUSIONS In a large, national birth cohort, prospectively documented hypothyroxinemia during early gestation to mid-gestation was associated with increased odds of schizophrenia in offspring. This information can inform translational studies of maternal hypothyroxinemia examining molecular and cellular deviations relevant to schizophrenia.
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Affiliation(s)
- David Gyllenberg
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York State Psychiatric Institute, New York, New York; Department of Child Psychiatry, Faculty of Medicine, University of Turku.
| | - Andre Sourander
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York State Psychiatric Institute, New York, NY, United States, Department of Child Psychiatry, Faculty of Medicine, University of Turku, Turku, Finland, Department of Child Psychiatry, Turku University Hospital, Turku, Finland
| | | | | | - Ian W. McKeague
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, United States
| | - Alan S. Brown
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York State Psychiatric Institute, New York, NY, United States, Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, United States
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Steinmaus C, Pearl M, Kharrazi M, Blount BC, Miller MD, Pearce EN, Valentin-Blasini L, DeLorenze G, Hoofnagle AN, Liaw J. Thyroid Hormones and Moderate Exposure to Perchlorate during Pregnancy in Women in Southern California. ENVIRONMENTAL HEALTH PERSPECTIVES 2016; 124:861-7. [PMID: 26485730 PMCID: PMC4892913 DOI: 10.1289/ehp.1409614] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 10/08/2015] [Indexed: 05/27/2023]
Abstract
BACKGROUND Findings from national surveys suggest that everyone in the United States is exposed to perchlorate. At high doses, perchlorate, thiocyanate, and nitrate inhibit iodide uptake into the thyroid and decrease thyroid hormone production. Small changes in thyroid hormones during pregnancy, including changes within normal reference ranges, have been linked to cognitive function declines in the offspring. OBJECTIVES We evaluated the potential effects of low environmental exposures to perchlorate on thyroid function. METHODS Serum thyroid hormones and anti-thyroid antibodies and urinary perchlorate, thiocyanate, nitrate, and iodide concentrations were measured in 1,880 pregnant women from San Diego County, California, during 2000-2003, a period when much of the area's water supply was contaminated from an industrial plant with perchlorate at levels near the 2007 California regulatory standard of 6 μg/L. Linear regression was used to evaluate associations between urinary perchlorate and serum thyroid hormone concentrations in models adjusted for urinary creatinine and thiocyanate, maternal age and education, ethnicity, and gestational age at serum collection. RESULTS The median urinary perchlorate concentration was 6.5 μg/L, about two times higher than in the general U.S. POPULATION Adjusted associations were identified between increasing log10 perchlorate and decreasing total thyroxine (T4) [regression coefficient (β) = -0.70; 95% CI: -1.06, -0.34], decreasing free thyroxine (fT4) (β = -0.053; 95% CI: -0.092, -0.013), and increasing log10 thyroid-stimulating hormone (β = 0.071; 95% CI: 0.008, 0.133). CONCLUSIONS These results suggest that environmental perchlorate exposures may affect thyroid hormone production during pregnancy. This could have implications for public health given widespread perchlorate exposure and the importance of thyroid hormone in fetal neurodevelopment. CITATION Steinmaus C, Pearl M, Kharrazi M, Blount BC, Miller MD, Pearce EN, Valentin-Blasini L, DeLorenze G, Hoofnagle AN, Liaw J. 2016. Thyroid hormones and moderate exposure to perchlorate during pregnancy in women in Southern California. Environ Health Perspect 124:861-867; http://dx.doi.org/10.1289/ehp.1409614.
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Affiliation(s)
- Craig Steinmaus
- Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Oakland, California, USA
- School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | | | - Martin Kharrazi
- Environmental Health Investigations Branch, California Department of Public Health, Richmond, California, USA
| | - Benjamin C. Blount
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mark D. Miller
- Pediatric Environmental Health Specialty Unit, University of California, San Francisco, San Francisco, California, USA
| | - Elizabeth N. Pearce
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Liza Valentin-Blasini
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Gerald DeLorenze
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Andrew N. Hoofnagle
- Department of Lab Medicine, University of Washington, Seattle, Washington, USA
| | - Jane Liaw
- School of Public Health, University of California, Berkeley, Berkeley, California, USA
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Ganaie MA, Charoo BA, Sofi RA, Ahmed A, Bhat JI. Maternal Overt Hypothyroidism and Neurobehavioral Outcome of Neonates: A Cohort Study from an Iodine-deficient Area of Northern India. Indian Pediatr 2016; 52:864-6. [PMID: 26499010 DOI: 10.1007/s13312-015-0733-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To study the relation between maternal overt hypothyroidism and neurodevelopmental outcome of neonates in iodine-deficient region of Northern India (Kashmir Valley). DESIGN Prospective cohort study. SETTING Endocrinology department of a tertiary-care hospital. PARTICIPANTS 82 hypothyroid pregnant women were enrolled and followed up till delivery. The neonates born to this group represented the case neonates. 51 euthyroid healthy pregnant women were selected as control group. The neonates born to these mothers served as controls. MAIN OUTCOME MEASURES Early neonatal behavioral assessment at 3-4 weeks of age. RESULTS The mean TSH and free T4 in neonates of mothers with well controlled hypothyroidism was significantly different from those born to mothers with poorly controlled hypothyroidism and controls in 1st trimester, but the difference was statistically insignificant for 2nd and 3rd trimester values. CONCLUSION Overt maternal hypothyroidism in iodine-deficient area constitutes a risk factor for an abnormal neurobehavioral development of affected child.
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Affiliation(s)
- Mohammad Ashraf Ganaie
- Department of *Endocrinology, AIIMS, New Delhi; and Department of Pediatrics, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir; India. Correspondence to: Dr Javeed Iqbal Bhat, Department of Pediatrics, SKIMS Soura, Jammu and Kashmir 190 011, India.
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Fan X, Wu L. The impact of thyroid abnormalities during pregnancy on subsequent neuropsychological development of the offspring: a meta-analysis. J Matern Fetal Neonatal Med 2016; 29:3971-6. [PMID: 26988121 DOI: 10.3109/14767058.2016.1152248] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To investigate the relationship between specific thyroid abnormalities in women during pregnancy and the subsequent neuropsychological development of their offspring. METHODS A systematic literature search of PubMed, Embase and Web of Science was conducted. Eligible studies were case-control or cohort study that explored this association with euthyroid thyroid abnormalities during pregnancy. The outcomes included intelligence scores and motor scores. Weighted mean differences (WMDs) and 95% confidence intervals (CIs) were calculated and heterogeneity was assessed with Cochrane Q chi-square test and I(2) statistics. A fixed-effects or random-effects model was used to pool the estimates according to the heterogeneity among the included studies. RESULTS Six studies, involving 4449 participants, were included. Children of women with thyroid abnormalities had mean intelligence score of 6.27 points and motor score of 5.99 points lower than that of children of euthyroid women. Subgroup analysis suggested that, children of women with hypothyroxinaemia, subclinical hypothyroidism and positive TPOAb had mean intelligence scores of 5.69 points, 8.76 points and 10.55 points, and mean motor scores of 4.19 points, 9.98 points and 9.03 points lower than those of the controls, respectively. CONCLUSIONS The thyroid abnormalities in pregnant women may adversely affect neuropsychological development of their offspring.
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Affiliation(s)
| | - Lina Wu
- b Department of Obstetrics and Gynecology , Central People's Hospital of Siping , Siping , China
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150
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Lischinsky JE, Skocic J, Clairman H, Rovet J. Preliminary Findings Show Maternal Hypothyroidism May Contribute to Abnormal Cortical Morphology in Offspring. Front Endocrinol (Lausanne) 2016; 7:16. [PMID: 26941710 PMCID: PMC4766309 DOI: 10.3389/fendo.2016.00016] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 02/11/2016] [Indexed: 12/18/2022] Open
Abstract
In rodents, insufficient thyroid hormone (TH) gestationally has adverse effects on cerebral cortex development. Comparable studies of humans examining how TH insufficiency affects cortical morphology are limited to children with congenital hypothyroidism or offspring of hypothyroxinemic women; effects on cortex of children born to women with clinically diagnosed hypothyroidism are not known. We studied archived MRI scans from 22 children aged 10-12 years born to women treated for preexisting or de novo hypothyroidism in pregnancy (HYPO) and 24 similar age and sex controls from euthyroid women. FreeSurfer Image Analysis Suite software was used to measure cortical thickness (CT) and a vertex-based approach served to compare HYPO versus control groups and Severe versus Mild HYPO subgroups as well as to perform regression analyses examining effects of trimester-specific maternal TSH on CT. Results showed that relative to controls, HYPO had multiple regions of both cortical thinning and thickening, which differed for left and right hemispheres. In HYPO, thinning was confined to medial and mid-lateral regions of each hemisphere and thickening to superior regions (primarily frontal) of the left hemisphere and inferior regions (particularly occipital and temporal) of the right. The Severe HYPO subgroup showed more thinning than Mild in frontal and temporal regions and more thickening in bilateral posterior and frontal regions. Maternal TSH values predicted degree of thinning and thickening within multiple brain regions, with the pattern and direction of correlations differing by trimester. Notably, some correlations remained when cases born to women with severe hypothyroidism were removed from the analyses, suggesting that mild variations of maternal TH may permanently affect offspring cortex. We conclude that maternal hypothyroidism during pregnancy has long-lasting manifestations on the cortical morphology of their offspring with specific effects reflecting both severity and timing of maternal TH insufficiency.
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Affiliation(s)
- Julieta E. Lischinsky
- Institute for Biomedical Sciences, The George Washington University, Washington, DC, USA
- Center for Neuroscience Research, Children’s National Medical Center, Washington, DC, USA
| | - Jovanka Skocic
- Neuroscience and Mental Health Program, The Hospital for Sick Children (SickKids), Toronto, ON, Canada
| | - Hayyah Clairman
- Neuroscience and Mental Health Program, The Hospital for Sick Children (SickKids), Toronto, ON, Canada
| | - Joanne Rovet
- Neuroscience and Mental Health Program, The Hospital for Sick Children (SickKids), Toronto, ON, Canada
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
- Department of Psychology, University of Toronto, Toronto, ON, Canada
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