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Joshi JS, Shanoo A, Patel N, Gupta A. From Conception to Delivery: A Comprehensive Review of Thyroid Disorders and Their Far-Reaching Impact on Feto-Maternal Health. Cureus 2024; 16:e53362. [PMID: 38435202 PMCID: PMC10907906 DOI: 10.7759/cureus.53362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
This comprehensive review delves into the multifaceted landscape of thyroid disorders during pregnancy, exploring their impact from conception to postpartum considerations. Key findings highlight the intricate interplay between maternal thyroid health and fetal development, emphasizing the critical importance of timely screening and targeted interventions. The evolving landscape of research and technology suggests a paradigm shift toward personalized approaches in clinical practice, emphasizing integrated care models and the integration of telehealth platforms. Postpartum considerations, including postpartum thyroiditis, underscore the necessity for ongoing monitoring and intervention for maternal well-being. Implications for clinical practice encompass healthcare provider education, public awareness campaigns, and policy advocacy for standardized screening guidelines. The call to action resonates for increased research funding to advance understanding and improve outcomes. By fostering awareness, education, and collaborative efforts, this review aims to navigate the complexities of thyroid disorders during pregnancy, ensuring a healthier start for both mothers and their infants.
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Affiliation(s)
- Jalormy S Joshi
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Amardeep Shanoo
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nainita Patel
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Aishwarya Gupta
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Ducharme M, Scarsi C, Bettazzi E, Mautone G, Lewis Y, Celi FS. A Novel Levothyroxine Solution Results in Similar Bioavailability Whether Taken 30 or Just 15 Minutes Before a High-Fat High-Calorie Meal. Thyroid 2022; 32:897-904. [PMID: 35469428 PMCID: PMC9419984 DOI: 10.1089/thy.2021.0604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Levothyroxine (LT4) sodium is a standard treatment for hypothyroidism. Its absorption and bioavailability when taken as a tablet have been shown to be significantly decreased with concomitant food ingestion. Therefore, LT4 formulations are recommended to be taken on an empty stomach, at least 30, ideally 60, minutes before breakfast, potentially affecting adherence to therapy. A novel LT4 solution (Tirosint®-SOL) has been shown to result in a faster absorption process than tablets or soft-gel capsule formulations. The objective of this trial was to evaluate the bioavailability of this preparation taken 15 minutes before a high-fat high-calorie meal in comparison with the minimally recommended 30-minute interval. Methods: Thirty-six (33 completers, 24 males and 9 females) healthy volunteers participating in the randomized study took 600 mcg of LT4 oral solution, single doses after a 10-hour fast, 15 or 30 minutes before a high-fat, high-calorie, FDA-approved standardized meal in a controlled research setting. We measured serum total thyroxine using Liquid Chromatography with Tandem Mass Spectrometry at baseline and multiple time points up to 72 hours after LT4 administration. The predefined equivalence boundaries for the extent of exposure reflected by the area under the curve (AUC) were 80-125%. The washout period was at least 35 days. Results: The geometric mean ratios and confidence intervals (CIs) for the baseline-adjusted extent of exposure represented by AUCs truncated at both 48 and 72 hours after dosing (AUC0-48: 90% [90% CI 86-94]; and AUC0-72: 92% [90% CI 87-97]) were within the prespecified equivalence boundaries. The baseline-adjusted peak concentration was also clinically similar (Cmax: 85% [90% CI 80-90]). The median tmax was 1.5 hours in each group. The rate of adverse events was similar between groups. Conclusions: We observed no significant difference in the pharmacokinetic properties of a novel LT4 solution administered 15 and 30 minutes before a high-fat high-calorie meal in normal subjects. Further research is needed to evaluate (a) the differences in overall bioavailability at other time points (including immediately premeal) and (b) the real-world effectiveness of this preparation in newly proposed administration conditions to optimize treatment outcomes in hypothyroid patients.
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Affiliation(s)
- Murray Ducharme
- Faculté de Pharmacie, University of Montreal and Learn and Confirm, Inc., St. Laurent, Quebec, Canada
- Address correspondence to: Murray Ducharme, PharmD, FCCP, FCP, Faculté de Pharmacie, University of Montreal, Learn and Confirm, Inc., 750 Marcel-Laurin, Suite 235, St. Laurent, QC H4M 2M4, Canada
| | | | | | | | - Yvette Lewis
- Learn and Confirm, Inc., St. Laurent, Quebec, Canada
| | - Francesco S. Celi
- Division of Endocrinology Diabetes and Metabolism, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
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Bocale R, Desideri G, Barini A, D’Amore A, Boscherini M, Necozione S, Lombardi CP. Long-Term Adherence to Levothyroxine Replacement Therapy in Thyroidectomized Patients. J Clin Med 2022; 11:jcm11154296. [PMID: 35893387 PMCID: PMC9332058 DOI: 10.3390/jcm11154296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 06/29/2022] [Accepted: 07/20/2022] [Indexed: 11/24/2022] Open
Abstract
(1) Background: We evaluated the long term adherence to two distinct formulations of levothyroxine (L-T4), liquid or solid, which are differently influenced by concomitant food ingestion. (2) Methods: A total of 106 thyroidectomized patients (82 female, mean age 58.2 ± 13.3 years) on L-T4 replacement therapy in either liquid (n = 52) or solid formulation (n = 54) were administered the four-item Medication Adherence Questionnaire (MAQ). (3) Results: The study population had 59.4% adherers and 40.6% non-adherers. The global MAQ score was significantly better in patients under liquid L-T4 in comparison to those under solid L-T4 (0.42 ± 0.82 vs. 0.83 ± 0.95, respectively, p = 0.0085). The patients on tablet L-T4 forgot to take their medication more frequently than those on liquid LT4 treatment (p = 0.0159) and were more often careless at times about taking their medication (p = 0.007), whilst about one in two thyroidectomized patients preferred tablets for lifetime medication therapy. The global MAQ score was directly correlated with the circulating TSH levels in the whole study population (0.700, p < 0.0001) and inversely correlated with both the FT3 (−0.220, p = 0.0232) and FT4 (−0.327, p = 0.0006) serum concentrations. (4) Conclusions: Long-term adherence to L-T4 treatment was globally satisfactory although it was better for the liquid formulation, which appears to represent an easier-to-manage L-T4 replacement therapy for most thyroidectomized patients, particularly for those with difficulties in taking L-T4 while fasting.
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Affiliation(s)
- Raffaella Bocale
- Division of Endocrine Surgery, “Agostino Gemelli” School of Medicine, University Foundation Polyclinic, Catholic University of the Sacred Heart, 00198 Rome, Italy; (R.B.); (A.D.); (M.B.); (C.P.L.)
| | - Giovambattista Desideri
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
- Correspondence: ; Tel.: +39-339-330-9326
| | - Angelina Barini
- Institute of Biochemistry and Clinical Biochemistry, Department of Laboratory Medicine, “Agostino Gemelli” School of Medicine, University Foundation Polyclinic, Catholic University of the Sacred Heart, 00198 Rome, Italy;
| | - Annamaria D’Amore
- Division of Endocrine Surgery, “Agostino Gemelli” School of Medicine, University Foundation Polyclinic, Catholic University of the Sacred Heart, 00198 Rome, Italy; (R.B.); (A.D.); (M.B.); (C.P.L.)
| | - Mauro Boscherini
- Division of Endocrine Surgery, “Agostino Gemelli” School of Medicine, University Foundation Polyclinic, Catholic University of the Sacred Heart, 00198 Rome, Italy; (R.B.); (A.D.); (M.B.); (C.P.L.)
| | - Stefano Necozione
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Celestino Pio Lombardi
- Division of Endocrine Surgery, “Agostino Gemelli” School of Medicine, University Foundation Polyclinic, Catholic University of the Sacred Heart, 00198 Rome, Italy; (R.B.); (A.D.); (M.B.); (C.P.L.)
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Solomon AL, Farwell AP, Pearce EN, Lee SY. Letter to the Editor: A Patient-Centered Survey-Based Assessment of Prenatal Management of Hypothyroidism for Women of Reproductive Age. Thyroid 2022; 32:871-874. [PMID: 35596561 PMCID: PMC9293681 DOI: 10.1089/thy.2022.0032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
| | - Alan P. Farwell
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Elizabeth N. Pearce
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Sun Y. Lee
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, Massachusetts, USA
- Address correspondence to: Sun Y. Lee, MD, MSc, Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, 720 Harrison Avenue, Suite 8100, Boston, MA 02118, USA
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Nagai MM, Zanetti MOB, Lemos CA, Campos MSDA, Ayres LR, Duarte G, Pereira LRL. High-risk pregnancy: characterization of medication use profile and association with clinical and sociodemographic factors. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2022. [DOI: 10.1590/1806-9304202200030010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract Objectives: describe the profile of medication use and adherence, and the association with clinical and sociodemographic characteristics of high-risk pregnant women attended at a university hospital. Methods: cross-sectional study with data collected through a questionnaire applied on 386 pregnant women. Results: most participants were seen only by the gynecologist (75.1%), started prenatal in the first gestational trimester (86.8%), did not plan the pregnancy (61.9%), and performed an average of 8.2 (SD=4.4) prenatal consultations. The most frequent diagnoses were arterial hypertension (20.5%) and diabetes mellitus (19.7%). Prevalence of medication use was 99.7%, with an average of 5.1 (SD=2.1) medication per woman and 12.7% self-medication. Antianemics (88.9%) and analgesics (63.2%) were the most prevalent classes and 17.9% of the women reported the use of medication with significant gestational risk. Only 36.5% were considered adherent, 32.9% declared they were unaware of the indication of the medication in use and 42% did not receive guidance on the use of the medication during pregnancy. There is no evidence of association between the number of the medication used and clinical and sociodemographic aspects. Conclusions: there is a need to develop strategies to improve the care of this population, with emphasis on strengthening multi-professional care.
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Díez JJ, Iglesias P, Gómez-Mateos MÁ. Management of primary hypothyroidism in adults: An analysis of the results of a survey in 546 primary care physicians. ENDOCRINOL DIAB NUTR 2022; 69:289-298. [PMID: 35636913 DOI: 10.1016/j.endien.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/10/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To document current practices in the management of adult patients with hypothyroidism in the setting of primary healthcare. METHODS We designed a web-based survey to inquire information on real-life practices regarding management of hypothyroidism by primary care physicians in the region of Madrid (Spain). RESULTS In total, 546 out of 3897 (14%) physicians (aged 50.9±8.5 yr, 404 females) completed the survey. More than 90% of respondents requested serum thyrotropin measurement in subjects with symptoms of thyroid hypofunction, family history of thyroid disease and history of autoimmune disease. A thyroid ultrasound was requested to evaluate subclinical and overt hypothyroidism by 27.1% and 69.6% of respondents, respectively. Only 22.1% of respondents stated that they do not treat subclinical hypothyroidism with thyrotropin values less than 10mU/l. Most physicians use brand-name formulations of levothyroxine and advise patients on how to take the tablets. To start treatment, the gradual replacement rate was the option chosen by most of the respondents, even in young patients. The thyrotropin target preferred by most respondents was 0.5-5.0mU/l, especially in older patients. In patients with persistent symptoms, 61.4% search for the causes through complementary investigations. A longer professional practice time was not always accompanied by better adherence to guidelines and expert recommendations. CONCLUSION Our results reveal a proactive attitude in the diagnosis and of therapy by most of the respondents. However, we observed a tendency to perform unnecessary diagnostic tests and an excessive propensity to treat mild subclinical hypothyroidism.
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Affiliation(s)
- Juan J Díez
- Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain; Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Madrid, Spain; Department of Medicine, Universidad Autónoma de Madrid, Spain.
| | - Pedro Iglesias
- Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain; Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Madrid, Spain
| | - María Ángeles Gómez-Mateos
- Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Madrid, Spain; Medical Management, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
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Siscart J, Orós M, Serna MC, Perejón D, Galván L, Ortega M. Adherence to treatment for hypothyroidism in pregnancy and relationship with thyrotropin control: a retrospective observational cohort study. BMC Pregnancy Childbirth 2022; 22:168. [PMID: 35232385 PMCID: PMC8886742 DOI: 10.1186/s12884-022-04483-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 02/07/2022] [Indexed: 12/27/2022] Open
Abstract
Background Hypothyroidism is the second most common endocrinological disease during pregnancy, with percentages that can range between 3.2 and 5.5%. A good maternal and foetal health outcome depends on thyroid hormone replacement therapy. The goal of such therapy is to maintain thyrotropin (TSH) in a range that is specific for pregnant women and varies between the trimesters of pregnancy. In our study, we wanted to analyse the adherence to hypothyroidism treatment among pregnant women and to evaluate the degree of control of the disease. Methods We performed a retrospective observational cohort study in pregnant women between 2012 and 2018 in the Lleida health region. Therapeutic adherence was analysed by the proportion of days covered (PDC). The relationship with other variables was assessed using the regression coefficients and their 95% confidence interval (CI). Results We examined a sample of 17,281 women, representing more than 92% of the pregnant women in the Lleida health region in the period analysed. Among this sample, the mean prevalence of hypothyroidism was 6.52% (0.07% clinical and 6.45% subclinical). 3.3% of the 17,281 pregnant women were treated. Among them, the mean adherence score was 79.6 ± 22.2. Of these, 54% presented high adherence. The latter had a higher mean age and better TSH control, in comparison to the ones showing low adherence. Conclusions Half of the treated patients had good adherence to treatment and a better TSH control, in comparison to the others. Most of them achieved a good control at the third trimester of pregnancy. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04483-8.
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Affiliation(s)
- Júlia Siscart
- Primary Care Research Institute IDIAP Jordi Gol, Catalan Institute of Health, Lleida, Spain. .,Eixample Health Center, Catalan Institute of Health, Lleida, Spain. .,Family Medicine Department, University of Lleida, Lleida, Spain.
| | - Míriam Orós
- Primary Care Research Institute IDIAP Jordi Gol, Catalan Institute of Health, Lleida, Spain.,Eixample Health Center, Catalan Institute of Health, Lleida, Spain.,Family Medicine Department, University of Lleida, Lleida, Spain
| | - M Catalina Serna
- Primary Care Research Institute IDIAP Jordi Gol, Catalan Institute of Health, Lleida, Spain.,Eixample Health Center, Catalan Institute of Health, Lleida, Spain.,Family Medicine Department, University of Lleida, Lleida, Spain
| | - Dani Perejón
- Primary Care Research Institute IDIAP Jordi Gol, Catalan Institute of Health, Lleida, Spain.,Eixample Health Center, Catalan Institute of Health, Lleida, Spain.,Family Medicine Department, University of Lleida, Lleida, Spain
| | | | - Marta Ortega
- Primary Care Research Institute IDIAP Jordi Gol, Catalan Institute of Health, Lleida, Spain. .,Family Medicine Department, University of Lleida, Lleida, Spain. .,Therapeutic Research Group in Primary Care (GRETAP), Catalan Institute of Health, Lleida, Spain.
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8
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Kirubarajan A, Lam A, Yu A, Taheri C, Khan S, Sethuram C, Mehta V, Olivieri N. Knowledge, Information Sources, and Institutional Trust of Patients Regarding Medication Use in Pregnancy: A Systematic Review. J Family Reprod Health 2021; 15:160-171. [PMID: 34721607 PMCID: PMC8536826 DOI: 10.18502/jfrh.v15i3.7133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: The objective of our study is to characterize the knowledge, information sources, and institutional trust of patients regarding medication use in pregnancy. Materials and methods: We conducted a review of three databases: MEDLINE, EMBASE, and CINAHL. We included observational studies and knowledge assessments that examined the knowledge, attitudes, beliefs or information sources of pregnant patients related to medication use during pregnancy. Extraction was completed by two independent reviewers, outcomes were summarized descriptively, and appraisal was conducted. Results: Of the 1359 search results, 34 studies met inclusion criteria. Thus, our systematic review encompasses the beliefs of 11,757 pregnant participants. In most studies, participants described apprehension regarding potential risks to the fetus and the inadequacy of safety information. Across the 23 knowledge assessments, the majority of studies reported patient misconceptions about prescription medication in pregnancy. The most preferred information source was a healthcare provider. However, many participants expressed frustration, mistrust, and skepticism regarding physician knowledge. A common source of mistrust was due to perceived physician self-interest as well as a lack of education tailored to pregnancy. Consequently, informal sources of information were also popular. Conclusion: There is a need to improve the health literacy and trust among pregnant patients regarding drug prescribing. There are modifiable risk factors for mistrust that require further attention.
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Affiliation(s)
- Abirami Kirubarajan
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Lam
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Amy Yu
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Cameron Taheri
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shawn Khan
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Claire Sethuram
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vikita Mehta
- Arts and Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Nancy Olivieri
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Division of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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Díez JJ, Iglesias P, Gómez-Mateos MÁ. Management of primary hypothyroidism in adults: An analysis of the results of a survey in 546 primary care physicians. ENDOCRINOL DIAB NUTR 2021; 69:S2530-0164(21)00188-9. [PMID: 34483069 DOI: 10.1016/j.endinu.2021.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/19/2021] [Accepted: 04/10/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To document current practices in the management of adult patients with hypothyroidism in the setting of primary healthcare. METHODS We designed a web-based survey to inquire information on real-life practices regarding management of hypothyroidism by primary care physicians in the region of Madrid (Spain). RESULTS In total, 546 out of 3897 (14%) physicians (aged 50.9±8.5 yr, 404 females) completed the survey. More than 90% of respondents requested serum thyrotropin measurement in subjects with symptoms of thyroid hypofunction, family history of thyroid disease and history of autoimmune disease. A thyroid ultrasound was requested to evaluate subclinical and overt hypothyroidism by 27.1% and 69.6% of respondents, respectively. Only 22.1% of respondents stated that they do not treat subclinical hypothyroidism with thyrotropin values less than 10mU/l. Most physicians use brand-name formulations of levothyroxine and advise patients on how to take the tablets. To start treatment, the gradual replacement rate was the option chosen by most of the respondents, even in young patients. The thyrotropin target preferred by most respondents was 0.5-5.0mU/l, especially in older patients. In patients with persistent symptoms, 61.4% search for the causes through complementary investigations. A longer professional practice time was not always accompanied by better adherence to guidelines and expert recommendations. CONCLUSION Our results reveal a proactive attitude in the diagnosis and of therapy by most of the respondents. However, we observed a tendency to perform unnecessary diagnostic tests and an excessive propensity to treat mild subclinical hypothyroidism.
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Affiliation(s)
- Juan J Díez
- Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain; Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Madrid, Spain; Department of Medicine, Universidad Autónoma de Madrid, Spain.
| | - Pedro Iglesias
- Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain; Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Madrid, Spain
| | - María Ángeles Gómez-Mateos
- Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Madrid, Spain; Medical Management, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
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Topaloğlu Ö, Yavuz A, Tiryaki Aylıkcı AB. Evaluation of adherence to levothyroxine and out-of-range thyroid-stimulating hormone levels in pregnant women with primary hypothyroidism. Int J Clin Pract 2021; 75:e14312. [PMID: 33999516 DOI: 10.1111/ijcp.14312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 04/28/2021] [Indexed: 01/19/2023] Open
Abstract
PURPOSE Adherence to levothyroxine (LT4) and attaining thyroid-stimulating hormone (TSH) goal in pregnancy has not been well-defined yet. We aimed to investigate adherence to LT4, success to reach TSH goal, and association between them in pregnant women with primary hypothyroidism. MATERIALS AND METHODS Eight-item Morisky Medication Adherence Scale (MMAS-8) was applied in third trimester in pregnant women with primary hypothyroidism (Hashimoto's thyroiditis, surgical hypothyroidism or iodine deficiency) whom LT4 was given for at least 3 months. Those with chronic illness or thyroid cancer were excluded. We grouped the patients according to MMAS-8 score (<6, low adherence vs ≥6, medium/high adherence), and TSH measurement in third trimester (in-range vs out-of-range). RESULTS Of total (n = 85), 57.64% (n = 49) had medium/high adherence to LT4, and 41.17% (n = 35) out-of-range TSH, but no association was found among them (P = .937). LT4 initiation in pregestational period, surgical hypothyroidism, high LT4 dose in second/third trimester and alternate-day dosing were associated with medium/high adherence. Age, number of visits, and less time between ingestion of LT4 and breakfast were associated with medium/high adherence. LT4 dose in second trimester and dose increment at the beginning of pregnancy were positively associated with in-range TSH. CONCLUSION Non-adherence and treatment failure are frequent in LT4-treated pregnant women. Adherence seems not to be associated with treatment success. Regular follow-up may improve adherence. Our study is the first to analyse both treatment success and adherence to LT4 in pregnancy.
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Affiliation(s)
- Ömercan Topaloğlu
- Endocrinology Clinics, Kocaeli Derince Training and Research Hospital, University of Health Sciences, Kocaeli, Turkey
| | - Arzu Yavuz
- Gynecology and Obstetrics Clinics, Kocaeli Derince Training and Research Hospital, University of Health Sciences, Kocaeli, Turkey
| | - Ahsen Banu Tiryaki Aylıkcı
- Internal Medicine Clinics, Kocaeli Derince Training and Research Hospital, University of Health Sciences, Kocaeli, Turkey
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Sontakke S, Takalikar V, Deshmukh J, Motghare VM, Kalikar M, Turankar A. Assessment of adherence to medication during chronic illnesses in pregnancy. Perspect Clin Res 2021; 12:153-158. [PMID: 34386380 PMCID: PMC8323557 DOI: 10.4103/picr.picr_111_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/14/2019] [Accepted: 11/24/2019] [Indexed: 11/04/2022] Open
Abstract
PURPOSE/AIM To evaluate adherence to medication in chronic illnesses during pregnancy and to identify factors responsible for non-adherence. METHODS This was a prospective, cross-sectional, questionnaire based study initiated after approval of the institutional ethics committee. Pregnant women suffering from any chronic illness (except HIV) were questioned to evaluate adherence to medication in chronic illnesses during pregnancy and to detect factors responsible for non-adherence using a semi-structured, open-ended questionnaire. Adherence to medication was also assessed using 4-item Morisky's medication adherence scale. RESULTS Rate of high adherence was significantly more (58.77%) with medications for chronic illness compared to medications for normal pregnancy (15.78%). Majority of women were more concerned about the chronic illness and believed that keeping the chronic illness under control is more important for normal growth of the baby. Unawareness about usefulness of each medicine and forgetfulness were the most common reasons for non-adherence to medications. Not taking prescribed dose was the most common type of non-adherence. Level of adherence positively correlated with level of education while it was inversely related to number of tablets per day. CONCLUSION Higher adherence to medications for chronic illnesses during pregnancy is an encouraging finding but at the same time poor adherence to medications for normal pregnancy is a matter of concern. Most of the issues responsible for non-adherence to medication as reported in this study can be resolved to a significant extent by planning and implementing interventions aimed at improving adherence to treatment during pregnancy in which health professionals play a major role.
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Affiliation(s)
| | - Vrushali Takalikar
- Department of Paediatrics, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Jitendra Deshmukh
- Department of Obstetrics and Gynaecology, GMC, Gondia, Maharashtra, India
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van den Broek S, Lupattelli A, Frank AS, Haug LS, Nordeng H. Thyroid hormone replacement therapy in pregnancy and motor function, communication skills, and behavior of preschool children: The Norwegian Mother, Father, and Child Cohort Study. Pharmacoepidemiol Drug Saf 2020; 30:716-726. [PMID: 33314561 PMCID: PMC8247290 DOI: 10.1002/pds.5184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 12/08/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE Limited research has focused on the association between prenatal thyroid hormone replacement therapy (THRT) and motor function, communication skills, and behavior in preschool children. Here, we estimated the association between THRT during pregnancy and the first trimester and these developmental outcomes. METHODS This study was based on the Norwegian Mother, Father, and Child Cohort Study (MoBa) and other national registries. We included mother-child pairs exposed to THRT during pregnancy (n = 663), after delivery (n = 728), or unexposed (n = 28 040). Exposure to THRT was defined according to filled prescriptions. Child outcomes, presented as T-score differences, were parent-reported using the Ages and Stages Questionnaire, Strengths and Difficulties Questionnaire, and Child Behavior Checklist. RESULTS Of 29 431 mother-child pairs, 2.3% were prenatally exposed to THRT. We found no difference between prenatally exposed and unexposed children in regards to gross motor function (β: 0.17, 95% CI -1.19, 1.54), fine motor function (β: -0.17, 95% CI -1.14, 0.80), communication (β: -0.31, 95% CI -1.58, 0.96), externalizing (β: -0.03, 95% CI -1.07, 1.01), internalizing (β: 0.89, 95% CI -0.20, 1.97), or social behaviors (β: -0.04, 95% CI -0.92, 0.84). Somatic complaints were higher in THRT-exposed children (β: 0.98, 95% CI 0.08, 1.87), and children whose mothers were exposed after delivery had more sleep problems than unexposed children (β: 0.99, 95% CI 0.24, 1.74). CONCLUSIONS Children prenatally exposed to THRT have developmental outcomes as positive as unexposed children on motor function, communication, and behavior. The association with somatic complaints and sleep were not clinically relevant.
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Affiliation(s)
- Sophie van den Broek
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, and PharmaTox Strategic Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway.,Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Angela Lupattelli
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, and PharmaTox Strategic Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Anna S Frank
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, and PharmaTox Strategic Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Line Småstuen Haug
- Department of Environmental Exposure and Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Hedvig Nordeng
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, and PharmaTox Strategic Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway.,Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
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13
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Ceulemans M, Lupattelli A, Nordeng H, Odalovic M, Twigg M, Foulon V. Women's Beliefs About Medicines and Adherence to Pharmacotherapy in Pregnancy: Opportunities for Community Pharmacists. Curr Pharm Des 2020; 25:469-482. [PMID: 30907309 DOI: 10.2174/1381612825666190321110420] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 03/18/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND During pregnancy, women might weigh the benefits of treatment against potential risks to the unborn child. However, non-adherence to necessary treatment can adversely affect both mother and child. To optimize pregnant women's beliefs and medication adherence, community pharmacists are ideally positioned to play an important role in primary care. OBJECTIVE This narrative review aimed to summarize the evidence on 1) pregnant women's beliefs, 2) medication adherence in pregnancy and 3) community pharmacists' counselling during pregnancy. METHODS Three search strategies were used in Medline and Embase to find original studies evaluating women's beliefs, medication adherence and community pharmacists' counselling during pregnancy. All original descriptive and analytic epidemiological studies performed in Europe, North America and Australia, written in English and published from 2000 onwards were included. RESULTS We included 14 studies reporting on women's beliefs, 11 studies on medication adherence and 9 on community pharmacists' counselling during pregnancy. Women are more reluctant to use medicines during pregnancy and tend to overestimate the teratogenic risk of medicines. The risk perception varies with the type of medicine, level of health literacy, education level and occupation. Furthermore, low medication adherence during pregnancy is common. Finally, limited evidence showed that the current community pharmacists' counselling is insufficient. Barriers hindering pharmacists are insufficient knowledge and limited access to reliable information. CONCLUSION Concerns about medication use and non-adherence are widespread among pregnant women. Community pharmacists' counselling during pregnancy is insufficient. Further education, training and research are required to support community pharmacists in fulfilling all the opportunities they have when counselling pregnant women.
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Affiliation(s)
- Michael Ceulemans
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Angela Lupattelli
- PharmacoEpidemiology and Drug Safety Research Group, School of Pharmacy, University of Oslo, Oslo, Norway
| | - Hedvig Nordeng
- PharmacoEpidemiology and Drug Safety Research Group, School of Pharmacy, University of Oslo, Oslo, Norway
| | - Marina Odalovic
- Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Michael Twigg
- School of Pharmacy, University of East Anglia, Norwich, NR47PQ, United Kingdom
| | - Veerle Foulon
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
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14
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Roldan Munoz S, Lupattelli A, de Vries ST, Mol PGM, Nordeng H. Differences in medication beliefs between pregnant women using medication, or not, for chronic diseases: a cross-sectional, multinational, web-based study. BMJ Open 2020; 10:e034529. [PMID: 32029496 PMCID: PMC7044950 DOI: 10.1136/bmjopen-2019-034529] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To assess whether medication beliefs differ between women who use or not use medication for their somatic chronic diseases during pregnancy and whether this association varies across diseases. DESIGN Cross-sectional web-based survey. SETTING Multinational study in Europe. PARTICIPANTS Pregnant women or women with children less than 1 year old from European countries and with asthma, allergy, cardiovascular, rheumatic diseases, diabetes, epilepsy and/or inflammatory bowel diseases (IBD). PRIMARY AND SECONDARY OUTCOME MEASURE Differences in scores of the Beliefs about Medicines Questionnaire (BMQ). RESULTS In total, 1219 women were included (ranging from 736 for allergy to 49 for IBD). Women using medication for their chronic disease (n=770; 63%) had higher scores on the BMQ subscales necessity (16.6 vs 12.1, p<0.001) and benefits (16.2 vs 15.4, p<0.001), and lower values on the subscales overuse (12.5 vs 13.1; p=0.005) and harm (9.8 vs 10.7, p<0.001) than women not using medication. No significant differences were shown for the concerns subscale (12.5 vs 12.3, p=0.484). Beliefs varied somewhat across diseases but in general more positive beliefs among women using medication were shown. Epilepsy was the disease where less differences were observed between women using and not using medication. CONCLUSION Women's beliefs were associated with medication use during pregnancy with only small differences across the diseases. Knowing pregnant women's beliefs could help identify women who are reluctant to use medication and could guide counselling to support making well-informed treatment decisions.
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Affiliation(s)
- Sonia Roldan Munoz
- Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Angela Lupattelli
- Pharmaco Epidemiology and Drug Safety Research Group, Department of Pharmacy, University of Oslo, Oslo, Norway
| | - Sieta T de Vries
- Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Peter G M Mol
- Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Hedvig Nordeng
- Pharmaco Epidemiology and Drug Safety Research Group, Department of Pharmacy, University of Oslo, Oslo, Norway
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Burkill S, Vattulainen P, Geissbuehler Y, Sabido Espin M, Popescu C, Suzart-Woischnik K, Hillert J, Artama M, Verkkoniemi-Ahola A, Myhr KM, Cnattingius S, Korhonen P, Montgomery S, Bahmanyar S. The association between exposure to interferon-beta during pregnancy and birth measurements in offspring of women with multiple sclerosis. PLoS One 2019; 14:e0227120. [PMID: 31887199 PMCID: PMC6936848 DOI: 10.1371/journal.pone.0227120] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 12/11/2019] [Indexed: 01/12/2023] Open
Abstract
Background Interferon-beta (IFN-beta) is a commonly used treatment for multiple sclerosis (MS). Current guidelines recommend cessation of treatment during pregnancy, however the results of past studies on the safety of prenatal exposure to IFN-beta have been conflicting. A large scale study of a population of MS women is therefore warranted. Objectives To assess whether, among those born to women with MS, infants prenatally exposed to IFN-beta show evidence of smaller size at birth relative to infants which were not prenatally exposed to any MS disease modifying drugs. Methods Swedish and Finnish register data was used. Births to women with MS in Sweden and Finland between 2005–2014 for which a birth measurement for weight, height, and head circumference was available were included. The exposure window was from 6 months prior to LMP to the end of pregnancy. Results In Sweden, 411 pregnancies were identified as exposed to IFN-beta during the exposure window, and 835 pregnancies were counted as unexposed to any MS DMD. The corresponding numbers for Finland were 232 and 331 respectively. Infants prenatally exposed to interferon-beta were on average 28 grams heavier (p = 0.17), 0.01 cm longer (p = 0.95), and had head circumferences 0.14 cm larger (p = 0.13) in Sweden. In Finland, infants were 50 grams lighter (p = 0.27), 0.02 cm shorter (p = 0.92) and had head circumferences 0.22 cm smaller (p = 0.15) relative to those unexposed. Conclusions This study provides evidence that exposure to IFN-beta during pregnancy does not influence birth weight, length, or head circumference.
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Affiliation(s)
- Sarah Burkill
- Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | | | | | | | | | | | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Miia Artama
- National Institute for Health and Welfare, Helsinki, Finland
| | | | - Kjell-Morten Myhr
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Sven Cnattingius
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | | | - Scott Montgomery
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Clinical Epidemiology and Biostatistics School of Medical Sciences, Örebro University, Örebro, Sweden
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Shahram Bahmanyar
- Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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16
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Abstract
Introduction Patients with hypothyroidism are managed with life-long levothyroxine (LT4) therapy. However, as with other chronic illnesses, drug adherence (DA) is a prominent issue in these patients. The aim of this study is to identify the extent of DA to LT4 in hypothyroidism patients and study the clinical factors contributing to DA in these patients. Methods This cross-sectional study assessed patient adherence to LT4 therapy by Modified Morisky Adherence Scale (MMAS). Factors predicting the pattern of medication adherence were also assessed in all patients. Data were entered and analyzed using SPSS v. 22.0. Results On MMAS, 79 (27.3%) participants indicated low adherence, 117 (40.48%) indicated medium adherence, and 93 (32.2%) participants indicated high adherence. Regular endocrinologist visits and knowledge about medication were highest in high adherent patients (p < 0.05). Need for assistance in taking medication, avoidance of medication with symptomatic relief and busy work schedule was highest in low adherent patients (p < 0.05). Conclusion Patients with hypothyroidism showed moderate adherence to their treatment.
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Affiliation(s)
- Rohan Kumar
- Medical Education and Simulation, Jinnah Sindh Medical University, Karachi, PAK
| | - Faizan Shaukat
- Internal Medicine, Jinnah Postgraduate Medical Center, Karachi, PAK
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17
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Beliefs about medicines and information needs among pregnant women visiting a tertiary hospital in Belgium. Eur J Clin Pharmacol 2019; 75:995-1003. [PMID: 30834472 DOI: 10.1007/s00228-019-02653-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 02/20/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To explore beliefs about medicines and information needs among pregnant women visiting a tertiary hospital in Belgium and to identify patient characteristics associated with beliefs about medicines. METHODS A cross-sectional study was performed at the outpatient obstetrics clinic of the University Hospital Leuven, Belgium, between December 2016 and March 2017. All pregnant women ≥ 18 years were invited to complete a web survey. The survey consisted of general and pregnancy-specific statements of the "Beliefs about Medicines" questionnaire and questions about information needs. Descriptive statistics, chi-square tests, Fisher's exact tests, and multinomial logistic regression were used to analyze the findings. RESULTS In total, 372 pregnant women participated. Most women showed positive attitudes towards medicines in general. However, almost 90% of women agreed to have a higher threshold to use medicines during pregnancy compared with non-pregnant situations. Likewise, 40% preferred natural remedies during pregnancy. Education in healthcare and education level were the main determinants associated with beliefs, with highly educated women showing a higher threshold to use medicines during pregnancy (p = 0.005). Most women searched online for pregnancy-related information (85%) and for information about medicines (74%). However, less than one-third discussed online-retrieved information with healthcare professionals (HCPs). CONCLUSIONS Pregnant women visiting a tertiary hospital in Belgium showed a higher threshold to use medicines during pregnancy compared with non-pregnant situations and had high information needs, including for information about medicines during pregnancy. HCPs should be aware of women's individual beliefs, guide them towards reliable websites, and discuss online-retrieved information during counseling.
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18
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Frank AS, Lupattelli A, Nordeng H. Risk factors for discontinuation of thyroid hormone replacement therapy in early pregnancy: a study from the Norwegian Mother and Child Cohort Study and the Medical Birth Registry of Norway. Acta Obstet Gynecol Scand 2018. [PMID: 29512826 DOI: 10.1111/aogs.13339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Approximately 3-5% of pregnant women have hypothyroidism. Despite the potential impact of untreated hypothyroidism on infant neurodevelopment, few studies have investigated the risk factors associated with discontinuation of thyroid hormone replacement therapy (THRT) in pregnancy. We aimed to identify such factors in a population of women using THRT prior to pregnancy. MATERIAL AND METHODS Data from the Norwegian Mother and Child Cohort Study were linked to records in the Medical Birth Registry of Norway. Pregnant women with hypothyroidism prior to pregnancy were categorized as discontinuers or continuers of THRT in pregnancy. The main analysis used generalized estimating equations based on multiply imputed data. RESULTS Of 86 848 enrolled pregnant women, 2720 (3.2%) had a medically confirmed thyroid disorder and/or reported use of thyroid therapy. More than half (n = 1587; 57.8%) used THRT prior to pregnancy; of these, 207 (13.0%) discontinued and 1380 (86.9%) continued THRT during early pregnancy. Having a non-medicated mental disorder [odds ratio (OR) 1.64, 95% CI 1.03-2.63] and non-compliance with recommended nutritional supplementation (OR 2.51, 95% CI 1.82-3.47) increased the odds of discontinuing THRT. Women medicated for somatic comorbidities (OR 0.56, 95% CI 0.33-0.98) had a 44% decreased odds of discontinuing THRT. CONCLUSIONS In Norway, around 13% of women with hypothyroidism discontinue THRT in early pregnancy. For discontinuers, non-medicated mental comorbidity and non-compliance with nutritional supplements presented increased risk, whereas having a medicated somatic disorder was protective. Health professionals advising women with hypothyroidism should be aware of risk factors associated with THRT discontinuation.
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Affiliation(s)
- Anna S Frank
- Pharmacoepidemiology and Drug Safety Research Group, School of Pharmacy, University of Oslo, Oslo, Norway
| | - Angela Lupattelli
- Pharmacoepidemiology and Drug Safety Research Group, School of Pharmacy, University of Oslo, Oslo, Norway
| | - Hedvig Nordeng
- Pharmacoepidemiology and Drug Safety Research Group, School of Pharmacy, University of Oslo, Oslo, Norway.,Department of Child Health and Development, National Institute of Public Health, Oslo, Norway
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Abstract
Thyroid hormones play a pivotal role in somatic growth, metabolic regulation and neurodevelopment. There is growing evidence regarding adverse obstetric and perinatal consequences of maternal thyroid hypofunction during early stages of pregnancy. These include: early pregnancy loss, preterm delivery and lower intelligence quotient (IQ) in children. Different clinical guidelines have been published by scientific societies for the management of thyroid diseases during pregnancy and levothyroxine (LT4) has become a therapeutic agent increasingly prescribed by obstetricians. The aim of this work was to search for both similarities and controversial clinical aspects from the currently available literature. Guidelines published from 2011 onwards have been analysed and compared, in order to clarify the evidence about the involvement of thyroid dysfunction in pregnancy complications and the impact of LT4 use in their prevention and/or treatment. This review summarizes the most updated knowledge about the effectiveness of LT4 for pregnancy complications, the current recommendations and its application into clinical practice. KEY MESSAGES The use of levothyroxine in obstetric practices requires a correct diagnosis and to consider the specific recommendations for each thyroid dysfunction entity. The effectiveness and safety of levothyroxine treatment in preventing adverse perinatal events in pregnant women with clinical hypothyroidism is supported by all the current guidelines. Levothyroxine therapy is strongly recommended in all cases of overt hypothyroidism and in cases of subclinical hypothyroidism associated to positive thyroid autoimmunity.
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Affiliation(s)
- Inés Velasco
- a Pediatrics, Gynecology & Obstetrics Unit , Riotinto Hospital , Huelva , Spain
| | - Peter Taylor
- b Thyroid Research Group , Systems Immunity Research Institute, Cardiff University School of Medicine , Cardiff , UK
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20
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Velasco I, Taylor P. Identifying and treating subclinical thyroid dysfunction in pregnancy: emerging controversies. Eur J Endocrinol 2018; 178:D1-D12. [PMID: 29070512 DOI: 10.1530/eje-17-0598] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 10/13/2017] [Accepted: 10/25/2017] [Indexed: 01/25/2023]
Abstract
Thyroid hormones are essential for an adequate growth and development of the fetus. In addition to the classical association between maternal hypothyroidism and neurological impairment in the progeny, other adverse reproductive events have been associated with maternal thyroid dysfunction including infertility, miscarriage and preterm delivery. Although all scientific societies endorse the treatment of overt hypothyroidism; the management and/or treatment of subclinical hypothyroidism, hypothyroxinemia or antithyroid antibody-positive women should be considered with caution. Important trials have found no clear benefit of treatment of subclinical hypothyroidism in terms of cognitive outcomes; however, other interventional studies appear to reduce some of the obstetric and perinatal complications. As a result, the dilemma between universal screening or selective screening of women at high risk of thyroid dysfunction during pregnancy remains unresolved. Despite this, levothyroxine is also now regularly prescribed by gynaecologists and centres for reproductive medicine. In this context, there is increasing concern regarding the risk of over diagnosis and subsequent potential overtreatment. Taken together, we need to reconsider how thyroid dysfunction should be identified in pregnant women and highlight the arguments for and against the use of levothyroxine in obstetric practices. Our main findings: the mismatch between the guidelines recommendations and the use of LT4 in clinical settings as well as the disparity of criteria between scientific societies from different medical specialties. In conclusion, it is essential to reach agreements between both endocrinologists and obstetricians.
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Affiliation(s)
- Inés Velasco
- Pediatrics, Gynecology & Obstetrics Unit, Riotinto Hospital, Huelva, Spain
| | - Peter Taylor
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, UK
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Cappelli C, Castello R, Marini F, Paoletta A, Marchetti M, Saullo M, Cristiano A, Pirola I, Gandossi E, Ferlin A, Castellano M. Adherence to Levothyroxine Treatment Among Patients With Hypothyroidism: A Northeastern Italian Survey. Front Endocrinol (Lausanne) 2018; 9:699. [PMID: 30532737 PMCID: PMC6265311 DOI: 10.3389/fendo.2018.00699] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 11/06/2018] [Indexed: 11/13/2022] Open
Abstract
Background: A significant number of patients show sub-optimal adherence to levothyroxine (LT4) therapy, mainly because they have to postpone their breakfast by at least 30 min. The aim of this observational cross-sectional study was to assess the therapeutic compliance of patients on LT4 treatment and to verify the preference of a lifetime treatment in tablet or liquid form. Patients and Methods: Ambulatory care patients aged 18 years or older, affected by hypothyroidism and on LT4 treatment (in tablet or liquid form) were administered the eight-item Morisky Medication Adherence Scale (MMAS-8). The MMAS-8 questionnaire was supplemented with 3 further items to specifically evaluate preference between tablet and liquid forms of LT4 for lifetime treatment. Results: A total of 320 patients (272 female), median age 47.9 ± 15.6 years (range, 20-78 years), completed the MMAS-8 questionnaire. Eighty-seven percent of the participants were adhering to their treatment for both tablet and liquid LT4 formulations, although significant differences emerged. Patients on LT4 tablets forgot to take their medication more frequently (p < 0.001), felt hassled about sticking to their treatment plan (p < 0.001), and had difficulty remembering to take all their medication(s) (p < 0.001) than those on liquid LT4 treatment. Conclusions: Adherence to LT4 treatment was high for both tablet and liquid formulations. Taking LT4 at breakfast was the most convenient option for most patients.
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Affiliation(s)
- Carlo Cappelli
- Department of Clinical and Experimental Sciences, SSD Medicina ad Indirizzo Endocrino-Metabolico, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
- *Correspondence: Carlo Cappelli
| | - Roberto Castello
- General Medicine and Endocrinology, University Hospital, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Fiorella Marini
- Department of Clinical and Experimental Sciences, SSD Medicina ad Indirizzo Endocrino-Metabolico, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Agostino Paoletta
- Endocrinology Outpatient Service, Azienda ULSS 6 Euganea, Cittadella, Italy
| | - Massimo Marchetti
- General Medicine and Endocrinology, Ospedale Bassano del Grappa, Bassano del Grappa, Italy
| | - Maura Saullo
- Department of Clinical and Experimental Sciences, SSD Medicina ad Indirizzo Endocrino-Metabolico, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Alessandra Cristiano
- Department of Clinical and Experimental Sciences, SSD Medicina ad Indirizzo Endocrino-Metabolico, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Ilenia Pirola
- Department of Clinical and Experimental Sciences, SSD Medicina ad Indirizzo Endocrino-Metabolico, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Elena Gandossi
- Department of Clinical and Experimental Sciences, SSD Medicina ad Indirizzo Endocrino-Metabolico, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Alberto Ferlin
- Department of Clinical and Experimental Sciences, SSD Medicina ad Indirizzo Endocrino-Metabolico, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Maurizio Castellano
- Department of Clinical and Experimental Sciences, SSD Medicina ad Indirizzo Endocrino-Metabolico, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
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