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Bernardi FR, Lucion MK, Dalle Mole R, Machado TD, Loreto BBL, Farias BL, Reis TM, Reis RS, Bigonha SM, Peluzio MDCG, Arcego DM, Dalmaz C, Silveira PP. Relationship between maternal biological features, environmental factors, and newborn neuromotor development associated with visual fixation abilities. Brain Cogn 2024; 180:106202. [PMID: 38991360 DOI: 10.1016/j.bandc.2024.106202] [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: 01/16/2024] [Revised: 06/30/2024] [Accepted: 07/01/2024] [Indexed: 07/13/2024]
Abstract
Newborn visual fixation abilities predict future cognitive, perceptive, and motor skills. However, little is known about the factors associated with the newborn visual fixation, which is an indicator of neurocognitive abilities. We analyzed maternal biological and environmental characteristics associated with fine motor skills (visual tracking) in 1 month old infants. Fifty-one infants were tested on visual tracking tasks (Infant Visuomotor Behavior Assessment Scale/ Guide for the Assessment of Visual Ability in Infants) and classified according to visual conducts scores. Differences between groups were compared considering motor development (Alberta Infant Motor Scale) maternal mental health (Edinburgh Postnatal Depression Scale and Hamilton Anxiety Scale); home environment (Affordances in the Home Environment for Development Scale); maternal care (Coding Interactive Behavior); breastmilk composition (total fatty acids, proteins, and cortisol); and maternal metabolic profile (serum hormones and interleukins). Mothers of infants with lower visual fixation scores had higher levels of protein in breastmilk at 3 months. Mothers of infants with better visual conduct scores had higher serum levels of T4 (at 1 month) and prolactin (at 3 months). There were no associations between visual ability and motor development, home environment, or maternal care. Early newborn neuromotor development, especially visual and fine motor skills, is associated with maternal biological characteristics (metabolic factors and breastmilk composition), highlighting the importance of early detection of maternal metabolic changes for the healthy neurodevelopment of newborns.
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Affiliation(s)
- Fernanda Rombaldi Bernardi
- Programa de Pós-Graduação em Neurociências, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Unidade de Terapia Intensiva Neonatal do Hospital Universitário Polydoro Ernani de São Thiago, Universidade Federal de Santa Catarina, EBSERH, Florianópolis, SC, Brazil
| | - Marta Knijnik Lucion
- Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Roberta Dalle Mole
- Department of Psychiatry, Faculty of Medicine, McGill University and Ludmer Centre for Neuroinformatics and Mental Health, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| | - Tania Diniz Machado
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Bruna Luciano Farias
- Faculdade de Fisioterapia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Tatiane Madeira Reis
- Faculdade de Biomedicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Roberta Sena Reis
- Faculdade de Nutrição, Universidade Federal de Goiás, Goiânia, Brazil
| | - Solange Mara Bigonha
- Programa de Pós-Graduação em Ciência da Nutrição, Departamento de Nutrição e Saúde, Universidade Federal de Viçosa, Brazil
| | - Maria do Carmo Gouveia Peluzio
- Programa de Pós-Graduação em Ciência da Nutrição, Departamento de Nutrição e Saúde, Universidade Federal de Viçosa, Brazil
| | - Danusa Mar Arcego
- Programa de Pós-Graduação em Neurociências, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Department of Psychiatry, Faculty of Medicine, McGill University and Ludmer Centre for Neuroinformatics and Mental Health, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| | - Carla Dalmaz
- Programa de Pós-Graduação em Neurociências, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Patrícia Pelufo Silveira
- Programa de Pós-Graduação em Neurociências, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Department of Psychiatry, Faculty of Medicine, McGill University and Ludmer Centre for Neuroinformatics and Mental Health, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada.
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Wei W, Liu A, Liu M, Li M, Wu X, Qin C, Shan Z, Zhang L. Development of an animal model of hypothyroxinemia during pregnancy in Wistar rats. Animal Model Exp Med 2024. [PMID: 38946346 DOI: 10.1002/ame2.12459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 05/21/2024] [Indexed: 07/02/2024] Open
Abstract
BACKGROUND Hypothyroxinemia is a subclinical thyroid hormone deficiency in which the mother has inadequate levels of T4 during pregnancy. The fetus relies entirely on the mother's T4 hormone level for early neurodevelopment. Isolated maternal hypothyroxinemia (IMH) in the first trimester of pregnancy can lead to lower intelligence, lower motor scores, and a higher risk of mental illness in descendants. Here, we focus on the autism-like behavior of IMH offspring. METHODS The animals were administered 1 ppm of propylthiouracil (PTU) for 9 weeks. Then, the concentrations of T3, T4, and thyroid-stimulating hormone (TSH) were detected using enzyme-linked immunosorbent assay (ELISA) to verify the developed animal model of IMH. We performed four behavioral experiments, including the marble burying test, open-field test, three-chamber sociability test, and Morris water maze, to explore the autistic-like behavior of 40-day-old offspring rats. RESULTS The ELISA test showed that the serum T3 and TSH concentrations in the model group were normal compared with the negative control group, whereas the T4 concentration decreased. In the behavioral experiments, the number of hidden marbles in the offspring of IMH increased significantly, the frequency of entering the central compartment decreased, and the social ratio decreased significantly. CONCLUSION The animal model of IMH was developed by the administration of 1 ppm of PTU for 9 weeks, and there were autistic-like behavior changes such as anxiety, weakened social ability, and repeated stereotyping in the IMH offspring by 40 days.
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Affiliation(s)
- Wei Wei
- School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Aihua Liu
- Department of Endocrinology and Metabolism, Peking University Third Hospital, Beijing, China
| | - Min Liu
- Institute of Laboratory Animal Sciences, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC), Beijing, China
| | - Mingfeng Li
- Institute of Laboratory Animal Sciences, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC), Beijing, China
| | - Xinghan Wu
- Institute of Laboratory Animal Sciences, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC), Beijing, China
| | - Chuan Qin
- School of Public Health, North China University of Science and Technology, Tangshan, China
- Institute of Laboratory Animal Sciences, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC), Beijing, China
| | - Zhongyan Shan
- Department of Endocrinology and Metabolism, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, Institute of Endocrinology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Ling Zhang
- Institute of Laboratory Animal Sciences, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC), Beijing, China
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Li X, Zhang Z, Cai W, Zhou X, Zhang Y, Wu C, Xu X, Wu H. Association Between Serum Ferritin Levels in Early Pregnancy and Thyroid Function and Pregnancy Outcomes in Chinese Population. Int J Womens Health 2023; 15:1951-1957. [PMID: 38106565 PMCID: PMC10723073 DOI: 10.2147/ijwh.s436651] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/22/2023] [Indexed: 12/19/2023] Open
Abstract
Background The relationship of iron deficiency and thyroid hormone has been researched a lot among pregnant or other healthy population. However, invisible iron deficiency, namely shortage of serum ferritin (sFer) level, has been barely investigated among Chinese pregnant women. This study aimed to explore the effects of sFer status on thyroid function and pregnancy outcomes in a population-based upper first-class hospital. Methods A total of 781 singleton pregnant women of gestation in Shanghai General Hospital took part in this retrospective cohort study. The participants were divided into four groups by quartiles of serum ferritin levels (Q1-4). Binary logistic regressions were used to examine the strength of association between the different traits and the serum ferritin (sFer) quartiles separately, where Q1 (lowest ferritin quartile) was taken as the base reference. One-way ANOVA was adopted to compare the averages of the different variables across sFer quartiles. Categorical measures were compared by Fisher exact test or chi-square test. Results As the sFer concentration rises, incidence of premature birth (15.8%vs 12.3% vs 9.20% vs 6.20% p = 0.016) as well as threatened miscarriage (14.8% vs 7.2% vs 8.70% vs 6.70% p = 0.021) presented a downward trend. Compared with the other sFer group, subjects of the low sFer group were older, more often to be found to have lower serum γT3 and FT4 levels in early pregnancy but not in middle pregnancy. Conclusion sFer concentration in the first trimester can affect thyroid function. The correction of invisible iron deficiency with inadequate sFer status prior to pregnancy or during early pregnancy is imperative, not only to prevent anemia, but also for maintaining optimum thyroid function and normal fetal development. For clinicians, sFer status of pregnant women should be attached great importance apart from attention to iron level.
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Affiliation(s)
- Xing Li
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, People’s Republic of China
| | - Zhuyuan Zhang
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, People’s Republic of China
| | - Wen Cai
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, People’s Republic of China
| | - Xuexin Zhou
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, People’s Republic of China
| | - Yan Zhang
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, People’s Republic of China
| | - Cailiang Wu
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, People’s Republic of China
| | - Xianming Xu
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, People’s Republic of China
| | - Hao Wu
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, People’s Republic of China
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Rannaud-Bartaire P, Fini JB. [Disruptors of thyroid hormones: Which consequences for human health and environment?]. Biol Aujourdhui 2023; 217:219-231. [PMID: 38018950 DOI: 10.1051/jbio/2023036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Indexed: 11/30/2023]
Abstract
Endocrine disruptors (EDs) of chemical origin are the subject of numerous studies, some of which have led to measures aimed at limiting their use and their impact on the environment and human health. Dozens of hormones have been described and are common to all vertebrates (some chemically related messengers have also been identified in invertebrates), with variable roles that are not always known. The effects of endocrine disruptors therefore potentially concern all animal species via all endocrine axes. These effects are added to the other parameters of the exposome, leading to strong, multiple and complex adaptive pressures. The effects of EDs on reproductive and thyroid pathways have been among the most extensively studied over the last 30 years, in a large number of species. The study of the effects of EDs on thyroid pathways and brain development goes hand in hand with increasing knowledge of 1) the different roles of thyroid hormones at cellular or tissue level (particularly developing brain tissue) in many species, 2) other hormonal pathways and 3) epigenetic interactions. If we want to understand how EDs affect living organisms, we need to integrate results from complementary scientific fields within an integrated, multi-model approach (the so-called translational approach). In the present review article, we aim at reporting recent discoveries and discuss prospects for action in the fields of medicine and research. We also want to highlight the need for an integrated, multi-disciplinary approach to studying impacts and taking appropriate action.
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Affiliation(s)
- Patricia Rannaud-Bartaire
- Laboratoire PHYMA, MNHN, UMR 7221, 7 rue Cuvier, 75005 Paris, France - Hôpital Saint-Vincent-De-Paul, GHICL, boulevard de Belfort, 59000 Lille, France
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Zhuo L, Wang Z, Yang Y, Liu Z, Wang S, Song Y. Obstetric and offspring outcomes in isolated maternal hypothyroxinaemia: a systematic review and meta-analysis. J Endocrinol Invest 2022; 46:1087-1101. [PMID: 36422828 DOI: 10.1007/s40618-022-01967-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/12/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine the association between isolated maternal hypothyroxinaemia (IMH) and adverse obstetric outcomes and offspring outcomes and also investigate the effects of levothyroxine therapy on IMH for the above outcomes. METHODS We systematically searched PubMed, EMBASE, and Cochrane Library, and the reference lists of key reviews were hand searched on June 9, 2021. Two authors independently screened titles/abstracts. Full articles were further assessed if the information suggested that the study met the inclusion/exclusion criteria, and two researchers performed data extraction and risk-of-bias assessment using standardized tables. Summary relative risks or the mean difference between maternal effects and offspring outcomes were calculated by a random-effects model. RESULTS We identified 38 eligible articles (35 cohort studies and two randomized controlled trials [RCT]). Meta-analysis showed that maternal IMH was associated with increased gestational diabetes mellitus, preterm premature rupture of membranes, preterm birth, fetal distress, and macrosomia outcomes in IMH compared to euthyroid women, and the relative risks were 1.42 (1.03-1.96), 1.50 (1.05-2.14), 1.33 (1.15-1.55), 1.75 (1.16-2.65) and 1.62 (1.35-1.94), respectively. IMH was not associated with placenta previa, gestational hypertension, pre-eclampsia, intrauterine growth restriction, and offspring outcomes like birth weight, low birth weight infants, fetal macrosomia, neonatal intensive care, neonatal death, or fetal head circumference. In addition, we did not find an association between IMH and adverse offspring cognitive defects. Due to insufficient data for meta-analysis, it failed to pool the evidence of levothyroxine's therapeutic effect on IMH and their offspring. CONCLUSIONS AND RELEVANCE IMH in pregnancy may relate to a few maternal and offspring outcomes. Moreover, there is currently no sufficient evidence that levothyroxine treatment during pregnancy reduces adverse maternal outcomes and disability in offspring. Further investigation to explore the beneficial effects of levothyroxine therapy is warranted.
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Affiliation(s)
- L Zhuo
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, People's Republic of China
| | - Z Wang
- Department of Endocrinology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China
- Shandong Institute of Endocrine and Metabolic Diseases, Jinan, Shandong, People's Republic of China
| | - Y Yang
- Department of Endocrinology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China
- Shandong Institute of Endocrine and Metabolic Diseases, Jinan, Shandong, People's Republic of China
| | - Z Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, People's Republic of China
| | - S Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, People's Republic of China.
| | - Y Song
- Department of Endocrinology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China.
- Shandong Institute of Endocrine and Metabolic Diseases, Jinan, Shandong, People's Republic of China.
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Abstract
Thyroid hormones are primarily responsible for regulating the basal metabolic rate but also make important contributions to reproductive function and fetal development. Both hyper- and hypothyroidism in pregnancy have been associated with increased risks of complications that include preeclampsia and low birth weight, among others. Furthermore, thyroid hormone deficiency in the developing fetus results in neurodevelopmental delay. As the fetus is exclusively reliant on maternal thyroid hormone for most of the first trimester and requires continued maternal supply until birth, identifying maternal thyroid dysfunction is critically important. However, evaluating thyroid function in pregnancy is challenging because of the many physiological changes that affect concentrations of thyroid-related analytes. Increasing plasma human chorionic gonadotropin (hCG) concentrations in the second half of the first trimester elicit a corresponding transient decrease in thyroid-stimulating hormone (TSH), and continually increasing estradiol concentrations throughout pregnancy cause substantial increases in thyroxine-binding globulin (TBG) and total thyroxine (T4) relative to the nonpregnant state. Lastly, free T4 concentrations gradually decrease with increasing gestational age. For these reasons, it is essential to interpret thyroid function test results in the context of trimester-specific reference intervals to avoid misclassification of thyroid status. This review summarizes the effects of thyroid dysfunction prior to conception and during pregnancy and describes considerations for the laboratory assessment of thyroid function in pregnant women.
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Affiliation(s)
- K Aaron Geno
- Department of Pathology, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Robert D Nerenz
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
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Liu Y, Li G, Guo N, Liu X, Huang S, Du Q. Association Between Maternal Characteristics and the Risk of Isolated Maternal Hypothyroxinemia. Front Endocrinol (Lausanne) 2022; 13:843324. [PMID: 35498400 PMCID: PMC9039333 DOI: 10.3389/fendo.2022.843324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 03/08/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE We aimed to determine the association between maternal characteristics and isolated maternal hypothyroxinemia (IMH). METHODS Pregnancies registered at Shanghai First Maternity and Infant Hospital between January 2014 and September 2020 were included in this cross-sectional study. IMH was defined as free thyroxine (FT4) levels below the 10th percentile with TSH within the normal reference range. Multivariate logistic regression models were used to identify potential risk factors for IMH, including demographic information, anthropometric measurements and nutritional status. RESULTS A total of 54586 singleton pregnancies were included, involving 6084 women with IMH and 48502 euthyroid women. Multivariate logistic regression analyses showed that the variables for women with ages ≥35 (adjusted OR = 1.30, 95% CI:1.20-1.40), non-local residence (adjusted OR = 1.16, 95% CI:1.09-1.23), multiparas (adjusted OR = 1.11, 95% CI:1.03-1.21), pre-pregnancy overweight (adjusted OR = 1.37, 95% CI:1.27-1.49) or obesity (adjusted OR = 1.35, 95% CI:1.18-1.54), and iron deficiency (adjusted OR = 1.27, 95% CI:1.20-1.35) were independent risk factors for IMH in the overall study population, which were identical to those in the first trimester subgroup. CONCLUSIONS Maternal characteristics were associated with the onset of IMH. Maternal age, residence of origin, parity, pre-pregnancy body mass index (BMI) and iron status should be comprehensively considered to evaluate the risk of IMH, according to which obstetricians could determine an optimal assessment time for thyroid function.
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Affiliation(s)
- Yang Liu
- Department of Obstetrics, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Guohua Li
- Department of Reproductive Immunology, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Nafei Guo
- Department of Nursing, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xiaosong Liu
- Department of Obstetrics, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Shijia Huang
- Department of Obstetrics, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Qiaoling Du
- Department of Obstetrics, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
- *Correspondence: Qiaoling Du,
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Moreno-Reyes R, Corvilain B, Daelemans C, Wolff F, Fuentes Peña C, Vandevijvere S. Iron Deficiency Is a Risk Factor for Thyroid Dysfunction During Pregnancy: A Population-Based Study in Belgium. Thyroid 2021; 31:1868-1877. [PMID: 34538131 DOI: 10.1089/thy.2021.0286] [Citation(s) in RCA: 9] [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: 01/01/2023]
Abstract
Background: Iron deficiency affects thyroid hormone synthesis by impairing the activity of the heme-dependent thyroid peroxidase. The prevalence of iron deficiency is elevated particularly in pregnant women. This study aimed to investigate the effects of iron status on thyroid function in a nationally representative sample of mildly iodine-deficient pregnant women. Methods: The study population comprised a sample of pregnant women in Belgium during the first and third trimesters of pregnancy (n = 1241). Women were selected according to a multistage proportional-to-size stratified and clustered sampling design. Urine and blood samples were collected, and a questionnaire was completed face to face with the study nurse. Concentrations of free thyroxine (fT4), total thyroxine (T4), free triiodothyronine, thyrotropin (TSH), thyroglobulin (Tg), thyroid peroxidase antibodies, Tg antibodies, hemoglobin, serum ferritin (SF), soluble transferrin receptor, urinary iodine concentrations (UICs) were measured and body iron stores (BIS) were calculated. Results: Median UICs were 117 and 132 μg/L in the first and third trimesters of pregnancy, respectively (p < 0.05). The frequency of SF <15 μg/L was 6.2% in the first trimester and 39.6% in the third trimester of pregnancy (p < 0.05). UIC was a significant predictor of serum Tg concentrations (p < 0.01) but not of thyroid hormone or TSH concentrations. The frequency of fT4<percentile 10th in the third trimester of pregnancy was 24% and 14% in pregnant women with negative BIS and positive BIS, respectively (p < 0.05). SF and BIS were significant predictors of fT4 and T4 in the first trimester of pregnancy (p < 0.05). Hemoglobin was a significant predictor of fT4 in both trimesters (p < 0.01) and for T4 in the third trimester (p = 0.015). Conclusion: Iron deficiency, but not mild iodine deficiency, is a determinant of serum fT4 and T4 in pregnant women. Correcting iron deficiency may help to maintain optimal thyroid function, in addition to preventing anemia during pregnancy.
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Affiliation(s)
- Rodrigo Moreno-Reyes
- Department of Nuclear Medicine, Laboratoire Hospitalier Universitaire de Bruxelles (LHUB-ULB); Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Bernard Corvilain
- Department of Endocrinology and Laboratoire Hospitalier Universitaire de Bruxelles (LHUB-ULB); Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Caroline Daelemans
- Department of Gynecology and Obstetrics, Hôpital Erasme; Laboratoire Hospitalier Universitaire de Bruxelles (LHUB-ULB); Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Fleur Wolff
- Department of Department of Clinical Chemistry, Laboratoire Hospitalier Universitaire de Bruxelles (LHUB-ULB); Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Camilo Fuentes Peña
- Department of Nuclear Medicine, Laboratoire Hospitalier Universitaire de Bruxelles (LHUB-ULB); Université Libre de Bruxelles (ULB), Brussels, Belgium
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Venugopalan L, Rajan A, Prasad HK, Sankaran A, Murugesan G, Ramanathan S. Impact of maternal thyroid disease on neonatal thyroid status. J Pediatr Endocrinol Metab 2021; 34:237-241. [PMID: 33048836 DOI: 10.1515/jpem-2020-0349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/23/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Prevalence of Maternal and congenital hypothyroidism is on the rise. To present the thyroid stimulating hormone screening results in babies born to hypothyroid mothers and assess the burden, aetiology of hypothyroidism in these babies. METHODS All antenatal mothers attending our hospital during the study period were enrolled into the study. Group I includes 249 term babies born to hypothyroid mothers and group II comprises 2154 newborns born to mothers who are euthyroid. Heel prick thyroid stimulating hormone was done for all newborns on day 3 for both groups. Confirmatory venous testing was done for all for babies in group I and screen positives belonging to group II. Evaluation and therapy done as per standard guidelines. RESULTS Thyroid stimulating hormone values in the two groups are presented. There was significant correlation between peak maternal thyroid stimulating hormone and neonatal day 3 heel prick in group I (r=0.7, P<0.05). The prevalence of positive screening test in groups I and II was 3.8 and 1.03% (p<0.05) whereas corresponding values for confirmed disease was 4.3 and 0.6%, respectively (p<0.05). Aetiological evaluation revealed both transient hypothyroidism (33.3%) and permanent hypothyroidism (66.6%). CONCLUSION 4.3% of babies born to hypothyroid mothers develop congenital hypothyroidism; aetiology being both transient and permanent. A venous test by 3 weeks is helpful in these babies to improve case identification.
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Affiliation(s)
- Lakshmi Venugopalan
- Department of Neonatology, Mehta Multispeciality Hospitals India pvt Ltd., Chetpet, Chennai, India
| | - Aishwarya Rajan
- Department of Paediatrics, Mehta Multispeciality Hospitals India pvt Ltd., Chetpet, Chennai, India
| | - Hemchand K Prasad
- Department of Paediatric Endocrinology and Diabetes, Mehta Multispeciality Hospitals India pvt Ltd., Chetpet, Chennai, India
| | - Anupama Sankaran
- Department of Paediatrics, Mehta Multispeciality Hospitals India pvt Ltd., Chetpet, Chennai, India
| | - Gnanabalan Murugesan
- Department of Neonatology, Mehta Multispeciality Hospitals India pvt Ltd., Chetpet, Chennai, India
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Ramezani Tehrani F, Nazarpour S, Behboudi-Gandevani S. Isolated maternal hypothyroxinemia and adverse pregnancy outcomes: A systematic review. J Gynecol Obstet Hum Reprod 2021; 50:102057. [PMID: 33401029 DOI: 10.1016/j.jogoh.2020.102057] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/28/2020] [Accepted: 12/29/2020] [Indexed: 02/08/2023]
Abstract
Maternal thyroid hormones are vital for a normal pregnancy and the development of fetus and childhood; inadequate availability of thyroid hormones during pregnancy is associated with adverse pregnancy outcomes. Isolated maternal hypothyroxinemia (IMH) is defined as a low maternal T4 in the absence of TSH elevation. This systematic review aimed to investigate the association between IMH and adverse pregnancy outcomes. PubMed, Scopus and Web of science were searched for retrieving observational studies published up to September 2020, investigating the association of IMH with adverse pregnancy outcomes. From a total of 308 articles, 17 met our eligibility criteria and were used for the purpose of the present study. Definition of IMH varied in different studies. While some studies reported no adverse pregnancy outcomes for IMH, other studies found a positive association between first trimester IMH and feto-maternal outcomes including gestational hypertension, gestational diabetes, preterm delivery, fetal distress, small for gestational age, musculoskeletal malformations, spontaneous abortion, placental abruption and macrosomia. IMH, identified in the second trimester was associated with an increase in the risk of gestational diabetes, and hypertensive disorders of pregnancy in one study. There is no consensus on the adverse effects of IMH on pregnancy outcomes. Further comprehensive cohort studies using one standard definition for IMH, with large sample size and control of important confounders such as iodine status and maternal Thyroid peroxidase antibody (TPOAb) are needed for precise assessment of this association.
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Affiliation(s)
- Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Sima Nazarpour
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Midwifery, Varamin - Pishva Branch, Islamic Azad University, Tehran, Iran.
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11
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Kampouri M, Margetaki K, Koutra K, Kyriklaki A, Karakosta P, Anousaki D, Chalkiadaki G, Vafeiadi M, Kogevinas M, Chatzi L. Maternal mild thyroid dysfunction and offspring cognitive and motor development from infancy to childhood: the Rhea mother-child cohort study in Crete, Greece. J Epidemiol Community Health 2020; 75:29-35. [PMID: 32907915 DOI: 10.1136/jech-2019-213309] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 05/12/2020] [Accepted: 08/12/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Maternal thyroid hormones' supply is crucial for fetal neurodevelopment; however, the role of maternal mild thyroid dysfunction is not clear. We aimed to assess the association of maternal mild thyroid dysfunction with child neuropsychological development from infancy to early childhood. METHODS We included 757 mother-child pairs from the prospective 'Rhea' cohort on Crete, Greece. Maternal thyroid functioning was assessed by quantitative analysis of serum thyroid-stimulating hormone, free thyroxine, thyroid peroxidase antibodies and thyroglobulin antibodies at early gestation (mean=14 weeks). Neuropsychological assessment was based on Bayley Scales of Infant Development (18 months of age), McCarthy Scales of Children's Abilities (4 years of age), Raven's Coloured Progressive Matrices, Trail Making Test and Finger Tapping Test (6 years of age). RESULTS In multivariate adjusted linear regression analyses, maternal hypothyroxinemia was associated with decreased verbal scores at 4 years and reduced motor speed at 6 years of age. Maternal thyroid autoimmunity was associated with decreased child perceptual and motor ability at 4 years of age. Four trajectories of longitudinal non-verbal cognitive development were identified and children exposed to maternal thyroid autoimmunity had increased risk for belonging to an adverse trajectory ('low': adjusted relative risk ratio (RRR) = 2.7 95% CI: (1.4, 5.2), 'high-decreasing': adjusted RRR = 2.2 95% CI: (1.2, 4.0), 'low-increasing': adjusted RRR = 1.8 95% CI: (1.0, 3.2)). CONCLUSION Maternal hypothyroxinemia is associated with reduced offspring verbal and motor ability. Maternal thyroid autoimmunity is associated with decreased offspring perceptual performance and motor ability and increased risk for adverse non-verbal cognitive development from infancy to childhood.
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Affiliation(s)
- Mariza Kampouri
- Department of Social Medicine, University of Crete School of Medicine, Heraklion, Greece
| | - Katerina Margetaki
- Department of Social Medicine, University of Crete School of Medicine, Heraklion, Greece
| | - Katerina Koutra
- Department of Social Medicine, University of Crete School of Medicine, Heraklion, Greece.,Department of Psychology, University of Crete School of Social Sciences, Rethimno, Greece
| | - Andriani Kyriklaki
- Department of Social Medicine, University of Crete School of Medicine, Heraklion, Greece
| | - Polyxeni Karakosta
- Department of Social Medicine, University of Crete School of Medicine, Heraklion, Greece
| | - Despoina Anousaki
- Department of Social Medicine, University of Crete School of Medicine, Heraklion, Greece
| | - Georgia Chalkiadaki
- Department of Social Medicine, University of Crete School of Medicine, Heraklion, Greece
| | - Marina Vafeiadi
- Department of Social Medicine, University of Crete School of Medicine, Heraklion, Greece
| | - Manolis Kogevinas
- Instituto de Salud Global Barcelona, Barcelona, Spain.,Hospital del Mar Institute for Medical Research, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Leda Chatzi
- Department of Social Medicine, University of Crete School of Medicine, Heraklion, Greece.,Preventive Medicine, University of Southern California, Los Angeles, California, USA.,Department of Genetics and Cell Biology, Maastricht University Faculty of Health Medicine and Life Sciences, Maastricht, Netherlands
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12
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Spann MN, Cheslack-Postava K, Brown AS. The association of serologically documented maternal thyroid conditions during pregnancy with bipolar disorder in offspring. Bipolar Disord 2020; 22:621-628. [PMID: 31758834 DOI: 10.1111/bdi.12879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Higher rates of thyroid conditions are reported in individuals with bipolar disorder. However, no study to date has considered whether maternal thyroid conditions during pregnancy are associated with offspring risk of bipolar disorder, even though the fetus exclusively relies on maternal thyroid hormones through the early second trimester. We therefore examined the association between offspring bipolar disorder and serologically documented maternal thyroid conditions. METHODS The study was based on a nested case-control design that utilized data from the Child Health and Development Study, a birth cohort that enrolled pregnant women from 1959 to 1966. Eighty-five cases with DSM-IV-TR were ascertained and matched to controls (1:2) by date of birth, sex, gestational timing of the serum draws, and residence in Alameda County the first year receiving treatment. Archived prenatal maternal serum drawn during early to mid-gestation was used to measure two thyroid hormones, free thyroxine (fT4) and thyroid stimulating hormone (TSH). Subclinical and clinical hypothyroxinemia, hypothyroidism, and hyperthyroidism were determined based on standard methods. RESULTS Exposure to maternal hypothyroxinemia was associated with a five-fold increased risk of offspring bipolar disorder with psychotic features, but not without psychotic features. In stratified analysis, female offspring demonstrated increased risk for bipolar disorder with exposure to maternal hypothyroxinemia. No significant association was found between maternal hypothyroidism and offspring bipolar disorder. CONCLUSIONS These findings suggest that prenatal thyroid hormone deficiency, particularly a thyroid condition marked by low levels of thyroxine, may be an important developmental mechanism related to the risk of bipolar disorder with psychotic features.
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Affiliation(s)
- Marisa N Spann
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Keely Cheslack-Postava
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA.,Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA
| | - Alan S Brown
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA.,Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA.,Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
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13
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Taylor PN, Muller I, Nana M, Velasco I, Lazarus JH. Indications for treatment of subclinical hypothyroidism and isolated hypothyroxinaemia in pregnancy. Best Pract Res Clin Endocrinol Metab 2020; 34:101436. [PMID: 32828674 DOI: 10.1016/j.beem.2020.101436] [Citation(s) in RCA: 12] [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: 12/20/2022]
Abstract
Thyroid hormones are essential for maintaining a pregnancy and optimal fetal neurological development. Pregnancy places additional demands on the thyroid axis and around 5% of women who have their thyroid function checked during gestation will have borderline low thyroid function (subclinical hypothyroidism or isolated hypothyroxinemia) identified. These borderline low thyroid states are associated with adverse obstetric and offspring outcomes. Whilst it is well established that overt hypothyroidism requires treatment with levothyroxine, it is less clear whether there is any benefit of treating borderline low thyroid states. This review summarizes the potential indications for treatment of subclinical hypothyroidism and isolated hypothyroxinemia.
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Affiliation(s)
- Peter N Taylor
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, CF14 4XN, UK.
| | - Ilaria Muller
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, CF14 4XN, UK; Department of Endocrinology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Melanie Nana
- Department of Diabetes and Endocrinology, Wrexham Maelor Hospital, Wrexham, LL13 7TD, UK
| | - Ines Velasco
- Pediatrics, Gynecology & Obstetrics Unit, Riotinto Hospital, Huelva, Spain
| | - John H Lazarus
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, CF14 4XN, UK
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14
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Kampouri M, Margetaki K, Koutra K, Kyriklaki A, Karakosta P, Sarri K, Anousaki D, Chalkiadaki G, Vafeiadi M, Kogevinas M, Chatzi L. Maternal mild thyroid dysfunction and child behavioral and emotional difficulties at 4 and 6 years of age: The Rhea mother-child cohort study, Crete, Greece. Horm Behav 2019; 116:104585. [PMID: 31476313 PMCID: PMC8801161 DOI: 10.1016/j.yhbeh.2019.104585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 08/11/2019] [Accepted: 08/20/2019] [Indexed: 12/21/2022]
Affiliation(s)
- Mariza Kampouri
- Department of Social Medicine, Faculty of Medicine, University of Crete, Greece.
| | - Katerina Margetaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Greece
| | - Katerina Koutra
- Department of Social Medicine, Faculty of Medicine, University of Crete, Greece
| | - Andriani Kyriklaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Greece
| | - Polyxeni Karakosta
- Department of Social Medicine, Faculty of Medicine, University of Crete, Greece
| | - Katerina Sarri
- Department of Social Medicine, Faculty of Medicine, University of Crete, Greece
| | - Despoina Anousaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Greece
| | - Georgia Chalkiadaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Greece
| | - Marina Vafeiadi
- Department of Social Medicine, Faculty of Medicine, University of Crete, Greece
| | - Manolis Kogevinas
- Instituto de Salud Global Barcelona, Spain; Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Leda Chatzi
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, USA; Department of Genetics & Cell Biology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
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15
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Systemic endocrinopathies (thyroid conditions and diabetes): impact on postnatal life of the offspring. Fertil Steril 2019; 111:1076-1091. [PMID: 31155115 DOI: 10.1016/j.fertnstert.2019.04.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 04/25/2019] [Accepted: 04/26/2019] [Indexed: 12/22/2022]
Abstract
Fetal programming may influence childhood and adult life, determining the risk of specific diseases. During earlier stages of pregnancy, the transfer of maternal thyroid hormones to the fetus is vital for adequate neurologic development. The presence of severe maternal thyroid dysfunction, particularly severe iodine deficiency, is devastating, leading to irreversible neurologic sequelae. Moreover, mild maternal thyroid conditions, such as a mild-to-moderate iodine deficiency, may also lead to milder neurologic and behavioral conditions later during the life of the offspring. Maternal dysglycemia due to pregestational or gestational diabetes mellitus is another common situation in which fetal development encounters a hostile environment. Hyperglycemia in utero may trigger metabolic conditions in the offspring, including abnormalities of glucose tolerance and weight excess. Physicians assisting pregnant women have to be aware about these conditions, because they may go unnoticed if not properly screened. Because an early diagnosis and appropriate management may prevent most of the possible negative consequences for the progeny, the prevention, early diagnosis, and proper management of these endocrine conditions should be offered to all women undergoing pregnancy. Here, we comprehensively review the current evidence about the effects of maternal thyroid dysfunction and maternal dysglycemia on the cognitive function and carbohydrate metabolism in the offspring, two prevalent conditions of utmost importance for the child's health and development.
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16
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Noyes PD, Friedman KP, Browne P, Haselman JT, Gilbert ME, Hornung MW, Barone S, Crofton KM, Laws SC, Stoker TE, Simmons SO, Tietge JE, Degitz SJ. Evaluating Chemicals for Thyroid Disruption: Opportunities and Challenges with in Vitro Testing and Adverse Outcome Pathway Approaches. ENVIRONMENTAL HEALTH PERSPECTIVES 2019; 127:95001. [PMID: 31487205 PMCID: PMC6791490 DOI: 10.1289/ehp5297] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 07/01/2019] [Accepted: 08/13/2019] [Indexed: 05/19/2023]
Abstract
BACKGROUND Extensive clinical and experimental research documents the potential for chemical disruption of thyroid hormone (TH) signaling through multiple molecular targets. Perturbation of TH signaling can lead to abnormal brain development, cognitive impairments, and other adverse outcomes in humans and wildlife. To increase chemical safety screening efficiency and reduce vertebrate animal testing, in vitro assays that identify chemical interactions with molecular targets of the thyroid system have been developed and implemented. OBJECTIVES We present an adverse outcome pathway (AOP) network to link data derived from in vitro assays that measure chemical interactions with thyroid molecular targets to downstream events and adverse outcomes traditionally derived from in vivo testing. We examine the role of new in vitro technologies, in the context of the AOP network, in facilitating consideration of several important regulatory and biological challenges in characterizing chemicals that exert effects through a thyroid mechanism. DISCUSSION There is a substantial body of knowledge describing chemical effects on molecular and physiological regulation of TH signaling and associated adverse outcomes. Until recently, few alternative nonanimal assays were available to interrogate chemical effects on TH signaling. With the development of these new tools, screening large libraries of chemicals for interactions with molecular targets of the thyroid is now possible. Measuring early chemical interactions with targets in the thyroid pathway provides a means of linking adverse outcomes, which may be influenced by many biological processes, to a thyroid mechanism. However, the use of in vitro assays beyond chemical screening is complicated by continuing limits in our knowledge of TH signaling in important life stages and tissues, such as during fetal brain development. Nonetheless, the thyroid AOP network provides an ideal tool for defining causal linkages of a chemical exerting thyroid-dependent effects and identifying research needs to quantify these effects in support of regulatory decision making. https://doi.org/10.1289/EHP5297.
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Affiliation(s)
- Pamela D Noyes
- National Center for Environmental Assessment, Office of Research and Development (ORD), U.S. Environmental Protection Agency (EPA), Washington, DC, USA
| | - Katie Paul Friedman
- National Center for Computational Toxicology, ORD, U.S. EPA, Research Triangle Park, North Carolina, USA
| | - Patience Browne
- Environment Health and Safety Division, Environment Directorate, Organisation for Economic Co-operation and Development (OECD), Paris, France
| | - Jonathan T Haselman
- Mid-Continent Ecology Division, National Health and Environmental Effects Research Laboratory (NHEERL), ORD, U.S. EPA, Duluth, Minnesota, USA
| | - Mary E Gilbert
- Toxicity Assessment Division, NHEERL, ORD, U.S. EPA, Research Triangle Park, North Carolina, USA
| | - Michael W Hornung
- Mid-Continent Ecology Division, National Health and Environmental Effects Research Laboratory (NHEERL), ORD, U.S. EPA, Duluth, Minnesota, USA
| | - Stan Barone
- Office of Pollution Prevention and Toxics, Office of Chemical Safety and Pollution Prevention, U.S. EPA, Washington, DC, USA
| | - Kevin M Crofton
- National Center for Computational Toxicology, ORD, U.S. EPA, Research Triangle Park, North Carolina, USA
| | - Susan C Laws
- Toxicity Assessment Division, NHEERL, ORD, U.S. EPA, Research Triangle Park, North Carolina, USA
| | - Tammy E Stoker
- Toxicity Assessment Division, NHEERL, ORD, U.S. EPA, Research Triangle Park, North Carolina, USA
| | - Steven O Simmons
- National Center for Computational Toxicology, ORD, U.S. EPA, Research Triangle Park, North Carolina, USA
| | - Joseph E Tietge
- Mid-Continent Ecology Division, National Health and Environmental Effects Research Laboratory (NHEERL), ORD, U.S. EPA, Duluth, Minnesota, USA
| | - Sigmund J Degitz
- Mid-Continent Ecology Division, National Health and Environmental Effects Research Laboratory (NHEERL), ORD, U.S. EPA, Duluth, Minnesota, USA
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17
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Remaud S, Demeneix B. [Thyroid hormones regulate neural stem cell fate]. Biol Aujourdhui 2019; 213:7-16. [PMID: 31274098 DOI: 10.1051/jbio/2019007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Indexed: 01/02/2023]
Abstract
Thyroid hormones (THs) are vital for vertebrate brain function throughout life, from early development to ageing. Epidemiological studies show an adequate supply of maternal TH during pregnancy to be necessary for normal brain development, and this from the first trimester of onwards. Maternal TH deficiency irreversibly affects fetal brain development, increasing the risk of offspring cognitive disorders and IQ loss. Mammalian and non-mammalian (zebrafish, xenopus, chicken) models are useful to dissect TH-dependent cellular and molecular mechanisms governing embryonic and fetal brain development: a complex process including cell proliferation, survival, determination, migration, differentiation and maturation of neural stem cells (NSCs). Notably, rodent models have strongly contributed to understand the key neurogenic roles of TH still at work in adult life. Neurogenesis continues in two main areas, the sub-ventricular zone lining the lateral ventricles (essential for olfaction) and the sub-granular zone in the dentate gyrus of the hippocampus (involved in memory, learning and mood control). In both niches, THs tightly regulate the balance between neurogenesis and oligodendrogenesis under physiological and pathological contexts. Understanding how THs modulate NSCs determination toward a neuronal or a glial fate throughout life is a crucial question in neural stem cell biology. Providing answers to this question can offer therapeutic strategies for brain repair, notably in neurodegenerative diseases, demyelinating diseases or stroke where new neurons and/or oligodendrocytes are required. The review focuses on TH regulation of NSC fate in mammals and humans both during development and in the adult.
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Affiliation(s)
- Sylvie Remaud
- Muséum National d'Histoire Naturelle, CNRS UMR 7221, Laboratoire Physiologie moléculaire de l'adaptation, 7 rue Cuvier 75005 Paris, France
| | - Barbara Demeneix
- Muséum National d'Histoire Naturelle, CNRS UMR 7221, Laboratoire Physiologie moléculaire de l'adaptation, 7 rue Cuvier 75005 Paris, France
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18
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Fini JB, Demeneix B. [Thyroid disruptors and their consequences on brain development and behavior]. Biol Aujourdhui 2019; 213:17-26. [PMID: 31274099 DOI: 10.1051/jbio/2019009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Indexed: 06/09/2023]
Abstract
An increase in the prevalence of many diseases affecting the nervous system in both children and adults has been reported. Some of these diseases are related to endocrine dysfunction, notably of the thyroid axis. Examples in children are attention deficit/hyperactivity disorders and Autism Spectrum Disorders, diagnosed but most often affecting the whole life, and multiple sclerosis or Alzheimer's disease in adults. It is becoming increasingly clear that embryonic exposure to thyroid hormone disruptors can lead to short- and long-term consequences, that often escape conventional neonatal diagnosis. Endocrine disruptors comprise a wide range of molecules, plasticizers, some pesticides, surfactants, flame-retardants, etc., many of which can interfere with thyroid hormone synthesis or their actions. We here report briefly the history of endocrine disruptors, their properties and the consequences on neuronal development of embryonic exposure to some of them.
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Affiliation(s)
- Jean-Baptiste Fini
- Muséum National d'Histoire Naturelle, CNRS UMR 7221, Laboratoire Physiologie moléculaire de l'adaptation, 7 rue Cuvier, 75005 Paris, France
| | - Barbara Demeneix
- Muséum National d'Histoire Naturelle, CNRS UMR 7221, Laboratoire Physiologie moléculaire de l'adaptation, 7 rue Cuvier, 75005 Paris, France
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19
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Torres-Sánchez L, Gamboa R, Bassol-Mayagoitia S, Huesca-Gómez C, Nava MP, Vázquez-Potisek JI, Yáñez-Estrada L, Mejía-Saucedo R, Blanco-Muñoz J. Para-occupational exposure to pesticides, PON1 polymorphisms and hypothyroxinemia during the first half of pregnancy in women living in a Mexican floricultural area. Environ Health 2019; 18:33. [PMID: 30975138 PMCID: PMC6460535 DOI: 10.1186/s12940-019-0470-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 03/20/2019] [Indexed: 05/30/2023]
Abstract
BACKGROUND Adequate maternal thyroxine (T4) concentrations during the first half of pregnancy are fundamental to the embryo's or fetus' neural development. Organophosphate pesticides (OP) can act as thyroid disruptors and genetic polymorphisms for paraoxonase 1 (PON1), an enzyme that detoxifies OP, could be involved in individual's susceptibility to them. We assessed the association between para-occupational exposure to pesticides, including OP, during pregnancy and maternal hypothyroxinemia, as well as the potential genetic susceptibility conferred by PON1 polymorphisms. METHODS We analyzed information from 381 healthy pregnant women (< 17 gestational weeks), who lived in a floricultural region of Mexico where pesticides, including OP, are routinely used. Women who were para-occupationally exposed to pesticides were those whose partner had an occupation involving contact with these products. Thyroid-Stimulating Hormone (TSH) and free T4 concentrations were determined using ELISA, and hypothyroxinemia was defined as free T4 concentrations <0.76 ng/dL. PON1192QR, PON155LM and PON1-108CT polymorphisms were determined through Polymerase Chain Reaction (PCR). The association between para-occupational exposure and genetic polymorphisms and hypothyroxinemia was estimated using logistic regression models. RESULTS One hundred and sixty two women (42.52%) were classified as para-occupationally exposed to pesticides. Hypothyroxinemia prevalence was 54%, and it was not significantly associated with pesticide para-occupational exposure (OR: 1.21 95% CI 0.75-1.94). Independently of para-occupational exposure, the likelihood of hypothyroxinemia was higher among women who were carriers of PON155MM than in those with PON155LL genotype (OR MM vs LL: 3.03; 95%CI 1.62, 5.70). PON1192 RR (OR RR vs QQ: 1.72; 95%CI 0.93, 3.17) and PON1-108TT (OR TT vs CC: 1.60; 95%CI 0.90, 2.70) genotypes were marginally associated with hypothyroxinemia. No significant interaction was observed between pesticides para-occupational exposure and PON1 polymorphisms. CONCLUSIONS These results suggest that PON1 polymorphisms could affect thyroid function during pregnancy in women living in areas where pesticides, including OP, are routinely used. Low exposure variability in this population, could be a possible explanation for the lack of association between para-occupational exposure and thyroid function.
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Affiliation(s)
- Luisa Torres-Sánchez
- Instituto Nacional de Salud Pública, Av. Universidad 655, Col. Sta. María Ahuacatitlán, 62100 Cuernavaca, Morelos, CP Mexico
| | - Ricardo Gamboa
- Physiology Department, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1, 14080 Mexico City, C.P Mexico
| | - Susana Bassol-Mayagoitia
- Faculty of Medicine, Universidad Autónoma de Coahuila, Morelos 900, 27000 Torreón, Coahuila, C.P Mexico
| | - Claudia Huesca-Gómez
- Physiology Department, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1, 14080 Mexico City, C.P Mexico
| | - Martha Patricia Nava
- Faculty of Medicine, Universidad Autónoma de Coahuila, Morelos 900, 27000 Torreón, Coahuila, C.P Mexico
| | | | - Leticia Yáñez-Estrada
- Faculty of Medicine, Universidad Autónoma de San Luís Potosí, Venustiano Carranza 2405. San Luis Potosí, 78000 San Luís Potosí, C.P Mexico
| | - Rebeca Mejía-Saucedo
- Faculty of Medicine, Universidad Autónoma de San Luís Potosí, Venustiano Carranza 2405. San Luis Potosí, 78000 San Luís Potosí, C.P Mexico
| | - Julia Blanco-Muñoz
- Instituto Nacional de Salud Pública, Av. Universidad 655, Col. Sta. María Ahuacatitlán, 62100 Cuernavaca, Morelos, CP Mexico
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An evaluation of the USEPA Proposed Approaches for applying a biologically based dose-response model in a risk assessment for perchlorate in drinking water. Regul Toxicol Pharmacol 2019; 103:237-252. [DOI: 10.1016/j.yrtph.2019.01.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/18/2019] [Accepted: 01/20/2019] [Indexed: 12/18/2022]
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21
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Chen Y, Xue F. The impact of gestational hypothyroxinemia on the cognitive and motor development of offspring. J Matern Fetal Neonatal Med 2018; 33:1940-1945. [PMID: 30348031 DOI: 10.1080/14767058.2018.1529749] [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: 01/01/2023]
Abstract
In the past decade, it is still controversial whether gestational hypothyroxinemia has adverse effects on fetal brain development. Animal models of maternal hypothyroxinemia have proved that thyroid hormone is necessary for the adequate development of a number of neuropsychological abilities whereas the type of deficit depends on the timing of thyroid hormone (TH) deficiency. However, different from animal experiments, evidence from clinical trials showed that the major determinant of mental and motor function delay in offspring is the gestational age at onset of maternal hypothyroxinemia. The correlation between levels of maternal FT4 in the first trimester and impaired neurodevelopment in offspring is strongest. With the progress of pregnancy, the correlation weakened gradually and disappeared until late pregnancy. Only two studies involving randomized controlled trials have examined the treatment of hypothyroxinemia with levothyroxine in pregnancy. However, both randomized trials were started too late in gestation to have a major influence on brain development.
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Affiliation(s)
- Yuanyuan Chen
- Obstetrics and Gynecology Department, Tianjin Medical University General Hospital, Tianjin, China
| | - Fengxia Xue
- Obstetrics and Gynecology Department, Tianjin Medical University General Hospital, Tianjin, China
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Ares Segura S, Temboury Molina C, Chueca Guindulain MJ, Grau Bolado G, Alija Merillas MJ, Caimari Jaume M, Casano Sancho P, Moreno Navarro JC, Rial Rodríguez JM, Rodríguez Sánchez A. Recommendations for the diagnosis and followup of the foetus and newborn child born to mothers with autoimmune thyroid disease. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.anpede.2018.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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23
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Ares Segura S, Temboury Molina C, Chueca Guindulain MJ, Grau Bolado G, Alija Merillas MJ, Caimari Jaume M, Casano Sancho P, Moreno Navarro JC, Rial Rodríguez JM, Rodríguez Sánchez A. [Recommendations for the diagnosis and follow up of the foetus and newborn child born to mothers with autoimmune thyroid disease]. An Pediatr (Barc) 2018; 89:254.e1-254.e7. [PMID: 30177500 DOI: 10.1016/j.anpedi.2018.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 07/17/2018] [Accepted: 07/19/2018] [Indexed: 02/08/2023] Open
Abstract
The objective of this document is to review the current recommendations in the management of the foetus and the newborn child born to mothers with autoimmune thyroid disease. In 2017, the American Thyroid Association published guidelines for the diagnosis and management of thyroid disease during pregnancy and post-partum. In this guide, 97 recommendations were made, and an algorithm for the diagnosis and treatment of gestational hypothyroidism was proposed. Also, in this last year, a wide review was been published on the foetal and neonatal approach of the child of a mother with Graves' disease. The importance of the determination of maternal antibodies against thyrotropin receptor in the second half of pregnancy is stressed, in order to adequately stratify the risk in the neonate.
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Affiliation(s)
- Susana Ares Segura
- Servicio de Neonatología, Hospital Universitario La Paz, Madrid, España.
| | | | | | - Gema Grau Bolado
- Endocrinología Infantil, Hospital Universitario Cruces, Barakaldo, Vizcaya, España
| | | | - María Caimari Jaume
- Endocrinología Pediátrica, Hospital Universitario Son Espases, Palma de Mallorca, Baleares, España
| | - Paula Casano Sancho
- Sección de Endocrinología Pediátrica, Hospital Sant Joan de Déu , Barcelona, España
| | | | | | - Amparo Rodríguez Sánchez
- Unidad de Metabolismo y Desarrollo, Hospital General Universitario Gregorio Marañón , Madrid, España
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Wang Y, Han J, Chen X, Zeng X, Wang Y, Dong J, Chen J. Maternal iodine supplementation improves motor coordination in offspring by modulating the mGluR1 signaling pathway in mild iodine deficiency-induced hypothyroxinemia rats. J Nutr Biochem 2018; 58:80-89. [DOI: 10.1016/j.jnutbio.2018.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 04/17/2018] [Accepted: 04/22/2018] [Indexed: 02/02/2023]
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Teng X, Shan Z, Li C, Yu X, Mao J, Wang W, Xie X, Du J, Zhang S, Gao Z, Zhang X, Li L, Fan C, Teng W. Iron Deficiency May Predict Greater Risk for Hypothyroxinemia: A Retrospective Cohort Study of Pregnant Women in China. Thyroid 2018; 28:968-975. [PMID: 29968513 DOI: 10.1089/thy.2017.0491] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Pregnant women are highly vulnerable to iron deficiency (ID) due to the increased iron needs during pregnancy. ID decreases circulating thyroid hormone concentrations likely through impairment of iron-dependent thyroid peroxidase. The present study aimed to explore the association between ID and hypothyroxinemia in a retrospective cohort of pregnant women in China. METHODS To investigate the relationship between ID and hypothyroxinemia, 723 pregnant women were retrospectively analyzed, including 675 and 309 women in the second and third trimesters, respectively. Trimester-specific hypothyroxinemia was defined as free thyroxine (fT4) levels below the 2.5th percentile of the reference range with normal serum thyrotropin (TSH) or TSH higher than the 97.5th percentile of the reference range in each trimester of pregnancy. Serum TSH, fT4, thyroid peroxidase antibodies, thyroglobulin antibodies, serum ferritin, soluble transferrin receptor, and urinary iodine concentrations were measured. Serum ferritin, soluble transferrin receptor, and total body iron were used to indicate the nutritional iron status. RESULTS Cross-sectional multiple linear regression analysis showed that iron status was positively associated with serum fT4 levels in the first and second trimesters of pregnancy, but not in the third trimester. Logistic regression analysis showed that ID was an independent risk factor for hypothyroxinemia (odds ratio = 14.86 [confidence interval 2.31-95.81], p = 0.005 in the first trimester and odds ratio = 3.36 [confidence interval 1.01-11.21], p = 0.048 in the second trimester). The prospective analysis showed that pregnant women with ID during the first trimester of pregnancy had lower serum fT4 levels and a higher rate of hypothyroxinemia in the second or third trimester than those without ID. CONCLUSIONS ID appears to be a risk factor to predict hypothyroxinemia in the first and second trimesters of pregnancy, but not in the third trimester. Pregnant women with ID in the first and second trimesters should be regarded as a high-risk group for maternal hypothyroxinemia.
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Affiliation(s)
- Xiaochun Teng
- 1 Department of Endocrinology and Metabolism, Endocrine Institute, and Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Hospital of China Medical University , Shenyang, China
| | - Zhongyan Shan
- 1 Department of Endocrinology and Metabolism, Endocrine Institute, and Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Hospital of China Medical University , Shenyang, China
| | - Chenyan Li
- 1 Department of Endocrinology and Metabolism, Endocrine Institute, and Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Hospital of China Medical University , Shenyang, China
| | - Xiaohui Yu
- 1 Department of Endocrinology and Metabolism, Endocrine Institute, and Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Hospital of China Medical University , Shenyang, China
| | - Jinyuan Mao
- 1 Department of Endocrinology and Metabolism, Endocrine Institute, and Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Hospital of China Medical University , Shenyang, China
| | - Weiwei Wang
- 1 Department of Endocrinology and Metabolism, Endocrine Institute, and Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Hospital of China Medical University , Shenyang, China
| | - Xiaochen Xie
- 1 Department of Endocrinology and Metabolism, Endocrine Institute, and Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Hospital of China Medical University , Shenyang, China
| | - Jianling Du
- 2 Department of Endocrinology, The First Affiliated Hospital of Dalian Medical University , Dalian, China
| | - Shaowei Zhang
- 3 Department of Endocrinology, No·202 Hospital of People's Liberation Army , Shenyang, China
| | - Zhengnan Gao
- 4 Department of Endocrinology, Dalian Municipal Central Hospital Affiliated of Dalian Medical University , Dalian, China
| | - Xiaomei Zhang
- 5 Department of Endocrinology, Peking University , International Hospital, Beijing, China
| | - Ling Li
- 6 Department of Endocrinology, Shengjing Hospital of China Medical University , Shenyang, China
| | - Chenling Fan
- 1 Department of Endocrinology and Metabolism, Endocrine Institute, and Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Hospital of China Medical University , Shenyang, China
| | - Weiping Teng
- 1 Department of Endocrinology and Metabolism, Endocrine Institute, and Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Hospital of China Medical University , Shenyang, China
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Maternal vitamin D concentrations are associated with faster childhood reaction time and response speed, but not with motor fluency and flexibility, at the age of 5-6 years: the Amsterdam Born Children and their Development (ABCD) Study. Br J Nutr 2018; 120:345-352. [PMID: 29843832 DOI: 10.1017/s0007114518001319] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
About 57 % of the pregnant European women have 25-hydroxyvitamin D (25(OH)D) concentrations below 50 nmol/l. However, as data on the impact of gestational vitamin D deficiency on maternal and fetal health are limited, the WHO does not advocate vitamin D supplementation as part of routine antenatal care. We explored associations between first trimester maternal 25(OH)D status and childhood cognition at 5-6 years of age (n 1854, primarily Caucasian). Median serum 25(OH)D was determined at 13 (interquartile range 12-14) weeks of gestation. Childhood attention, motor fluency and flexibility and executive function were assessed using the Amsterdam Neuropsychological Tasks. Restricted cubic splines and linear regression analyses were used to analyse the data while adjusting for many maternal and child related covariates. Higher 25(OH)D status (nmol/l) was associated with better attention and executive functioning as shown by a faster reaction time (β -0·30 (sd 0·14) ms, P=0·03), faster response speed (β -0·58 (sd 0·21) ms, P=0·006), and better response speed stability (β -0·45 (sd 0·17) ms, P=0·009). No associations were observed of serum 25(OH)D with motor fluency and flexibility. Associations were most pronounced among children of African origin (n 205) as compared with those of Caucasian or another origin, for example attention (reaction time, β -2·06 (sd 0·70) ms, P=0·004) and executive function (response speed, β -1·95 (sd 0·94) ms, P=0·04). Concluding, maternal 25(OH)D status was significantly associated with childhood attention and executive function, while no associations were observed for 25(OH)D status with motor fluency and flexibility.
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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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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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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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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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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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Gothié JD, Demeneix B, Remaud S. Comparative approaches to understanding thyroid hormone regulation of neurogenesis. Mol Cell Endocrinol 2017; 459:104-115. [PMID: 28545819 DOI: 10.1016/j.mce.2017.05.020] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 05/11/2017] [Accepted: 05/19/2017] [Indexed: 12/12/2022]
Abstract
Thyroid hormone (TH) signalling, an evolutionary conserved pathway, is crucial for brain function and cognition throughout life, from early development to ageing. In humans, TH deficiency during pregnancy alters offspring brain development, increasing the risk of cognitive disorders. How TH regulates neurogenesis and subsequent behaviour and cognitive functions remains a major research challenge. Cellular and molecular mechanisms underlying TH signalling on proliferation, survival, determination, migration, differentiation and maturation have been studied in mammalian animal models for over a century. However, recent data show that THs also influence embryonic and adult neurogenesis throughout vertebrates (from mammals to teleosts). These latest observations raise the question of how TH availability is controlled during neurogenesis and particularly in specific neural stem cell populations. This review deals with the role of TH in regulating neurogenesis in the developing and the adult brain across different vertebrate species. Such evo-devo approaches can shed new light on (i) the evolution of the nervous system and (ii) the evolutionary control of neurogenesis by TH across animal phyla. We also discuss the role of thyroid disruptors on brain development in an evolutionary context.
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Affiliation(s)
- Jean-David Gothié
- CNRS, UMR 7221, Muséum National d'Histoire Naturelle, F-75005 Paris France
| | - Barbara Demeneix
- CNRS, UMR 7221, Muséum National d'Histoire Naturelle, F-75005 Paris France.
| | - Sylvie Remaud
- CNRS, UMR 7221, Muséum National d'Histoire Naturelle, F-75005 Paris France.
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Yang J, Zhu L, Li X, Zheng H, Wang Z, Hao Z, Liu Y. Maternal iodine status during lactation and infant weight and length in Henan Province, China. BMC Pregnancy Childbirth 2017; 17:383. [PMID: 29145827 PMCID: PMC5689181 DOI: 10.1186/s12884-017-1569-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 11/06/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Infants are very sensitive to iodine deficiency. Breastfed infants are dependent on maternal iodine intake. The aim of this study was to evaluate the relationship between maternal iodine status during lactation and infant weight and length. METHODS A cross-sectional survey was conducted to investigate maternal iodine status and infant anthropometric measures in Henan Province, China. Only exclusive breastfeeding mothers and their infants < 6 months of age (n = 747) were included in our final analysis. Urine samples were collected from all the mothers and infants. Infant weight and length were measured and converted into weight-for-age Z-score (WAZ) and height-for-age Z-score (HAZ) using the World Health Organization (WHO) AnthroPlus software. RESULTS The median urinary iodine concentration (UIC) in lactating women was significant lower than that in their infants (177.4 vs 261.1 μg/L, P < 0.001). A positive correlation was found between maternal and infant urinary iodine concentration (r = 0.203, P < 0.01). The mean HAZ and WAZ values were lowest in the infants whose mothers had UIC below 50 μg/L (n = 41). Infant WAZ with maternal UIC below 50 μg/L was significantly lower than those with maternal UIC of 50 μg/L or above (P = 0.043). After adjusting for confounding factors, there were significant differences in infant WAZ between maternal UIC groups. CONCLUSIONS The present study suggests that maternal iodine status during lactation may be related to their infant anthropometric index. Appropriate iodine intake of lactating women is beneficial for their infants.
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Affiliation(s)
- Jin Yang
- Department for Endemic Disease Control and Prevention, Center for Disease Control of Henan Province, Room 4201, No. 105 Nongye Nan Road, Zhengdong New District, Zhengzhou, 450016 China
| | - Lin Zhu
- Department for Endemic Disease Control and Prevention, Center for Disease Control of Henan Province, Room 4201, No. 105 Nongye Nan Road, Zhengdong New District, Zhengzhou, 450016 China
| | - Xiaofeng Li
- Department for Endemic Disease Control and Prevention, Center for Disease Control of Henan Province, Room 4201, No. 105 Nongye Nan Road, Zhengdong New District, Zhengzhou, 450016 China
| | - Heming Zheng
- Department for Endemic Disease Control and Prevention, Center for Disease Control of Henan Province, Room 4201, No. 105 Nongye Nan Road, Zhengdong New District, Zhengzhou, 450016 China
| | - Zhe Wang
- Department for Endemic Disease Control and Prevention, Center for Disease Control of Henan Province, Room 4201, No. 105 Nongye Nan Road, Zhengdong New District, Zhengzhou, 450016 China
| | - Zongyu Hao
- Department for Endemic Disease Control and Prevention, Center for Disease Control of Henan Province, Room 4201, No. 105 Nongye Nan Road, Zhengdong New District, Zhengzhou, 450016 China
| | - Yang Liu
- Department for Endemic Disease Control and Prevention, Center for Disease Control of Henan Province, Room 4201, No. 105 Nongye Nan Road, Zhengdong New District, Zhengzhou, 450016 China
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Rubin R, Pearl M, Kharrazi M, Blount BC, Miller MD, Pearce EN, Valentin-Blasini L, DeLorenze G, Liaw J, Hoofnagle AN, Steinmaus C. Maternal perchlorate exposure in pregnancy and altered birth outcomes. ENVIRONMENTAL RESEARCH 2017; 158:72-81. [PMID: 28601764 PMCID: PMC5578729 DOI: 10.1016/j.envres.2017.05.030] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 05/23/2017] [Accepted: 05/24/2017] [Indexed: 05/13/2023]
Abstract
BACKGROUND At high medicinal doses perchlorate is known to decrease the production of thyroid hormone, a critical factor for fetal development. In a large and uniquely exposed cohort of pregnant women, we recently identified associations between environmental perchlorate exposures and decreased maternal thyroid hormone during pregnancy. Here, we investigate whether perchlorate might be associated with birthweight or preterm birth in the offspring of these women. METHODS Maternal urinary perchlorate, serum thyroid hormone concentrations, birthweight, gestational age, and urinary nitrate, thiocyanate, and iodide were collected in 1957 mother-infant pairs from San Diego County during 2000-2003, a period when the county's water supply was contaminated with perchlorate. Associations between perchlorate exposure and birth outcomes were examined using linear and logistic regression analyses adjusted for maternal age, weight, race/ethnicity, and other factors. RESULTS Perchlorate was not associated with birth outcomes in the overall population. However, in analyses confined to male infants, log10 maternal perchlorate concentrations were associated with increasing birthweight (β=143.1gm, p=0.01), especially among preterm births (β=829.1g, p<0.001). Perchlorate was associated with male preterm births ≥2500g (odds ratio=3.03, 95% confidence interval=1.09-8.40, p-trend=0.03). Similar associations were not seen in females. CONCLUSIONS This is the first study to identify associations between perchlorate and increasing birthweight. Further research is needed to explore the differences we identified related to infant sex, preterm birth, and other factors. Given that perchlorate exposure is ubiquitous, and that long-term impacts can follow altered birth outcomes, future research on perchlorate could have widespread public health importance.
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Affiliation(s)
- Rainbow Rubin
- School of Public Health, University of California, Berkeley, CA, USA
| | | | - Martin Kharrazi
- Environmental Health Investigations Branch, California Department of Public Health, Richmond, CA, USA
| | - Benjamin C Blount
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mark D Miller
- Western States Pediatric Environmental Health Specialty Unit, University of California, San Francisco, CA, USA
| | - Elizabeth N Pearce
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, MA, USA
| | - Liza Valentin-Blasini
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gerald DeLorenze
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Jane Liaw
- School of Public Health, University of California, Berkeley, CA, USA
| | - Andrew N Hoofnagle
- Departments of Lab Medicine and Medicine, University of Washington, Seattle, Washington, USA
| | - Craig Steinmaus
- School of Public Health, University of California, Berkeley, CA, USA; Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Oakland, CA, USA.
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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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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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Kostecka-Matyja M, Fedorowicz A, Bar-Andziak E, Bednarczuk T, Buziak-Bereza M, Dumnicka P, Górska M, Krasnodębska M, Niedźwiedzka B, Pach D, Ruchała M, Siewko K, Solnica B, Sowiński J, Szelachowska M, Trofimiuk-Müldner M, Wachowiak-Ochmańska K, Hubalewska-Dydejczyk A. Reference Values for TSH and Free Thyroid Hormones in Healthy Pregnant Women in Poland: A Prospective, Multicenter Study. Eur Thyroid J 2017; 6:82-88. [PMID: 28589089 PMCID: PMC5422751 DOI: 10.1159/000453061] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 08/11/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The diagnosis and treatment of thyroid diseases in pregnant women remains a challenge. Various medical associations recommend establishing the reference intervals for thyroid hormones by a local laboratory. Considering differences within geophysical, socioeconomic conditions, and iodine prophylaxis in various populations, it is advisable to assess reference intervals for thyroid hormones specific to a region of residence. The objective was to assess trimester-specific reference intervals for TSH, fT3, and fT4 for pregnant women in the Polish population. METHODS AND RESULTS We conducted a prospective study in 4 centers representing different regions of Poland (Krakow, Warsaw, Poznan, and Bialystok). Our study included consecutive, healthy pregnant women (172 patients), with an age range of 27-47 years. All women had a negative history for thyroid diseases, normal thyroid peroxidase antibody levels, and proper iodine prophylaxis. All newborns had TSH levels in the appropriate reference range. Serum TSH, fT3, fT4, and thyroid-peroxidase antibodies were measured in each trimester. The reference intervals were calculated using the percentile method, as recommended by the International Federation of Clinical Chemistry. The reference values calculated were 0.009-3.177, 0.05-3.442, and 0.11-3.53 mIU/L for TSH; 3.63-6.55, 3.29-5.45, and 3.1-5.37 pmol/L for fT3; and 11.99-21.89, 10.46-16.67, and 8.96-17.23 pmol/L for fT4 in consecutive trimesters of pregnancy. Reference intervals for pregnant women when compared to the general population showed a lower concentration of TSH in every trimester of pregnancy and lower fT4 in the 2nd and 3rd trimesters. CONCLUSIONS Using appropriate trimester-specific reference intervals may improve care of pregnant women by preventing misdiagnosis and inadequate treatment.
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Affiliation(s)
- Marta Kostecka-Matyja
- Chair and Department of Endocrinology, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Anna Fedorowicz
- Chair and Department of Endocrinology, Jagiellonian University, Collegium Medicum, Krakow, Poland
- *Alicja Hubalewska-Dydejczyk, Chair and Department of Endocrinology, Jagiellonian University, Collegium Medicum, Kopernika 17 str, PL-31-501 Kraków (Poland), E-Mail
| | - Ewa Bar-Andziak
- Department of Internal Medicine and Endocrinology, Medical University, Warsaw, Poland
| | - Tomasz Bednarczuk
- Department of Internal Medicine and Endocrinology, Medical University, Warsaw, Poland
| | - Monika Buziak-Bereza
- Chair and Department of Endocrinology, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Paulina Dumnicka
- Department of Medical Diagnostics, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Maria Górska
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University, Bialystok, Poland
| | | | - Beata Niedźwiedzka
- Department of Internal Medicine and Endocrinology, Medical University, Warsaw, Poland
| | - Dorota Pach
- Chair and Department of Endocrinology, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Marek Ruchała
- Department of Endocrinology, Metabolism and Internal Medicine, University of Medical Sciences, Poznan, Poland
| | - Katarzyna Siewko
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University, Bialystok, Poland
| | - Bogdan Solnica
- Department of Diagnostics, Chair of Clinical Biochemistry, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Jerzy Sowiński
- Department of Endocrinology, Metabolism and Internal Medicine, University of Medical Sciences, Poznan, Poland
| | - Małgorzata Szelachowska
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University, Bialystok, Poland
| | | | | | - Alicja Hubalewska-Dydejczyk
- Chair and Department of Endocrinology, Jagiellonian University, Collegium Medicum, Krakow, Poland
- *Alicja Hubalewska-Dydejczyk, Chair and Department of Endocrinology, Jagiellonian University, Collegium Medicum, Kopernika 17 str, PL-31-501 Kraków (Poland), E-Mail
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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: 39] [Impact Index Per Article: 5.6] [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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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: 1312] [Impact Index Per Article: 187.4] [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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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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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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Surana V, Aggarwal S, Khandelwal D, Singla R, Bhattacharya S, Chittawar S, Kalra S, Dutta D. A 2016 clinical practice pattern in the management of primary hypothyroidism among doctors from different clinical specialties in New Delhi. Indian J Endocrinol Metab 2017; 21:165-177. [PMID: 28217518 PMCID: PMC5240060 DOI: 10.4103/2230-8210.196012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND This study aimed to document practices in managing hypothyroidism among doctors in New Delhi, with special focus on subclinical hypothyroidism, pregnancy, and old age, and to compare it with global practices. METHODS During an academic program attended by 394 doctors, all participants were given a questionnaire designed based on thyroid practices survey done by Burch et al. to evaluate the practice patterns. Questions were based on evaluating doctor's preferred choices in diagnosis, therapy, and follow-up of hypothyroidism in different scenarios. RESULTS Responses from 308 questionnaires (general physicians [n = 204], obstetricians [n = 51], pediatricians [n = 27], surgeons [n = 12], endocrinologists [n = 10], and others [n = 4]) were analyzed. In the evaluation of 52-year-old female patient with primary hypothyroidism, 52% doctors would prefer thyroid ultrasonography, comparable to global rates. Nearly 96.1% doctors would have initiated levothyroxine, with a large majority of doctors (83.77%) preferred using branded levothyroxine. About 58.74% doctors preferred gradual restoration of euthyroidism. Levothyroxine dose of 25 mcg was the most preferred increment dose (46.07%) during follow-up, with 6 weekly being the most frequent dose adjustment frequency (41.57%). Most preferred target thyroid-stimulating hormone (TSH) in the 52-year-old female patient was 2.5-4.99 mU/L (63.96%), 25-year-old female patient was 1-2.49 mU/L (53.90%), and in 85-year-old female was 2.5-4.99 mU/L (45.45%). Only 68% of doctors in our study preferred keeping TSH <2.5 mU/L during the first trimester of pregnancy, in contrast to global trends of 95% (P < 0.001). CONCLUSION There was a disproportionately high use of ultrasonography in hypothyroidism management, near exclusive preference for branded levothyroxine, widespread use of age-specific TSH targets, and low threshold for treating mild thyroid failure, a highly variable approach to both rates and means of restoring euthyroidism for overt primary hypothyroidism. There is a need for spreading awareness regarding TSH targets in pregnancy.
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Affiliation(s)
- Vineet Surana
- Department of Endocrinology, Paras Hospitals, Gurgaon, Haryana, India
| | - Sameer Aggarwal
- Department of Medicine, Division of Endocrinology, Pandit Bhagwat Dayal Sharma Post-Graduate Institute of Medical Sciences, Karnal, Haryana, India
| | - Deepak Khandelwal
- Department of Endocrinology, Maharaja Agrasen Hospital, New Delhi, India
| | - Rajiv Singla
- Department of Endocrinology, Kalpravriksh Superspeciality Clinic, Dwarka, New Delhi, India
| | - Saptarshi Bhattacharya
- Department of Endocrinology, Max Super-Speciality Hospital, Patparganj, New Delhi, India
| | - Sachin Chittawar
- Department of Medicine, Division of Endocrinology, Gandhi Medical College and Hamidia Hospital, Bhopal, Madhya Pradesh, India
| | - Sanjay Kalra
- Department of Endocrinology, BRIDE, Karnal, Haryana, India
| | - Deep Dutta
- Department of Endocrinology, Post-Graduate Institute of Medical Education and Research and Dr. Ram Manohar Lohia Hospital, New Delhi, India
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Karatas A, Erdem H, Karatas Z, Ozlu T, Cakmak B. The effect of smoking on placental pendrin expression. J OBSTET GYNAECOL 2016; 37:11-14. [PMID: 28013561 DOI: 10.1080/01443615.2016.1174825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Pendrin is important for transport of iodine across the placenta. Thiocyanate coming from cigarette is a competitive inhibitor of iodine transport. We aimed to evaluate the pendrin immunostaining intensity in placentas of smoker and non-smoker women. Placental tissues from 61 women, of which 28 were in smoking, and 33 were in non-smoking group were evaluated by immunohistochemical staining. Positive immunostaining was evaluated using a semiquantitative score: 0, negative; +, mild; ++, moderate; and +++, intense. Birth weight was significantly lower in the smoker group (p = 0.024). There was a negative correlation between birth weight and intensity of placental pendrin immunostaining in the smoker group (r = -0.44, p = 0.02). Placentas of the smoking women showed significantly higher immunostaining with pendrin than the control group (p = 0.006). Thiocyonate coming from cigarettes may competitively inhibit pendrin mediated iodine transport in the placenta and adversely affect foetal development by this mechanism.
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Affiliation(s)
- Ahmet Karatas
- a Department of Obstetrics and Gynaecology , School of Medicine, Abant Izzet Baysal University, Golkoy Kampusu, Golkoy Yerleskesi , Bolu , Turkey
| | - Havva Erdem
- b Department of Medical Pathology , School of Medicine, Duzce University, Merkez Yerleskesi , Konuralp , Duzce , Turkey
| | - Zehra Karatas
- c Department of Paediatrics , School of Medicine, Abant Izzet Baysal University, Golkoy Kampusu, Golkoy Yerleskesi , Bolu , Turkey
| | - Tulay Ozlu
- a Department of Obstetrics and Gynaecology , School of Medicine, Abant Izzet Baysal University, Golkoy Kampusu, Golkoy Yerleskesi , Bolu , Turkey
| | - Bulent Cakmak
- d Department of Obstetrics and Gynaecology , School of Medicine, Gaziosmanpasa University, Sevki Erek Yerleskesi , Tokat , Turkey
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Wang Y, Dong J, Wang Y, Wei W, Song B, Shan Z, Teng W, Chen J. Developmental Hypothyroxinemia and Hypothyroidism Reduce Parallel Fiber-Purkinje Cell Synapses in Rat Offspring by Downregulation of Neurexin1/Cbln1/GluD2 Tripartite Complex. Biol Trace Elem Res 2016; 173:465-74. [PMID: 27033232 DOI: 10.1007/s12011-016-0664-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 02/23/2016] [Indexed: 01/19/2023]
Abstract
Iodine is a significant micronutrient. Iodine deficiency (ID)-induced hypothyroxinemia and hypothyroidism during developmental period can cause cerebellar dysfunction. However, mechanisms are still unclear. Therefore, the present research aims to study effects of developmental hypothyroxinemia caused by mild ID and hypothyroidism caused by severe ID or methimazole (MMZ) on parallel fiber-Purkinje cell (PF-PC) synapses in filial cerebellum. Maternal hypothyroxinemia and hypothyroidism models were established in Wistar rats using ID diet and deionized water supplemented with different concentrations of potassium iodide or MMZ water. Birth weight and cerebellum weight were measured. We also examined PF-PC synapses using immunofluorescence, and western blot analysis was conducted to investigate the activity of Neurexin1/cerebellin1 (Cbln1)/glutamate receptor d2 (GluD2) tripartite complex. Our results showed that hypothyroxinemia and hypothyroidism decreased birth weight and cerebellum weight and reduced the PF-PC synapses on postnatal day (PN) 14 and PN21. Accordingly, the mean intensity of vesicular glutamate transporter (VGluT1) and Calbindin immunofluorescence was reduced in mild ID, severe ID, and MMZ groups. Moreover, maternal hypothyroxinemia and hypothyroidism reduced expression of Neurexin1/Cbln1/GluD2 tripartite complex. Our study supports the hypothesis that developmental hypothyroxinemia and hypothyroidism reduce PF-PC synapses, which may be attributed to the downregulation of Neurexin1/Cbln1/GluD2 tripartite complex.
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Affiliation(s)
- Yuan Wang
- Department of Occupational and Environmental Health, School of Public Health, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, 110122, People's Republic of China
| | - Jing Dong
- Department of Occupational and Environmental Health, School of Public Health, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, 110122, People's Republic of China
| | - Yi Wang
- Department of Occupational and Environmental Health, School of Public Health, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, 110122, People's Republic of China
| | - Wei Wei
- Department of Occupational and Environmental Health, School of Public Health, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, 110122, People's Republic of China
| | - Binbin Song
- Department of Occupational and Environmental Health, School of Public Health, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, 110122, People's Republic of China
| | - Zhongyan Shan
- Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Weiping Teng
- Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Jie Chen
- Department of Occupational and Environmental Health, School of Public Health, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, 110122, People's Republic of China.
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Nijkamp JW, Korteweg FJ, Groen H, Timmer A, Van Den Berg G, Bossuyt PM, Mol BWJ, Erwich JJHM. Thyroid function testing in women who had a stillbirth. Clin Endocrinol (Oxf) 2016; 85:291-8. [PMID: 26666415 DOI: 10.1111/cen.13002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 10/04/2015] [Accepted: 12/10/2015] [Indexed: 10/22/2022]
Abstract
CONTEXT Thyroid dysfunction is thought to be associated with stillbirth. Therefore, thyroid function is often recommended in the diagnostic investigations for stillbirth. OBJECTIVE We aimed to evaluate the added value of thyroid function testing in the diagnostic investigations for stillbirth. DESIGN AND PATIENTS A nationwide multicentre prospective cohort study in 1025 women who suffered stillbirth >20 weeks of gestation performed between 2002 and 2008. In each woman, an extensive diagnostic work-up was performed, including placental examination and autopsy. TSH and FT4 values below the 2·5th percentile or above the 97·5th percentile according local laboratory reference values were regarded as abnormal. Women with a history of thyroid disease were evaluated separately. MAIN OUTCOME MEASURES Thyroid function abnormalities in women with stillbirth. RESULTS Of 1025 included women, 21 had a history of thyroid disease (2%). In the 875 with TSH and FT4 results and no history of thyroid disease, 10% had hypothyroxinemia, 4·6% subclinical hypothyroidism, 1·6% overt hypothyroidism and 1·5% subclinical hyperthyroidism. Women with a subclinical hyperthyroidism more often had a foetal death caused by foetal hydrops: 23% vs 2·9% (adjusted OR 10·3, 95% CI 2·5-42). CONCLUSIONS Women with a stillbirth had a slightly higher prevalence of overt hypothyroidism, subclinical hypothyroidism and hypothyroxinaemia compared to previous studies on thyroid dysfunction in pregnant women. Given the absence of a strong associations with the cause of stillbirth, and no demonstrated beneficial effects of treating thyroid dysfunction in these women, routine screening after stillbirth is not justified.
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Affiliation(s)
- Janna W Nijkamp
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Fleurisca J Korteweg
- Department of Obstetrics and Gynecology, Martini Hospital, Groningen, The Netherlands
| | - Henk Groen
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Albertus Timmer
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gerrit Van Den Berg
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Patrick M Bossuyt
- Department of Clinical Epidemiology & Biostatistics, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Ben Willem J Mol
- The Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, Australia
| | - Jan Jaap H M Erwich
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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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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Moleti M, Trimarchi F, Tortorella G, Candia Longo A, Giorgianni G, Sturniolo G, Alibrandi A, Vermiglio F. Effects of Maternal Iodine Nutrition and Thyroid Status on Cognitive Development in Offspring: A Pilot Study. Thyroid 2016; 26:296-305. [PMID: 26586553 DOI: 10.1089/thy.2015.0336] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND OBJECTIVE Maternal iodine nutrition and thyroid status may influence neurocognitive development in offspring. This study investigated the effects on the intelligence quotient (IQ) of children born to mothers with different levels of iodine supplementation, with or without the administration of levothyroxine (LT4), prior to and during pregnancy. PATIENTS AND METHODS This pilot, prospective, observational study included four study groups, each comprising 15 mother-child pairs, identified on the basis of maternal histories of iodized salt consumption and LT4 treatment prior to and during pregnancy. The groups were labeled as follows: iodine (I), no iodine (no-I), iodine + LT4 (I + T4), and no iodine + LT4 (no-I + T4). IQ tests were administered to children at 6-12 years of age with the Wechsler Intelligence Scale for Children-3rd Edition (WISC-III), with full-scale IQ (FSIQ), verbal IQ (VIQ), and performance IQ (PIQ) being evaluated. RESULTS Children of I and I + T4 mothers had similar verbal, performance, and FSIQs, which were 14, 10, and 13 points higher, respectively, than children born to no-I and no-I + T4 mothers. A positive association was found between VIQ and maternal urinary iodine (β = 1.023 [confidence interval (CI) 1.003-1.043]; p = 0.028), but not with maternal free thyroxine concentrations at any stage of pregnancy. Overall, the prevalence of borderline or defective cognitive function was more than threefold higher in the children of mothers not using iodized salt than of those mothers using it (76.9% vs. 23.1%, odds ratio 7.667 [CI 2.365-24.856], χ2 = 12.65; p = 0.0001). CONCLUSIONS Neuro-intellectual outcomes in children appear to be more dependent on their mothers' nutritional iodine status than on maternal thyroid function. These results support the growing body of evidence that prenatal, mild-to-moderate iodine deficiency adversely affects cognitive development later in life, with a seemingly greater impact on verbal abilities.
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Affiliation(s)
- Mariacarla Moleti
- 1 Department of Clinical and Experimental Medicine, University of Messina , Messina, Italy
| | - Francesco Trimarchi
- 1 Department of Clinical and Experimental Medicine, University of Messina , Messina, Italy
| | - Gaetano Tortorella
- 2 Department of Pediatric, Gynecological, and Biomedical Sciences, University of Messina , Messina, Italy
| | - Alice Candia Longo
- 2 Department of Pediatric, Gynecological, and Biomedical Sciences, University of Messina , Messina, Italy
| | - Grazia Giorgianni
- 1 Department of Clinical and Experimental Medicine, University of Messina , Messina, Italy
| | - Giacomo Sturniolo
- 1 Department of Clinical and Experimental Medicine, University of Messina , Messina, Italy
| | - Angela Alibrandi
- 3 Department of Economic Sciences, University of Messina , Messina, Italy
| | - Francesco Vermiglio
- 1 Department of Clinical and Experimental Medicine, University of Messina , Messina, Italy
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Lazarus J, Taylor P. HYPOTHYROXINAEMIA AND BRAIN DEVELOPMENT. ACTA ENDOCRINOLOGICA (BUCHAREST, ROMANIA : 2005) 2016; 12:1-6. [PMID: 31258792 PMCID: PMC6586752 DOI: 10.4183/aeb.2016.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aim of this review is to indicate the current position on the role of thyroxine (T4) and fetal brain development with particular relevance to the human situation. Adequate maternal iodine nutrition and maternal circulating thyroxine (T4) concentrations are essential to ensure optimum T4 placental passage which in turn will ensure transport of T4 into fetal brain cells. These processes are discussed and the role of thyroid hormone transporters is considered. The emphasis on isolated maternal hypothyroxinaemia (IH) as an important factor affecting brain development is discussed from the animal experimental point of view as well as in the clinical setting. There is evidence of neurocognitive impairment as assessed by different modalities in children up to the age of 8 years and some suggestion of increased psychiatric disorder in older persons whose mothers had IH during gestation. Although international guidelines have not in general recommended thyroxine therapy for IH the recent demonstration of adverse obstetric outcomes in women with isolated maternal hypothyroxinaemia may warrant a revision of this strategy.
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Affiliation(s)
- J.H. Lazarus
- Thyroid Research Group, Cardiff School of Medicine, Cardiff, United Kingdom
| | - P.N. Taylor
- Thyroid Research Group, Cardiff School of Medicine, Cardiff, United Kingdom
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