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Korevaar TIM, Derakhshan A, Taylor PN, Meima M, Chen L, Bliddal S, Carty DM, Meems M, Vaidya B, Shields B, Ghafoor F, Popova PV, Mosso L, Oken E, Suvanto E, Hisada A, Yoshinaga J, Brown SJ, Bassols J, Auvinen J, Bramer WM, López-Bermejo A, Dayan C, Boucai L, Vafeiadi M, Grineva EN, Tkachuck AS, Pop VJM, Vrijkotte TG, Guxens M, Chatzi L, Sunyer J, Jiménez-Zabala A, Riaño I, Murcia M, Lu X, Mukhtar S, Delles C, Feldt-Rasmussen U, Nelson SM, Alexander EK, Chaker L, Männistö T, Walsh JP, Pearce EN, Steegers EAP, Peeters RP. Association of Thyroid Function Test Abnormalities and Thyroid Autoimmunity With Preterm Birth: A Systematic Review and Meta-analysis. JAMA 2019; 322:632-641. [PMID: 31429897 PMCID: PMC6704759 DOI: 10.1001/jama.2019.10931] [Citation(s) in RCA: 185] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 07/08/2019] [Indexed: 01/27/2023]
Abstract
Importance Maternal hypothyroidism and hyperthyroidism are risk factors for preterm birth. Milder thyroid function test abnormalities and thyroid autoimmunity are more prevalent, but it remains controversial if these are associated with preterm birth. Objective To study if maternal thyroid function test abnormalities and thyroid autoimmunity are risk factors for preterm birth. Data Sources and Study Selection Studies were identified through a search of the Ovid MEDLINE, EMBASE, Web of Science, the Cochrane Central Register of Controlled Trials, and Google Scholar databases from inception to March 18, 2018, and by publishing open invitations in relevant journals. Data sets from published and unpublished prospective cohort studies with data on thyroid function tests (thyrotropin [often referred to as thyroid-stimulating hormone or TSH] and free thyroxine [FT4] concentrations) or thyroid peroxidase (TPO) antibody measurements and gestational age at birth were screened for eligibility by 2 independent reviewers. Studies in which participants received treatment based on abnormal thyroid function tests were excluded. Data Extraction and Synthesis The primary authors provided individual participant data that were analyzed using mixed-effects models. Main Outcomes and Measures The primary outcome was preterm birth (<37 weeks' gestational age). Results From 2526 published reports, 35 cohorts were invited to participate. After the addition of 5 unpublished data sets, a total of 19 cohorts were included. The study population included 47 045 pregnant women (mean age, 29 years; median gestational age at blood sampling, 12.9 weeks), of whom 1234 (3.1%) had subclinical hypothyroidism (increased thyrotropin concentration with normal FT4 concentration), 904 (2.2%) had isolated hypothyroxinemia (decreased FT4 concentration with normal thyrotropin concentration), and 3043 (7.5%) were TPO antibody positive; 2357 (5.0%) had a preterm birth. The risk of preterm birth was higher for women with subclinical hypothyroidism than euthyroid women (6.1% vs 5.0%, respectively; absolute risk difference, 1.4% [95% CI, 0%-3.2%]; odds ratio [OR], 1.29 [95% CI, 1.01-1.64]). Among women with isolated hypothyroxinemia, the risk of preterm birth was 7.1% vs 5.0% in euthyroid women (absolute risk difference, 2.3% [95% CI, 0.6%-4.5%]; OR, 1.46 [95% CI, 1.12-1.90]). In continuous analyses, each 1-SD higher maternal thyrotropin concentration was associated with a higher risk of preterm birth (absolute risk difference, 0.2% [95% CI, 0%-0.4%] per 1 SD; OR, 1.04 [95% CI, 1.00-1.09] per 1 SD). Thyroid peroxidase antibody-positive women had a higher risk of preterm birth vs TPO antibody-negative women (6.6% vs 4.9%, respectively; absolute risk difference, 1.6% [95% CI, 0.7%-2.8%]; OR, 1.33 [95% CI, 1.15-1.56]). Conclusions and Relevance Among pregnant women without overt thyroid disease, subclinical hypothyroidism, isolated hypothyroxinemia, and TPO antibody positivity were significantly associated with higher risk of preterm birth. These results provide insights toward optimizing clinical decision-making strategies that should consider the potential harms and benefits of screening programs and levothyroxine treatment during pregnancy.
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Affiliation(s)
- T I M Korevaar
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Arash Derakhshan
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Peter N Taylor
- Thyroid Research Group, Systems Immunity Research Institute, School of Medicine, Cardiff University, Cardiff, England
| | - Marcel Meima
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Liangmiao Chen
- Department of Endocrinology and Rui'an Center of the Chinese-American Research Institute for Diabetic Complications, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Sofie Bliddal
- Department of Medical Endocrinology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - David M Carty
- Department of Diabetes, Endocrinology, and Clinical Pharmacology, Glasgow Royal Infirmary, Glasgow, Scotland
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
| | - Margreet Meems
- Departments of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Bijay Vaidya
- Department of Endocrinology, Royal Devon and Exeter Hospital NHS Foundation Trust, University of Exeter Medical School, Exeter, England
| | - Beverley Shields
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, England
| | - Farkhanda Ghafoor
- National Health Research Complex, Shaikh Zayed Medical Complex, Lahore, Pakistan
| | - Polina V Popova
- Almazov National Medical Research Centre, St Petersburg, Russia
- Department of Internal Diseases and Endocrinology, St Petersburg Pavlov State Medical University, St Petersburg, Russia
| | - Lorena Mosso
- Department of Endocrinology, Pontificia Universidad Catolica de Chile, Santiago
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School, Boston, Massachusetts
- Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Eila Suvanto
- Department of Obstetrics and Gynecology and Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Aya Hisada
- Center for Preventive Medical Science, Chiba University, Chiba, Japan
| | - Jun Yoshinaga
- Faculty of Life Sciences, Toyo University, Gunma, Japan
| | - Suzanne J Brown
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Judit Bassols
- Maternal-Fetal Metabolic Research Group, Girona Biomedical Research Institute, Dr Josep Trueta Hospital, Girona, Spain
| | - Juha Auvinen
- Medical Research Center Oulu, Oulu University Hospital, Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Wichor M Bramer
- Medical Library, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Abel López-Bermejo
- Pediatric Endocrinology Research Group, Girona Biomedical Research Institute, Dr Josep Trueta Hospital, Girona, Spain
| | - Colin Dayan
- Thyroid Research Group, Institute of Molecular and Experimental Medicine, School of Medicine, Cardiff University, Cardiff, England
| | - Laura Boucai
- Division of Endocrinology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, Weill Cornell University, New York, New York
| | - Marina Vafeiadi
- Department of Social Medicine, University of Crete, Heraklion, Greece
| | - Elena N Grineva
- Almazov National Medical Research Centre, St Petersburg, Russia
- Department of Internal Diseases and Endocrinology, St Petersburg Pavlov State Medical University, St Petersburg, Russia
| | - Alexandra S Tkachuck
- Almazov National Medical Research Centre, St Petersburg, Russia
- Department of Internal Diseases and Endocrinology, St Petersburg Pavlov State Medical University, St Petersburg, Russia
| | - Victor J M Pop
- Departments of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
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Fernández-Barrés S, Romaguera D, Valvi D, Martínez D, Vioque J, Navarrete-Muñoz EM, Amiano P, Gonzalez-Palacios S, Guxens M, Pereda E, Riaño I, Tardón A, Iñiguez C, Arija V, Sunyer J, Vrijheid M. Mediterranean dietary pattern in pregnant women and offspring risk of overweight and abdominal obesity in early childhood: the INMA birth cohort study. Pediatr Obes 2016; 11:491-499. [PMID: 26763767 DOI: 10.1111/ijpo.12092] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 10/19/2015] [Accepted: 11/10/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND Animal models have suggested that maternal diet quality may reduce offspring obesity risk regardless of maternal body weight; however, evidence from human studies is scarce. OBJECTIVE The aim of this study was to evaluate associations between adherence to the Mediterranean diet (MD) during pregnancy and childhood overweight and abdominal obesity risk at 4 years of age. METHODS We analysed 1827 mother-child pairs from the Spanish 'Infancia y Medio Ambiente' cohort study, recruited between 2003 and 2008. Diet was assessed during pregnancy using a food frequency questionnaire and MD adherence by the relative Mediterranean diet score (rMED). Overweight (including obesity) was defined as an age-specific and sex-specific body mass index ≥85th percentile (World Health Organization referent), and abdominal obesity as a waist circumference (WC) >90th percentile. Multivariate adjusted linear and logistic regression models were used to evaluate associations between pregnancy rMED and offspring overweight and abdominal obesity. RESULT There was no association between rMED and body mass index z-score, whereas there was a significant association between higher adherence to MD and lower WC (β of high vs. low rMED: -0.62 cm; 95% confidence interval: -1.10, -0.14 cm, P for trend = 0.009). CONCLUSION Pregnancy adherence to the MD was not associated with childhood overweight risk, but it was associated with lower WC, a marker of abdominal obesity.
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Affiliation(s)
- S Fernández-Barrés
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,Nutrition and Mental Health Group, Universitat Rovira I Virgili (URV), Reus, Spain
| | - D Romaguera
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,Instituto de Investigación Sanitaria de Palma (IdISPa), Hospital Universitari Son Espases, Palma de Mallorca, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
| | - D Valvi
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - D Martínez
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - J Vioque
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Universidad Miguel Hernandez, Alicante, Spain
| | - E M Navarrete-Muñoz
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Universidad Miguel Hernandez, Alicante, Spain
| | - P Amiano
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Public Health Division of Gipuzkoa, BioDonostia Research Institute, San Sebastián, Spain
| | - S Gonzalez-Palacios
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Universidad Miguel Hernandez, Alicante, Spain
| | - M Guxens
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - E Pereda
- Facultad de Psicología, Universidad del País Vasco-Euskal Herriko Unibertsitatea (UPV-EHU), Bizkaia, Spain
| | - I Riaño
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Hospital San Agustín, SESPA, Asturias, Spain
| | - A Tardón
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Universidad de Oviedo, Asturias, Spain
| | - C Iñiguez
- FISABIO - Universitat Jaume I - Universitat de València Epidemiology and Environmental Health Joint Research Unit, Valencia, Spain
| | - V Arija
- Nutrition and Mental Health Group, Universitat Rovira I Virgili (URV), Reus, Spain
| | - J Sunyer
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,Institut Hospital del Mar d'Investigacions Mèdiques-Parc de Salut Mar, Barcelona, Spain
| | - M Vrijheid
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,Institut Hospital del Mar d'Investigacions Mèdiques-Parc de Salut Mar, Barcelona, Spain
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