Association of maternal thyroid function with birthweight: a systematic review and individual-participant data meta-analysis

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dc.contributor.authorDerakhshan, Arash
dc.contributor.authorPeeters, Robin P.
dc.contributor.authorTaylor, Peter N.
dc.contributor.authorBliddal, Sofie
dc.contributor.authorCarty, David M.
dc.contributor.authorMeems, Margreet
dc.contributor.authorVaidya, Bijay
dc.contributor.authorChen, Liangmiao
dc.contributor.authorKnight, Bridget A.
dc.contributor.authorGhafoor, Farkhanda
dc.contributor.authorPopova, Polina V.
dc.contributor.authorMosso, Lorena
dc.contributor.authorOken, Emily
dc.contributor.authorSuvanto, Eila
dc.contributor.authorHisada, Aya
dc.contributor.authorYoshinaga, Jun
dc.contributor.authorBrown, Suzanne J.
dc.contributor.authorBassols, Judit
dc.contributor.authorAuvinen, Juha
dc.contributor.authorBramer, Wichor M.
dc.contributor.authorLopez-Bermejo, Abel
dc.contributor.authorDayan, Colin M.
dc.contributor.authorFrench, Robert
dc.contributor.authorBoucai, Laura
dc.contributor.authorVafeiadi, Marina
dc.contributor.authorGrineva, Elena N.
dc.contributor.authorPop, Victor J. M.
dc.contributor.authorVrijkotte, Tanja G.
dc.contributor.authorChatzi, Leda
dc.contributor.authorSunyer, Jordi
dc.contributor.authorJimenez-Zabala, Ana
dc.contributor.authorRiano, Isolina
dc.contributor.authorRebagliato, Marisa
dc.contributor.authorLu, Xuemian
dc.contributor.authorPirzada, Amna
dc.contributor.authorMannisto, Tuija
dc.contributor.authorDelles, Christian
dc.contributor.authorFeldt-Rasmussen, Ulla
dc.contributor.authorAlexander, Erik K.
dc.contributor.authorNelson, Scott M.
dc.contributor.authorChaker, Layal
dc.contributor.authorPearce, Elizabeth N.
dc.contributor.authorGuxens, Monica
dc.contributor.authorSteegers, Eric A. P.
dc.contributor.authorWalsh, John P.
dc.contributor.authorKorevaar, Tim I. M.
dc.date.accessioned2025-01-23T19:51:38Z
dc.date.available2025-01-23T19:51:38Z
dc.date.issued2020
dc.description.abstractBackground Adequate transplacental passage of maternal thyroid hormone is important for normal fetal growth and development. Maternal overt hypothyroidism and hyperthyroidism are associated with low birthweight, but important knowledge gaps remain regarding the effect of subclinical thyroid function test abnormalities on birthweight-both in general and during the late second and third trimester of pregnancy. The aim of this study was to examine associations of maternal thyroid function with birthweight.
dc.description.abstractMethods In this systematic review and individual-participant data meta-analysis, we searched MEDLINE (Ovid), Embase, Web of Science, the Cochrane Central Register of Controlled Trials, and Google Scholar from inception to Oct 15, 2019, for prospective cohort studies with data on maternal thyroid function during pregnancy and birthweight, and we issued open invitations to identify study authors to join the Consortium on Thyroid and Pregnancy. We excluded participants with multiple pregnancies, in-vitro fertilisation, pre-existing thyroid disease or thyroid medication usage, miscarriages, and stillbirths. The main outcomes assessed were small for gestational age (SGA) neonates, large for gestational age neonates, and newborn birthweight. We analysed individual-participant data using mixed-effects regression models adjusting for maternal age, BMI, ethnicity, smoking, parity, gestational age at blood sampling, fetal sex, and gestational age at birth. The study protocol was pre-registered at the International Prospective Register of Systematic Reviews, CRD42016043496.
dc.description.abstractFindings We identified 2526 published reports, from which 36 cohorts met the inclusion criteria. The study authors for 15 of these cohorts agreed to participate, and five more unpublished datasets were added, giving a study population of 48 145 mother-child pairs after exclusions, of whom 1275 (3.1%) had subclinical hypothyroidism (increased thyroid stimulating hormone [TSH] with normal free thyroxine [FT4]) and 929 (2.2%) had isolated hypothyroxinaemia (decreased FT4 with normal TSH). Maternal subclinical hypothyroidism was associated with a higher risk of SGA than was euthyroidism (11.8% vs 10.0%; adjusted risk difference 2.43%, 95% CI 0.43 to 4.81; odds ratio [OR] 1.24, 1.04 to 1 .48; p=0.015) and lower mean birthweight (mean difference -38 g, -61 to -15; p=0.0015), with a higher effect estimate for measurement in the third trimester than in the first or second. Isolated hypothyroxinaemia was associated with a lower risk of SGA than was euthyroidism (7.3% vs 10.0%, adjusted risk difference -2.91, -4.49 to -0.88; OR 0.70, 0.55 to 0.91; p=0.0073) and higher mean birthweight (mean difference 45 g, 18 to 73; p=0.0012). Each 1 SD increase in maternal TSH concentration was associated with a 6 g lower birthweight (-10 to -2; p=0.0030), with higher effect estimates in women who were thyroid peroxidase antibody positive than for women who were negative (p(interaction)=0.10). Each 1 SD increase in FT 4 concentration was associated with a 21 g lower birthweight (-25 to -17; p< 0.0001), with a higher effect estimate for measurement in the third trimester than the first or second.
dc.description.abstractInterpretation Maternal subclinical hypothyroidism in pregnancy is associated with a higher risk of SGA and lower birthweight, whereas isolated hypothyroxinaemia is associated with lower risk of SGA and higher birthweight. There was an inverse, dose-response association of maternal TSH and FT4 (even within the normal range) with birthweight. These results advance our understanding of the complex relationships between maternal thyroid function and fetal outcomes, and they should prompt careful consideration of potential risks and benefits of levothyroxine therapy during pregnancy. Copyright (C) 2020 Esevier Ltd. All rights reserved.
dc.fuente.origenWOS
dc.identifier.doi10.1016/S2213-8587(20)30061-9
dc.identifier.eissn2213-8595
dc.identifier.issn2213-8587
dc.identifier.urihttps://doi.org/10.1016/S2213-8587(20)30061-9
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/100591
dc.identifier.wosidWOS:000537458500013
dc.issue.numero6
dc.language.isoen
dc.pagina.final510
dc.pagina.inicio501
dc.revistaLancet diabetes & endocrinology
dc.rightsacceso restringido
dc.subject.ods03 Good Health and Well-being
dc.subject.odspa03 Salud y bienestar
dc.titleAssociation of maternal thyroid function with birthweight: a systematic review and individual-participant data meta-analysis
dc.typeartículo
dc.volumen8
sipa.indexWOS
sipa.trazabilidadWOS;2025-01-12
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