Risk Factors for Thyroid Dysfunction in Pregnancy: An Individual Participant Data Meta-Analysis

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dc.article.number106217
dc.contributor.authorOsinga J.A.
dc.contributor.authorLiu Y.
dc.contributor.authorMannisto T.
dc.contributor.authorVafeiadi M.
dc.contributor.authorTao F.-B.
dc.contributor.authorVaidya B.
dc.contributor.authorVrijkotte T.G.
dc.contributor.authorMosso L.
dc.contributor.authorBassols J.
dc.contributor.authorLopez-Bermejo A.
dc.contributor.authorBoucai L.
dc.contributor.authorAminorroaya A.
dc.contributor.authorFeldt-Rasmussen U.
dc.contributor.authorHisada A.
dc.contributor.authorYoshinaga J.
dc.contributor.authorBroeren M.A.
dc.contributor.authorItoh S.
dc.contributor.authorKishi R.
dc.contributor.authorAshoor G.
dc.contributor.authorChen L.
dc.contributor.authorVeltri F.
dc.contributor.authorLu X.
dc.contributor.authorTaylor P.N.
dc.contributor.authorBrown S.J.
dc.contributor.authorChatzi L.
dc.contributor.authorPopova P.V.
dc.contributor.authorGrineva E.N.
dc.contributor.authorGhafoor F.
dc.contributor.authorPirzada A.
dc.contributor.authorKianpour M.
dc.contributor.authorOken E.
dc.contributor.authorSuvanto E.
dc.contributor.authorHattersley A.
dc.contributor.authorRebagliato M.
dc.contributor.authorRiano-Galan I.
dc.contributor.authorIrizar A.
dc.contributor.authorVrijheid M.
dc.contributor.authorDelgado-Saborit J.M.
dc.contributor.authorFernandez-Somoano A.
dc.contributor.authorSanta-Marina L.
dc.contributor.authorBoelaert K.
dc.contributor.authorBrenta G.
dc.contributor.authorDhillon-Smith R.
dc.contributor.authorDosiou C.
dc.contributor.authorEaton J.L.
dc.contributor.authorGuan H.
dc.contributor.authorLee S.Y.
dc.contributor.authorMaraka S.
dc.contributor.authorMorris-Wiseman L.F.
dc.contributor.authorNguyen C.T.
dc.contributor.authorShan Z.
dc.contributor.authorGuxens M.
dc.contributor.authorPop V.J.
dc.contributor.authorWalsh J.P.
dc.contributor.authorNicolaides K.H.
dc.contributor.authorD'Alton M.E.
dc.contributor.authorVisser W.E.
dc.contributor.authorCarty D.M.
dc.contributor.authorDelles C.
dc.contributor.authorNelson S.M.
dc.contributor.authorAlexander E.K.
dc.contributor.authorChaker L.
dc.contributor.authorPalomaki G.E.
dc.contributor.authorPeeters R.P.
dc.contributor.authorBliddal S.
dc.contributor.authorHuang K.
dc.contributor.authorPoppe K.G.
dc.contributor.authorPearce E.N.
dc.contributor.authorDerakhshan A.
dc.contributor.authorKorevaar T.I.
dc.contributor.otherNCD Risk Factor Collaboration (NCD-RisC)
dc.date.accessioned2024-08-15T08:00:19Z
dc.date.available2024-08-15T08:00:19Z
dc.date.issued2024
dc.description.abstractCopyright 2024, © American Thyroid Association; Published by Mary Ann Liebert, Inc.Background: International guidelines recommend targeted screening to identify gestational thyroid dysfunction. However, currently used risk factors have questionable discriminative ability. We quantified the risk for thyroid function test abnormalities for a subset of risk factors currently used in international guidelines. Methods: We included prospective cohort studies with data on gestational maternal thyroid function and potential risk factors (maternal age, body mass index [BMI], parity, smoking status, pregnancy through in vitro fertilization, twin pregnancy, gestational age, maternal education, and thyroid peroxidase antibody [TPOAb] or thyroglobulin antibody [TgAb] positivity). Exclusion criteria were pre-existing thyroid disease and use of thyroid interfering medication. We analyzed individual participant data using mixed-effects regression models. Primary outcomes were overt and subclinical hypothyroidism and a treatment indication (defined as overt hypothyroidism, subclinical hypothyroidism with thyrotropin >10 mU/L, or subclinical hypothyroidism with TPOAb positivity). Results: The study population comprised 65,559 participants in 25 cohorts. The screening rate in cohorts using risk factors currently recommended (age >30 years, parity ≥2, BMI ≥40) was 58%, with a detection rate for overt and subclinical hypothyroidism of 59%. The absolute risk for overt or subclinical hypothyroidism varied <2% over the full range of age and BMI and for any parity. Receiver operating characteristic curves, fitted using maternal age, BMI, smoking status, parity, and gestational age at blood sampling as explanatory variables, yielded areas under the curve ranging from 0.58 to 0.63 for the primary outcomes. TPOAbs/TgAbs positivity was associated with overt hypothyroidism (approximate risk for antibody negativity 0.1%, isolated TgAb positivity 2.4%, isolated TPOAb positivity 3.8%, combined antibody positivity 7.0%; p < 0.001), subclinical hypothyroidism (risk for antibody negativity 2.2%, isolated TgAb positivity 8.1%, isolated TPOAb positivity 14.2%, combined antibody positivity 20.0%; p < 0.001) and a treatment indication (risk for antibody negativity 0.2%, isolated TgAb positivity 2.2%, isolated TPOAb positivity 3.0%, and combined antibody positivity 5.1%; p < 0.001). Twin pregnancy was associated with a higher risk of overt hyperthyroidism (5.6% vs. 0.7%; p < 0.001). Conclusions: The risk factors assessed in this study had poor predictive ability for detecting thyroid function test abnormalities, questioning their clinical usability for targeted screening. As expected, TPOAb positivity (used as a benchmark) was a relevant risk factor for (subclinical) hypothyroidism. These results provide insights into different risk factors for gestational thyroid dysfunction.
dc.description.funderNational Research and Development Agency of Chile, National Doctoral Scholarship
dc.format.extent1 página
dc.fuente.origenScopus
dc.identifier.doi10.1089/thy.2023.0646
dc.identifier.eissn1365-2206
dc.identifier.issn15579077 10507256
dc.identifier.pubmedid15880187
dc.identifier.scopusidSCOPUS_ID:85188990292
dc.identifier.urihttps://doi.org/10.1089/thy.2023.0646
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/87460
dc.identifier.wosidWOS:001193585500001
dc.information.autorucFacultad de Medicina; Mosso Gomez, Lorena Montserrat; S/I; 88201
dc.issue.numero20
dc.language.isoen
dc.nota.accesoContenido parcial
dc.pagina.final2901
dc.pagina.inicio2885
dc.relation.ispartof92nd Meeting and Expo of the Endocrine Society (ENDO 2010), JUN 19-22, 2010, San Diego, CA
dc.revistaThyroid
dc.rightsacceso restringido
dc.subjectpregnancy
dc.subjectrisk factors
dc.subjectscreening
dc.subjectthyroid
dc.subjectthyroid function tests
dc.subject.ddc610
dc.subject.deweyMedicina y saludes_ES
dc.subject.ods03 Good health and well-being
dc.subject.odspa03 Salud y bienestar
dc.titleRisk Factors for Thyroid Dysfunction in Pregnancy: An Individual Participant Data Meta-Analysis
dc.typeartículo
dc.volumen29
sipa.codpersvinculados88201
sipa.indexScopus
sipa.trazabilidadCarga WOS-SCOPUS;15-08-2024
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