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

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Harvard

Derakhshan, A, Peeters, RP, Taylor, PN, Bliddal, S, Carty, DM, Meems, M, Vaidya, B, Chen, L, Knight, BA, 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, CM, French, R, Boucai, L, Vafeiadi, M, Grineva, EN, Pop, VJM, Vrijkotte, TG, Chatzi, L, Sunyer, J, Jiménez-Zabala, A, Riaño, I, Rebagliato, M, Lu, X, Pirzada, A, Männistö, T, Delles, C, Feldt-Rasmussen, U, Alexander, EK, Nelson, SM, Chaker, L, Pearce, EN, Guxens, M, Steegers, EAP, Walsh, JP & Korevaar, TIM 2020, 'Association of maternal thyroid function with birthweight: a systematic review and individual-participant data meta-analysis', The Lancet Diabetes and Endocrinology, bind 8, nr. 6, s. 501-510. https://doi.org/10.1016/S2213-8587(20)30061-9

APA

Derakhshan, A., Peeters, R. P., Taylor, P. N., Bliddal, S., Carty, D. M., Meems, M., Vaidya, B., Chen, L., Knight, B. A., Ghafoor, F., Popova, P. V., Mosso, L., Oken, E., Suvanto, E., Hisada, A., Yoshinaga, J., Brown, S. J., Bassols, J., Auvinen, J., ... Korevaar, T. I. M. (2020). Association of maternal thyroid function with birthweight: a systematic review and individual-participant data meta-analysis. The Lancet Diabetes and Endocrinology, 8(6), 501-510. https://doi.org/10.1016/S2213-8587(20)30061-9

CBE

Derakhshan A, Peeters RP, Taylor PN, Bliddal S, Carty DM, Meems M, Vaidya B, Chen L, Knight BA, 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 CM, French R, Boucai L, Vafeiadi M, Grineva EN, Pop VJM, Vrijkotte TG, Chatzi L, Sunyer J, Jiménez-Zabala A, Riaño I, Rebagliato M, Lu X, Pirzada A, Männistö T, Delles C, Feldt-Rasmussen U, Alexander EK, Nelson SM, Chaker L, Pearce EN, Guxens M, Steegers EAP, Walsh JP, Korevaar TIM. 2020. Association of maternal thyroid function with birthweight: a systematic review and individual-participant data meta-analysis. The Lancet Diabetes and Endocrinology. 8(6):501-510. https://doi.org/10.1016/S2213-8587(20)30061-9

MLA

Vancouver

Author

Derakhshan, Arash ; Peeters, Robin P ; Taylor, Peter N ; Bliddal, Sofie ; Carty, David M ; Meems, Margreet ; Vaidya, Bijay ; Chen, Liangmiao ; Knight, Bridget A ; Ghafoor, Farkhanda ; Popova, Polina V ; Mosso, Lorena ; Oken, Emily ; Suvanto, Eila ; Hisada, Aya ; Yoshinaga, Jun ; Brown, Suzanne J ; Bassols, Judit ; Auvinen, Juha ; Bramer, Wichor M ; López-Bermejo, Abel ; Dayan, Colin M ; French, Robert ; Boucai, Laura ; Vafeiadi, Marina ; Grineva, Elena N ; Pop, Victor J M ; Vrijkotte, Tanja G ; Chatzi, Leda ; Sunyer, Jordi ; Jiménez-Zabala, Ana ; Riaño, Isolina ; Rebagliato, Marisa ; Lu, Xuemian ; Pirzada, Amna ; Männistö, Tuija ; Delles, Christian ; Feldt-Rasmussen, Ulla ; Alexander, Erik K ; Nelson, Scott M ; Chaker, Layal ; Pearce, Elizabeth N ; Guxens, Mònica ; Steegers, Eric A P ; Walsh, John P ; Korevaar, Tim I M. / Association of maternal thyroid function with birthweight : a systematic review and individual-participant data meta-analysis. I: The Lancet Diabetes and Endocrinology. 2020 ; Bind 8, Nr. 6. s. 501-510.

Bibtex

@article{4322e1eb5e9d48a38a7d7955b930abc9,
title = "Association of maternal thyroid function with birthweight: a systematic review and individual-participant data meta-analysis",
abstract = "BACKGROUND: 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.METHODS: 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.FINDINGS: 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 (pinteraction=0·10). Each 1 SD increase in FT4 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.INTERPRETATION: 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.FUNDING: Netherlands Organization for Scientific Research (grant 401.16.020).",
author = "Arash Derakhshan and Peeters, {Robin P} and Taylor, {Peter N} and Sofie Bliddal and Carty, {David M} and Margreet Meems and Bijay Vaidya and Liangmiao Chen and Knight, {Bridget A} and Farkhanda Ghafoor and Popova, {Polina V} and Lorena Mosso and Emily Oken and Eila Suvanto and Aya Hisada and Jun Yoshinaga and Brown, {Suzanne J} and Judit Bassols and Juha Auvinen and Bramer, {Wichor M} and Abel L{\'o}pez-Bermejo and Dayan, {Colin M} and Robert French and Laura Boucai and Marina Vafeiadi and Grineva, {Elena N} and Pop, {Victor J M} and Vrijkotte, {Tanja G} and Leda Chatzi and Jordi Sunyer and Ana Jim{\'e}nez-Zabala and Isolina Ria{\~n}o and Marisa Rebagliato and Xuemian Lu and Amna Pirzada and Tuija M{\"a}nnist{\"o} and Christian Delles and Ulla Feldt-Rasmussen and Alexander, {Erik K} and Nelson, {Scott M} and Layal Chaker and Pearce, {Elizabeth N} and M{\`o}nica Guxens and Steegers, {Eric A P} and Walsh, {John P} and Korevaar, {Tim I M}",
note = "Copyright {\textcopyright} 2020 Elsevier Ltd. All rights reserved.",
year = "2020",
month = jun,
doi = "10.1016/S2213-8587(20)30061-9",
language = "English",
volume = "8",
pages = "501--510",
journal = "The Lancet Diabetes and Endocrinology",
issn = "2213-8587",
publisher = "London The Lancet, Diabetes & Endocrinology, 2013",
number = "6",

}

RIS

TY - JOUR

T1 - Association of maternal thyroid function with birthweight

T2 - a systematic review and individual-participant data meta-analysis

AU - Derakhshan, Arash

AU - Peeters, Robin P

AU - Taylor, Peter N

AU - Bliddal, Sofie

AU - Carty, David M

AU - Meems, Margreet

AU - Vaidya, Bijay

AU - Chen, Liangmiao

AU - Knight, Bridget A

AU - Ghafoor, Farkhanda

AU - Popova, Polina V

AU - Mosso, Lorena

AU - Oken, Emily

AU - Suvanto, Eila

AU - Hisada, Aya

AU - Yoshinaga, Jun

AU - Brown, Suzanne J

AU - Bassols, Judit

AU - Auvinen, Juha

AU - Bramer, Wichor M

AU - López-Bermejo, Abel

AU - Dayan, Colin M

AU - French, Robert

AU - Boucai, Laura

AU - Vafeiadi, Marina

AU - Grineva, Elena N

AU - Pop, Victor J M

AU - Vrijkotte, Tanja G

AU - Chatzi, Leda

AU - Sunyer, Jordi

AU - Jiménez-Zabala, Ana

AU - Riaño, Isolina

AU - Rebagliato, Marisa

AU - Lu, Xuemian

AU - Pirzada, Amna

AU - Männistö, Tuija

AU - Delles, Christian

AU - Feldt-Rasmussen, Ulla

AU - Alexander, Erik K

AU - Nelson, Scott M

AU - Chaker, Layal

AU - Pearce, Elizabeth N

AU - Guxens, Mònica

AU - Steegers, Eric A P

AU - Walsh, John P

AU - Korevaar, Tim I M

N1 - Copyright © 2020 Elsevier Ltd. All rights reserved.

PY - 2020/6

Y1 - 2020/6

N2 - BACKGROUND: 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.METHODS: 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.FINDINGS: 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 (pinteraction=0·10). Each 1 SD increase in FT4 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.INTERPRETATION: 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.FUNDING: Netherlands Organization for Scientific Research (grant 401.16.020).

AB - BACKGROUND: 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.METHODS: 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.FINDINGS: 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 (pinteraction=0·10). Each 1 SD increase in FT4 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.INTERPRETATION: 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.FUNDING: Netherlands Organization for Scientific Research (grant 401.16.020).

U2 - 10.1016/S2213-8587(20)30061-9

DO - 10.1016/S2213-8587(20)30061-9

M3 - Journal article

C2 - 32445737

VL - 8

SP - 501

EP - 510

JO - The Lancet Diabetes and Endocrinology

JF - The Lancet Diabetes and Endocrinology

SN - 2213-8587

IS - 6

ER -

ID: 59978122