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Levothyroxine therapy during pregnancy minimizes neonatal adverse events
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Treatment with levothyroxine in pregnant women with abnormal thyroid function results in a decreased risk for early gestational age at delivery and early cesarean sections, study data show.
“Our work raises the possibility of providing real benefits from using a safe, cheap and well-established treatment by simply extending it to the number of pregnant women we treat,” Peter Taylor, MBChB, MSc, a Welsh Clinical Academic Trainee in diabetes and endocrinology at the University of Cardiff, said in a press release. “We should consider universal thyroid screening in pregnancy as it compared favorably in terms of cost-effectiveness with other conditions that we currently screen for.”
Taylor and colleagues evaluated data from the Controlled Antenatal Thyroid Screening study on pregnant women with normal thyroid function (n = 12,608), subclinical hypothyroidism (n = 340) and isolated hypothyroxinemia (n = 305) to determine the effect of treatment with levothyroxine on stillbirth, neonatal death, preterm delivery (< 34 weeks), Apgar score of less than 7 at 5 minutes, length of hospital stay more than 5 days, early gestational age (< 37 weeks) and early cesarean sections (< 37 weeks). Among participants, 518 were identified as having abnormal thyroid function, and these women were randomly assigned to levothyroxine therapy (n = 263) or no treatment (n = 255) at the end of the first trimester.
Rates of stillbirth, neonatal death, preterm delivery, Apgar score of less than 7 at 5 minutes and length of hospital stay of more than 5 days did not significantly differ between the treated and untreated group.
The odds for stillbirth were higher among participants with subclinical hypothyroidism who were not treated compared with women with normal thyroid function (OR = 4.37; 95% CI, 1.04-18.3). No participant treated with levothyroxine experienced stillbirth.
Compared with participants with normal thyroid function, participants with isolated hypothyroxinemia who were treated had an increased risk for early gestational age at delivery (OR = 1.58; 95% CI, 1.04-2.5).
Compared with untreated participants, those with isolated hypothyroxinemia treated with levothyroxine had a decreased risk for early gestational age at delivery (OR = 0.37; 95% CI, 0.14-0.99) and early cesarean sections (P = .04).
“We have indicated that there may be real benefits from correcting borderline thyroid function in pregnant women using a commonly used inexpensive drug, levothyroxine,” Taylor told Endocrine Today. “This has important outcomes, including reducing stillbirth and prematurity, although more studies are needed. It also raises the possibility that as hypothyroidism and borderline thyroid function are common, there is a compelling argument for universal thyroid screening in pregnancy. More focus on thyroid status is needed [as well as] consideration of universal thyroid screening.” – by Amber Cox
Reference:
Taylor PN, et al. Abstract #OC6.3. Presented at: Society for Endocrinology Annual Conference; Nov. 7-9, 2016; Brighton, United Kingdom.
Disclosure: Taylor reports no relevant financial disclosures.