番茄社区

BALTIMORE -- Under 50% of pregnant patients who met thyroid disease risk factor criteria as defined by guidelines were appropriately screened, a real-world retrospective study showed.

Among 1,025 new obstetric visits, only 87 of the 198 patients who met American College of Obstetricians and Gynecologists (ACOG) criteria were screened, and only 108 of the 826 who met American Thyroid Association (ATA) criteria were screened, reported Allan Dong, MD, of Advocate Lutheran General Hospital in Park Ridge, Illinois, during his poster presentation at the ACOG annual meeting.

Notably, of the women who met ATA criteria, those who were appropriately screened had significantly higher live birth rates compared with those who were not screened (92.6% vs 83.3%, P=0.006), as well as significantly lower miscarriage rates (4.6% vs 12.4%, P=0.009).

Though a similar magnitude of difference was seen for patients meeting ACOG criteria, there was no statistically significant differences between the screened and not-screened patients for live birth rates (92% vs 83.8%, P=0.065) or miscarriage rates (5.8% vs 12.6%, P=0.082).

Preterm delivery rates were also not significantly different between women who were screened and not screened based on either organization's criteria.

In their guidance, pregnancy has a significant effect on thyroid gland function, and thyroid disease is common in women who are pregnant.

, thyrotoxicosis and hypothyroidism are associated with adverse pregnancy outcomes. In addition, there are concerns about the effects of overt maternal thyroid disease on fetal development. Moreover, medications that affect the maternal thyroid gland can cross the placenta and affect the fetal thyroid gland.

However, ACOG recommends that only certain patients be screened for thyroid disease, including patients who have a history of thyroid disease, those who have a family history of thyroid disease, those who have a history of type 1 diabetes, or those with suspected thyroid disease based on symptoms.

The ATA guidelines are broader, which is why the sample size meeting these criteria in this study was larger. In addition to ACOG's at-risk groups, the ATA also recommends screening anyone over age 30, people with any autoimmune disorder, people with a body mass index (BMI) greater than 40, anyone with a history of head or neck radiation, and those with a history of pregnancy loss or preterm delivery, among others.

"ACOG is saying we should screen these people with these risk factors -- do we do that? And it doesn't look like we do," Dong told 番茄社区. "If the guidelines recommend targeted screening, we as physicians need to follow the guideline, otherwise we're not helping anybody."

In his presentation, Dong said that improving adherence to thyroid disease screening may lead to improved outcomes in pregnancy, with previous studies showing benefits to universal screening.

For this study, the researchers included all new obstetric patients at Advocate Lutheran General in 2020. The hospital's policy is to follow ACOG guidelines for thyroid disease screening. Only 199 patients didn't meet criteria based on ATA or ACOG guidelines.

While the study was conducted at one hospital in Illinois, Dong said he suspects the findings apply more broadly across the U.S.

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