Dr Sanjay Kalra, DM (AIIMS)
Less than half of pregnant women who meet the screening criteria for thyroid disease as per guidelines are properly screened, according to a study, which analysed obstetrical practice in this regard. The findings were presented at the 2023 ACOG Annual Clinical & Scientific Meeting and also published in the journal Obstetrics and Gynecology.1
All new obstetric patients visiting the Advocate Lutheran General Hospital in Illinois in 2020 were evaluated for this study with the objective to compare the pregnancy outcomes in women who met the guideline recommended screening criteria for thyroid disease and were either screened or not screened.
Out of the 1025 new obstetric visits recorded, 198 met the American College of Obstetricians and Gynecologists (ACOG) thyroid screening criteria. Of these, only 87 (43.9%) were screened for thyroid disease. There were 826 women who met the American Thyroid Association (ATA) criteria and of these only 108 (13.1%) were screened.
Women who met the ATA criteria and were screened had higher live birth rates compared to those who were not screened; 92.6% vs 83.3%, respectively. They also had significantly lower miscarriage rates; 4.63% vs 12.41%, respectively.
When the subgroup of women meeting the ACOG criteria was examined, differences between the screened and unscreened patients were observed for live birth rates and miscarriage rates but they were not statistically significant; 92% vs 83.8%, respectively and 5.8% vs 12.6%, respectively.
The preterm delivery rates were comparable between those who were screened or those who were not screened based on either criteria.
Universal screening for thyroid disease in pregnancy is not recommended by the American College of Obstetricians and Gynecologists (ACOG). Screening is indicated only for those with a family or personal history of thyroid disease or type 1 diabetes or in whom thyroid disease is suspected based on symptoms.2 Similarly, the American Thyroid Association (ATA) guidelines are also ambiguous on universal screening, nevertheless their scope is broader. They additionally recommend testing (serum TSH) for anyone over the age of 30 years, those with autoimmune disorders; history of head or neck radiation or prior thyroid surgery; history of pregnancy loss, preterm delivery, or infertility; those with BMI ≥40 and those who live in areas with known moderate to severe iodine insufficiency.3
This retrospective study shows that less than 50% of pregnant women are screened for thyroid disease in pregnancy in obstetrical practice. More women met the screening criteria when the ATA criteria were used compared to the ACOG criteria. Those who were screened as per the ATA criteria had better pregnancy outcomes compared to those who were not screened. These findings do make a case for universal screening for thyroid disease in pregnancy. Greater adherence to the screening guidelines may improve pregnancy outcomes.
References
- Allan D, et al. Do clinicians appropriately screen for thyroid disease in pregnancy using targeted screening guidelines? a real-world retrospective study [ID: 1368322]. Obstet Gynecol. 2023 May;141(Suppl 1):70S-70S. DOI: https://doi.org/10.1097/01.AOG.0000930664.18246.a7
- Thyroid disease in pregnancy: ACOG Practice Bulletin, Number 223. Obstet Gynecol. 2020 Jun;135(6):e261-e274. doi: 10.1097/AOG.000000000000389.
- Alexander EK, et al. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid. 2017;27(3):315-389. doi: 10.1089/thy.2016.0457. 2017.
