Osinga, J. A. J., Liu, Y., Männistö, T., Vafeiadi, M., Tao, F. B., Vaidya, B., Vrijkotte, T. G. M., Mosso, L., Bassols, J., López-Bermejo, A., Boucai, L., Aminorroaya, A., Feldt-Rasmussen, U., Hisada, A., Yoshinaga, J., Broeren, M. A. C., Itoh, S., Kishi, R., Ashoor, G., ... Korevaar, T. I. M. (2024). Risk Factors for Thyroid Dysfunction in Pregnancy: An Individual Participant Data Meta-Analysis. Thyroid, 34(5), 646-658. https://doi.org/10.1089/thy.2023.0646
Osinga, JAJ, Liu, Y, Männistö, T, Vafeiadi, M, Tao, FB, Vaidya, B, Vrijkotte, TGM, Mosso, L, Bassols, J, López-Bermejo, A, Boucai, L, Aminorroaya, A, Feldt-Rasmussen, U, Hisada, A, Yoshinaga, J, Broeren, MAC, Itoh, S, Kishi, R, Ashoor, G, Chen, L, Veltri, F, Lu, X, Taylor, PN, Brown, SJ, Chatzi, L, Popova, PV, Grineva, EN, Ghafoor, F, Pirzada, A, Kianpour, M, Oken, E, Suvanto, E, Hattersley, A, Rebagliato, M, Riaño-Galán, I, Irizar, A, Vrijheid, M, Delgado-Saborit, JM, Fernández-Somoano, A, Santa-Marina, L, Boelaert, K, Brenta, G, Dhillon-Smith, R, Dosiou, C, Eaton, JL, Guan, H, Lee, SY, Maraka, S, Morris-Wiseman, LF, Nguyen, CT, Shan, Z, Guxens, M, Pop, VJM, Walsh, JP, Nicolaides, KH, D'Alton, ME, Visser, WE, Carty, DM, Delles, C, Nelson, SM, Alexander, EK, Chaker, L, Palomaki, GE, Peeters, RP, Bliddal, S, Huang, K, Poppe, KG, Pearce, EN, Derakhshan, A & Korevaar, TIM 2024, 'Risk Factors for Thyroid Dysfunction in Pregnancy: An Individual Participant Data Meta-Analysis', Thyroid, vol. 34, n° 5, pp. 646-658. https://doi.org/10.1089/thy.2023.0646
@article{af0e12619160446b86e1985bc61e87a7,
title = "Risk Factors for Thyroid Dysfunction in Pregnancy: An Individual Participant Data Meta-Analysis",
abstract = "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.",
author = "Osinga, {Joris A.J.} and Yindi Liu and Tuija M{\"a}nnist{\"o} and Marina Vafeiadi and Tao, {Fang Biao} and Bijay Vaidya and Vrijkotte, {Tanja G.M.} and Lorena Mosso and Judit Bassols and Abel L{\'o}pez-Bermejo and Laura Boucai and Ashraf Aminorroaya and Ulla Feldt-Rasmussen and Aya Hisada and Jun Yoshinaga and Broeren, {Maarten A.C.} and Sachiko Itoh and Reiko Kishi and Ghalia Ashoor and Liangmiao Chen and Flora Veltri and Xuemian Lu and Taylor, {Peter N.} and Brown, {Suzanne J.} and Leda Chatzi and Popova, {Polina V.} and Grineva, {Elena N.} and Farkhanda Ghafoor and Amna Pirzada and Maryam Kianpour and Emily Oken and Eila Suvanto and Andrew Hattersley and Marisa Rebagliato and Isolina Ria{\~n}o-Gal{\'a}n and Amaia Irizar and Martine Vrijheid and Delgado-Saborit, {Juana Maria} and Ana Fern{\'a}ndez-Somoano and Loreto Santa-Marina and Kristien Boelaert and Gabriela Brenta and Rima Dhillon-Smith and Chrysoula Dosiou and Eaton, {Jennifer L.} and Haixia Guan and Lee, {Sun Y.} and Spyridoula Maraka and Morris-Wiseman, {Lilah F.} and Nguyen, {Caroline T.} and Zhongyan Shan and M{\`o}nica Guxens and Pop, {Victor J.M.} and Walsh, {John P.} and Nicolaides, {Kypros H.} and D'Alton, {Mary E.} and Visser, {W. Edward} and Carty, {David M.} and Christian Delles and Nelson, {Scott M.} and Alexander, {Erik K.} and Layal Chaker and Palomaki, {Glenn E.} and Peeters, {Robin P.} and Sofie Bliddal and Kun Huang and Poppe, {Kris G.} and Pearce, {Elizabeth N.} and Arash Derakhshan and Korevaar, {Tim I.M.}",
note = "Publisher Copyright: Copyright 2024, Mary Ann Liebert, Inc., publishers.",
year = "2024",
month = may,
day = "24",
doi = "10.1089/thy.2023.0646",
language = "English",
volume = "34",
pages = "646--658",
journal = "Thyroid",
issn = "1050-7256",
publisher = "Mary Ann Liebert Inc.",
number = "5",
}
TY - JOUR
T1 - Risk Factors for Thyroid Dysfunction in Pregnancy
T2 - An Individual Participant Data Meta-Analysis
AU - Osinga, Joris A.J.
AU - Liu, Yindi
AU - Männistö, Tuija
AU - Vafeiadi, Marina
AU - Tao, Fang Biao
AU - Vaidya, Bijay
AU - Vrijkotte, Tanja G.M.
AU - Mosso, Lorena
AU - Bassols, Judit
AU - López-Bermejo, Abel
AU - Boucai, Laura
AU - Aminorroaya, Ashraf
AU - Feldt-Rasmussen, Ulla
AU - Hisada, Aya
AU - Yoshinaga, Jun
AU - Broeren, Maarten A.C.
AU - Itoh, Sachiko
AU - Kishi, Reiko
AU - Ashoor, Ghalia
AU - Chen, Liangmiao
AU - Veltri, Flora
AU - Lu, Xuemian
AU - Taylor, Peter N.
AU - Brown, Suzanne J.
AU - Chatzi, Leda
AU - Popova, Polina V.
AU - Grineva, Elena N.
AU - Ghafoor, Farkhanda
AU - Pirzada, Amna
AU - Kianpour, Maryam
AU - Oken, Emily
AU - Suvanto, Eila
AU - Hattersley, Andrew
AU - Rebagliato, Marisa
AU - Riaño-Galán, Isolina
AU - Irizar, Amaia
AU - Vrijheid, Martine
AU - Delgado-Saborit, Juana Maria
AU - Fernández-Somoano, Ana
AU - Santa-Marina, Loreto
AU - Boelaert, Kristien
AU - Brenta, Gabriela
AU - Dhillon-Smith, Rima
AU - Dosiou, Chrysoula
AU - Eaton, Jennifer L.
AU - Guan, Haixia
AU - Lee, Sun Y.
AU - Maraka, Spyridoula
AU - Morris-Wiseman, Lilah F.
AU - Nguyen, Caroline T.
AU - Shan, Zhongyan
AU - Guxens, Mònica
AU - Pop, Victor J.M.
AU - Walsh, John P.
AU - Nicolaides, Kypros H.
AU - D'Alton, Mary E.
AU - Visser, W. Edward
AU - Carty, David M.
AU - Delles, Christian
AU - Nelson, Scott M.
AU - Alexander, Erik K.
AU - Chaker, Layal
AU - Palomaki, Glenn E.
AU - Peeters, Robin P.
AU - Bliddal, Sofie
AU - Huang, Kun
AU - Poppe, Kris G.
AU - Pearce, Elizabeth N.
AU - Derakhshan, Arash
AU - Korevaar, Tim I.M.
N1 - Publisher Copyright:
Copyright 2024, Mary Ann Liebert, Inc., publishers.
PY - 2024/5/24
Y1 - 2024/5/24
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85188990292&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85188990292&partnerID=8YFLogxK
U2 - 10.1089/thy.2023.0646
DO - 10.1089/thy.2023.0646
M3 - Article
C2 - 38546971
AN - SCOPUS:85188990292
SN - 1050-7256
VL - 34
SP - 646
EP - 658
JO - Thyroid
JF - Thyroid
IS - 5
ER -