Subclinical Hypothyroidism in Pregnancy: A Systematic Review and Meta-Analysis

ObjectiveTo determine in women with subclinical hypothyroidism diagnosed in pregnancy whether levothyroxine treatment compared with control, impacts important obstetrical or childhood outcomes (specifically IQ) in randomised controlled trials.DesignSystematic review and meta-analysis.Study eligibility criteriaRandomised trials which met all the following were included: (1) reported original data of women with subclinical hypothyroidism diagnosed in pregnancy (by any prespecified study definition); (2) randomised to either levothyroxine or control (placebo or no treatment); (3) reported obstetrical outcomes and/or childhood neurodevelopmental outcomes and (4) published from 1980 to January 2018 in either English or French language.Data sourcesMedline, EMBASE, CINAHL, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov.Outcome measuresObstetrical, neonatal and childhood outcomes including: miscarriage, gestational hypertension, pre-eclampsia, preterm delivery, mode of delivery, neonatal intensive care unit admission, birth weight, gestational age at delivery, childhood IQ and neurodevelopmental scores.Risk of bias assessmentCochrane Risk of Bias Tool (Modified) for Quality Assessment of Randomised Controlled TrialsResultsThree trials of low to unclear risk of bias with 1837 participants were included. Two studies were meta-analysed for maternal and neonatal outcomes and two studies for childhood IQ. No statistically significant differences were found for any clinical outcomes with levothyroxine therapy compared with control.LimitationsOnly three trials were identified for inclusion.ConclusionsThis review, based on three randomised trials in women with subclinical hypothyroidism diagnosed in pregnancy, found no evidence of benefit of levothyroxine therapy on obstetrical, neonatal, childhood IQ or neurodevelopmental outcomes. Current trial evidence does not support the treatment of subclinical hypothyroidism diagnosed in pregnancy.PROSPERO registration numberCRD4201707980.

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Subclinical hypothyroidism and non-alcoholic fatty liver disease: A systematic review and meta-analysis

Endocrine Abstracts ◽

10.1530/endoabs.70.aep916 ◽

2020 ◽

Author(s):

Yuli Guzman-Prado ◽

Ondrej Samson

Keyword(s):

Systematic Review ◽

Liver Disease ◽

Fatty Liver ◽

Subclinical Hypothyroidism ◽

Fatty Liver Disease ◽

Meta Analysis ◽

Alcoholic Fatty Liver ◽

Alcoholic Fatty Liver Disease

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Levothyroxine and the risk of adverse pregnancy outcomes in women with subclinical hypothyroidism: a systematic review and meta-analysis

BMC Endocrine Disorders ◽

10.1186/s12902-021-00699-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Magnus Bein ◽

Oriana Hoi Yun Yu ◽

Sonia Marzia Grandi ◽

Francesca Y. E. Frati ◽

Ihab Kandil ◽

...

Keyword(s):

Systematic Review ◽

Subclinical Hypothyroidism ◽

Pregnancy Outcomes ◽

Neonatal Death ◽

Observational Studies ◽

Pregnancy Loss ◽

Meta Analysis ◽

Adverse Pregnancy Outcomes ◽

Adverse Pregnancy ◽

Levothyroxine Treatment

Abstract Background Levothyroxine replacement therapy may decrease the risk of adverse pregnancy outcomes among women with subclinical hypothyroidism (SCH). The aim of this study is to conduct a systematic review and meta-analysis to examine the risk of adverse pregnancy, perinatal, and early childhood outcomes among women with SCH treated with levothyroxine. Methods A systematic literature search was conducted using Ovid-Medline, Ovid-EMBASE, Pubmed (non-Medline), Ebsco-CINAHL Plus with full text and Cochrane Library databases. Randomized controlled studies (RCTs) and observational studies examining the association between treatment of SCH during pregnancy and our outcomes of interest were included. Studies that compared levothyroxine treatment versus no treatment were eligible for inclusion. Data from included studies were extracted and quality assessment was performed by two independent reviewers. Results Seven RCTs and six observational studies met our inclusion criteria. A total of 7342 individuals were included in these studies. RCTs demonstrated several sources of bias, with lack of blinding of the participants or research personnel; only one study was fully blinded. In the observational studies, there was moderate to serious risk of bias due to lack of adjustment for certain confounding variables, participant selection, and selective reporting of results. Pooled analyses showed decreased risk of pregnancy loss (RR: 0.79; 95% CI: 0.67 to 0.93) and neonatal death (RR: 0.35; 95% CI: 0.17 to 0.72) associated with levothyroxine treatment during pregnancy among women with SCH. There were no associations between levothyroxine treatment and outcomes during labour and delivery, or cognitive status in children at 3 or 5 years of age. Conclusion Treatment of SCH with levothyroxine during pregnancy is associated with decreased risks of pregnancy loss and neonatal death. Given the paucity of available data and heterogeneity of included studies, additional studies are needed to address the benefits of levothyroxine use among pregnant women with SCH.

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Letter to the Editor Regarding Safety and Efficacy of Enoxaparin in Pregnancy: A Systematic Review and Meta-analysis. Are All the Underlying Data True?

Advances in Therapy ◽

10.1007/s12325-021-01673-2 ◽

2021 ◽

Author(s):

Ben W. Mol

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Safety And Efficacy ◽

Letter To The Editor ◽

In Pregnancy

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Incidence of kidney stones in pregnancy and associations with adverse obstetrical outcomes: a systematic review and meta-analysis of 4.7 million pregnancies

The Journal of Maternal-Fetal & Neonatal Medicine ◽

10.1080/14767058.2021.1878141 ◽

2021 ◽

pp. 1-9

Author(s):

Abirami Kirubarajan ◽

Cameron Taheri ◽

Matthew Yau ◽

Reenika Aggarwal ◽

Andrew C. L. Lam ◽

...

Keyword(s):

Systematic Review ◽

Kidney Stones ◽

Meta Analysis ◽

Obstetrical Outcomes ◽

In Pregnancy

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Maternal Iron Status in Pregnancy and Child Health Outcomes after Birth: A Systematic Review and Meta-Analysis

Nutrients ◽

10.3390/nu13072221 ◽

2021 ◽

Vol 13 (7) ◽

pp. 2221

Author(s):

Hugo G. Quezada-Pinedo ◽

Florian Cassel ◽

Liesbeth Duijts ◽

Martina U. Muckenthaler ◽

Max Gassmann ◽

...

Keyword(s):

Systematic Review ◽

Iron Deficiency ◽

Child Health ◽

Methodological Quality ◽

Iron Status ◽

Meta Analysis ◽

Child Health Outcomes ◽

Maternal Iron ◽

In Pregnancy

In pregnancy, iron deficiency and iron overload increase the risk for adverse pregnancy outcomes, but the effects of maternal iron status on long-term child health are poorly understood. The aim of the study was to systematically review and analyze the literature on maternal iron status in pregnancy and long-term outcomes in the offspring after birth. We report a systematic review on maternal iron status during pregnancy in relation to child health outcomes after birth, from database inception until 21 January 2021, with methodological quality rating (Newcastle-Ottawa tool) and random-effect meta-analysis. (PROSPERO, CRD42020162202). The search identified 8139 studies, of which 44 were included, describing 12,7849 mother–child pairs. Heterogeneity amongst the studies was strong. Methodological quality was predominantly moderate to high. Iron status was measured usually late in pregnancy. The majority of studies compared categories based on maternal ferritin, however, definitions of iron deficiency differed across studies. The follow-up period was predominantly limited to infancy. Fifteen studies reported outcomes on child iron status or hemoglobin, 20 on neurodevelopmental outcomes, and the remainder on a variety of other outcomes. In half of the studies, low maternal iron status or iron deficiency was associated with adverse outcomes in children. Meta-analyses showed an association of maternal ferritin with child soluble transferrin receptor concentrations, though child ferritin, transferrin saturation, or hemoglobin values showed no consistent association. Studies on maternal iron status above normal, or iron excess, suggest deleterious effects on infant growth, cognition, and childhood Type 1 diabetes. Maternal iron status in pregnancy was not consistently associated with child iron status after birth. The very heterogeneous set of studies suggests detrimental effects of iron deficiency, and possibly also of overload, on other outcomes including child neurodevelopment. Studies are needed to determine clinically meaningful definitions of iron deficiency and overload in pregnancy.

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