scholarly journals Practice Variation in the Care of Subclinical Hypothyroidism During Pregnancy: A National Survey of Physicians in the United States

2019 ◽  
Vol 3 (10) ◽  
pp. 1892-1906 ◽  
Author(s):  
Freddy J K Toloza ◽  
Naykky M Singh Ospina ◽  
Rene Rodriguez-Gutierrez ◽  
Derek T O’Keeffe ◽  
Juan P Brito ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Subclinical Hypothyroidism ◽  
Online Survey ◽  
The United States ◽  
American Thyroid Association ◽  
Clinical Practices ◽  
Endocrine Society ◽  
Clinical Scenarios ◽  
In Pregnancy ◽  
Current Practices

Abstract Evidence regarding the effects of subclinical hypothyroidism (SCH) on adverse pregnancy outcomes and the ability of levothyroxine (LT4) treatment to prevent them is unclear. Available recommendations for the management of SCH during pregnancy are inconsistent. We conducted a nationwide survey among physicians assessing their knowledge of and current practices in the care of SCH in pregnancy and compared these with the most recent American Thyroid Association (ATA) recommendations. In this cross-sectional study, an online survey was sent to active US members of the Endocrine Society. This survey included questions about current practices and clinical scenarios aimed at assessing diagnostic evaluation, initiation of therapy, and follow-up in pregnant women with SCH. In total, 162 physicians completed the survey. ATA guidelines were reviewed by 76%, of whom 53% indicated that these guidelines actually changed their practice. Universal screening was the preferred screening approach (54%), followed by targeted screening (30%). For SCH diagnosis, most respondents (52%) endorsed a TSH level >2.5 mIU/L as a cutoff, whereas 5% endorsed a population-based cutoff as recommended by the ATA. The decision to initiate treatment varied depending on the specific clinical scenario; however, when LT4 was initiated, respondents expected a small/very small reduction in maternofetal complications. In conclusion, despite recently updated guidelines, there is still wide variation in clinical practices regarding the care of women with SCH in pregnancy. Highly reliable randomized trials are required to evaluate the effectiveness of the most uncertain treatment practices on the care of pregnant women with SCH.

scholarly journals The Treatment of Hypothyroidism in Pregnancy

2017 ◽  
Vol 24 (2) ◽  
pp. 155-160
Author(s):  
Rucsandra Dănciulescu Miulescu ◽  
Andrada Doina Mihai
Keyword(s):  
Pregnant Women ◽  
Subclinical Hypothyroidism ◽  
Thyroid Disease ◽  
Hormone Deficiency ◽  
Specific Reference ◽  
Overt Hypothyroidism ◽  
American Thyroid Association ◽  
Diagnosis And Management ◽  
Pregnancy And Postpartum ◽  
In Pregnancy

Abstract Hypothyroidism is a pathologic condition generated by the thyroid hormone deficiency. The American Thyroid Association advises for the screening of hypothyroidism beginning at 35 years and thereafter every 5 years in people at high risk for this condition: females older than 60 years, pregnant women, patients with other autoimmune disease or patients with a history of neck irradiation. In pregnant women, hypothyroidism can been associated with adverse effect for both mother and child. The „Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum“ recommends the treatment of maternal overt hypothyroidism: females with a thyrotropin (TSH) level higher than the trimester-specific reference interval and decreased free thyroxine (FT4), and females for which TSH level is higher than 10.0 mIU/L, irrespective of the FT4 value, with administration of oral levothyroxine. The goal of treatment of maternal overt hypothyroidism is to bring back the serum TSH values to the reference range specific for the pregnancy trimester. The Guidelines of the „European Thyroid Association for the Management of Subclinical Hypothyroidism in Pregnancy and in Children“ recommends treatment of pregnancy associated subclinical hypothyroidism with the following levothyroxine doses: „1.20 μg/kg/day for TSH≤4.2 mU/l, 1.42 μg/kg/day for TSH >4.2-10 and 2.33 μg/kg/day for overt hypothyroidism“. The „Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum“ and the „European Thyroid Association for the Management of Subclinical Hypothyroidism in Pregnancy and in Children“ do not recommend the treatment of isolated hypothyroxinemia in pregnancy.

scholarly journals Overt and subclinical hypothyroidism among Bangladeshi pregnant women and its effect on fetomaternal outcome

2015 ◽  
Vol 40 (2) ◽  
pp. 52-57 ◽  
Author(s):  
M Sharmeen ◽  
PA Shamsunnahar ◽  
TR Laita ◽  
SB Chowdhury
Keyword(s):  
Adverse Effects ◽  
Pregnant Women ◽  
Subclinical Hypothyroidism ◽  
Thyroid Dysfunction ◽  
Perinatal Outcomes ◽  
Fetal Outcome ◽  
Thyroid Stimulating Hormone ◽  
Overt Hypothyroidism ◽  
Adequate Treatment ◽  
In Pregnancy

Objectives: Thyroid disorders are among the common endocrine problems in pregnant women. It is now well established that not only overt but subclinical thyroid dysfunction also has adverse effects on maternal and fetal outcome. There are few data from Bangladesh about the prevalence of thyroid dysfunction in pregnancy. With this background, this study aims to find out thyroid dysfunction (both overt and subclinical hypothyroidism) in pregnancy and its impact on obstetrical outcome.Methods: We studied the evaluation of 50 admitted pregnancies corresponding to 29 women with subclinical hypothyroidism and rest 21 was overt hypothyroidism. Detailed history and examination were performed. Apart from routine obstetrical investigations, Thyroid Stimulating Hormone (TSH) estimation was done. Their obstetrical and perinatal outcomes were noted.Results: Overt hypothyroidism was significantly (p<0.05) higher in 25 to 44 years age group. However two and three abortions were significantly (p<0.05) higher in overt hypothyroidism patients. In sub clinical hypothyroidism 86.2% conceived firstly within 2 years and 66.7% in overt hypothyroidism patients conceived firstly in between 3 to 5 years after marriage. Overt hypothyroids were prone to have pregnancy-induced hypertension 42.9%, intrauterine growth restriction (P=0.001) and gestational diabetes (38.1%) as compared to subclinical cases. Neonatal complications were significantly more in overt hypothyroidism group. Mean TSH level was significantly (p<0.05) higher in overt hypothyroidism patients but mean FT4 level was almost similar in both groups. Majority of the patient underwent caesarean section in both groups due to associated medical and obstetrical complications. None of the babies showed hypothyroidism by cord blood tests. In this analysis our results showed that overt hypothyroidism among Bangladeshi pregnant women are associated with more maternal complication & adverse parental outcome than subclinical hypothyroidism. The adequate treatment of hypothyroidism during gestation minimizes risks and generally, makes it possible for pregnancies to be carried to term without complications. Significant adverse effects on maternal and fetal outcome were seen emphasizing the importance of routine antenatal thyroid screening.Bangladesh Med Res Counc Bull 2014; 40 (2): 52-57

scholarly journals Comparison of universal and targeted screening for thyroid dysfunction in pregnant Egyptian women

2014 ◽  
Vol 171 (2) ◽  
pp. 285-291 ◽  
Author(s):  
Iman Z Ahmed ◽  
Yara M Eid ◽  
Hussein El Orabi ◽  
Hani Refat Ibrahim
Keyword(s):  
Clinical Practice ◽  
Pregnant Women ◽  
Practice Guidelines ◽  
Subclinical Hypothyroidism ◽  
Thyroid Dysfunction ◽  
Risk Group ◽  
Low Risk ◽  
Endocrine Society ◽  
Targeted Screening ◽  
Egyptian Women

ObjectiveTo compare universal vs targeted screening for thyroid dysfunction and to estimate the prevalence of hypothyroidism in pregnant Egyptian women.Subjects and methodsA total of 168 of pregnant women who attended the outpatient obstetric clinic at Ain Shams University Hospital (Cairo, Egypt) for antenatal care between September 2011 and December 2011 were enrolled. Based on the detailed data collection and results of laboratory testing, they were subdivided into the high- and low-risk group for thyroid disease according to the most recent Endocrine Society clinical practice guidelines, as well as into groups by trimester for application of American Thyroid Association guidelines. The group values were subjected to statistical analysis for estimating the prevalence of clinical and subclinical hypothyroidism and for identifying significant differences.ResultsOf the 168 patients, 104 were classified into the low-risk group and 64 into the high-risk group. Using the trimesteric and normal population cutoff values for thyroid functions, the prevalence of hypothyroidism was found to be 56% (n=94) and 44.6% (n=75) respectively. No statistically significant differences were found between the high- and low-risk group regarding prevalence of either clinical or subclinical hypothyroidism, and no significant differences were found regarding the prevalence of hypothyroidism in the first, second, or third trimester.ConclusionUse of the most recent Endocrine Society clinical practice guidelines led to missed detection of clinical or subclinical hypothyroidism in 34.5% of pregnant women. Universal screening of pregnant women for thyroid dysfunction should thus be adopted throughout Egypt.

scholarly journals Screening of Diabetes in Pregnancy

2021 ◽  
Author(s):  
Barış Sever ◽  
Halil Gürsoy Pala
Keyword(s):  
Pregnant Women ◽  
Diagnostic Criteria ◽  
International Association ◽  
Threshold Value ◽  
Study Groups ◽  
The United States ◽  
Population Characteristics ◽  
Diabetes In Pregnancy ◽  
Screening Programs ◽  
In Pregnancy

The prevalence of gestational diabetes mellitus (GDM) is approximately 6% of pregnant women in the United States. The prevalence ranges is about from 2% to 38% worldwide and varies among racial-ethnic groups, often paralleling the prevalence of type 2 diabetes. The prevalence also varies due to differences in screening practices, population characteristics (eg, mean age and body mass index [BMI] of pregnant women), testing method, and diagnostic criteria. The prevalence is increasing over time, possibly due to increases in mean maternal age and weight, particularly with increasing obesity. In 2010, the International Association of Diabetes and Pregnancy Study Groups proposed new screening and diagnostic criteria for diabetes in pregnancy. Using these criteria, the global prevalence of hyperglycemia in pregnancy is estimated at 17%, with regional estimates ranging from 10% in North America to 25% in Southeast Asia. Different screening programs are carried out in different clinics, and all these differences lead to different results in the frequency of GDM. The criteria of the method and threshold value acceptance depends on the health policies of the countries, the experience of the clinicians and the characteristics of the patient population. In this review, we analyzed the methods recommended for GDM screening in pregnancy.

scholarly journals Prevalence of thyroid disorders in pregnancy

2018 ◽  
Vol 7 (9) ◽  
pp. 3493
Author(s):  
Sangeeta Pahwa ◽  
Sabia Mangat
Keyword(s):  
Pregnant Women ◽  
Subclinical Hypothyroidism ◽  
First Trimester ◽  
Antenatal Clinic ◽  
Fetal Outcome ◽  
Overt Hypothyroidism ◽  
Thyroid Disorders ◽  
Subclinical Hyperthyroidism ◽  
Thyroid Screening ◽  
In Pregnancy

Background: Thyroid disorders are among the common endocrine problems in pregnant women. Often overlooked in pregnancy due to nonspecific symptoms and hyper-metabolic state of pregnancy. Western literature shows prevalence of hypothyroidism in pregnancy as 2.5% and hypothyroidism as 0.1-0.4%. There is paucity of data on prevalence of thyroid disorders in India pregnant population. This study was carried out to know prevalence of thyroid disorders in pregnant women in Indian population.Methods: One hundred pregnant women attending antenatal clinic in first trimester were registered. Detailed history and examination was done. Apart from routine basic and obstetrical investigations, TSH, FT3 and FT4 level estimation was done.Results: Prevalence of thyroid dysfunction was high in this study in first trimester pregnant women, with subclinical hypothyroidism in 6%, overt hypothyroidism in 2%, subclinical hyperthyroidism 2 % and overt hyperthyroidism 0%.Conclusions: Prevalence of thyroid disorders, especially subclinical hypothyroidism (6%), overt hypothyroidism (2%) and subclinical hyperthyroidism (2%) was high. To prevent adverse effects on maternal and fetal outcome, we are emphasizing the importance of routine antenatal thyroid screening.

Trends in pediatric obesity management, a survey from the Pediatric Endocrine Society Obesity Committee

2020 ◽  
Vol 33 (4) ◽  
pp. 469-472 ◽  
Author(s):  
Ashley H. Shoemaker ◽  
Stephanie T. Chung ◽  
Amy Fleischman ◽  
_ _
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Pediatric Obesity ◽  
Online Survey ◽  
Treatment Options ◽  
The United States ◽  
Pediatric Endocrinology ◽  
Lifestyle Modifications ◽  
Endocrine Society ◽  
Weight Loss Medications

AbstractBackgroundIn the United States, 18.5% of children are obese. Dietary and lifestyle modifications are key, but often ineffective. There are limited approved pediatric pharmacotherapies. The objective of this study was to evaluate current treatment practices for pediatric obesity among members of the Pediatric Endocrine Society (PES, n = 1300) and the Pediatric Obesity Weight Evaluation Registry (POWER, n = 42) consortium.MethodsA 10-question online survey on treatment of children with obesity in clinical practice was conducted.ResultsThe response rates were 19% for PES and 20% for POWER members. The majority were female (65%) and board certified in pediatric endocrinology (81%). Most practitioners saw 5–10 patients with obesity/week and 19% prescribed weight-loss medications. POWER participants were more likely to prescribe weight-loss medications than PES participants (46% vs. 18%, p =  0.02). Metformin was the most commonly prescribed medication. Response to medication was poor. Use of dietary non-pharmacological treatment options was uncommon. Over half of the respondents (56%) referred patients for bariatric surgery and 53% had local access to pediatric bariatric surgery.ConclusionsMetformin was the most common drug prescribed among respondents, but successful weight-loss responses were uncommon. Among practitioners who are using pharmacological interventions, therapeutic strategies vary widely. Targeted research in pharmacologic and surgical treatment for pediatric obesity is urgently needed.

scholarly journals Do we need to screen and treat pregnant women for subclinical hypothyroidism? A cross sectional study in a rural tertiary centre in Kerala, India

2017 ◽  
Vol 6 (3) ◽  
pp. 781
Author(s):  
Radha K. R. ◽  
Nishu Sugunan ◽  
Resmy C. R.
Keyword(s):  
Pregnant Women ◽  
Subclinical Hypothyroidism ◽  
Universal Screening ◽  
Cross Sectional Study ◽  
P Value ◽  
Sectional Study ◽  
Maternal Complications ◽  
Cross Sectional ◽  
Neonatal Hypothyroidism ◽  
In Pregnancy

Background: Hypothyroidism (HT) is associated with maternal and perinatal morbidity. Subclinical HT rather than overt occur in pregnancy, because overt HT causes infertility. Treatment of overt HT was beneficial in reducing the fetal and maternal complications, Usefulness of correcting subclinical hypothyroidism was doubtful, hence Universal screening of pregnant women was not recommended.Methods: Cross sectional study, conducted in the department of obstetrics and gynecology, Government Medical College, Thrissur, Kerala, India. 50 consecutive cases of subclinical hypothyroidism in pregnancy were analyzed for Thyroid function, antenatal, natal, postnatal complications. Perinatal complications, including neonatal hypothyroidism also noted. Statistical analysis done using computer software Epi info3.4. Data expressed in its frequency and percentage, continuous data in mean.Results: All women in the study group received levothyroxine during pregnancy from time of diagnosis. At the time of delivery 84% women were euthyroid and 16% hypothyroid. Complications like anemia 36%, abruption 4%, and postpartum hemorrhage 6% showed a statistically significant association, while pre-eclampsia 20%, preterm labor 22% had no statistically significant association. Comparing the women who are euthyroid as a result of levothyroxine supplementation to women inadequately treated, complications like anemia (33% versus 50%, p value 0.042), abruption (0% versus 4%, p value0.023), PPH (2% versus 6%, p value 0.014) were significantly less in well controlled.Conclusions: Significant association was noted between inadequately treated hypothyroidism and maternal complications like anaemia, placental abruption, placenta previa, PPH, preterm delivery, and caesarean section rate for foetal distress. Universal screening of pregnant women for thyroid status is recommended.

The Importance of Hepatitis B Antigen Screening in Pregnancy

2020 ◽  
Vol 39 (6) ◽  
pp. 363-368
Author(s):  
Jeanne Perino ◽  
Christine N. Adams
Keyword(s):  
United States ◽  
Hepatitis B ◽  
Pregnant Women ◽  
Medical Record ◽  
Vertical Transmission ◽  
Significant Risk ◽  
The United States ◽  
Screening Process ◽  
Hepatitis B Antigen ◽  
In Pregnancy

In the United States, pregnant women are screened for hepatitis B antigen because of the significant risk of perinatal vertical transmission of hepatitis to the fetus. It is important that the maternal hepatitis B antigen screen is documented in the medical record to ensure appropriate prophylaxis for the neonate. The purpose of this column is to discuss the pathophysiology of hepatitis B, as well as the screening process and prophylaxis for the neonate.

scholarly journals Care by Midwives, Obstetricians, and Dietitians for Pregnant Women Following a Strict Plant-Based Diet: A Cross-Sectional Study

Nutrients ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 2394
Author(s):  
Deidre Meulenbroeks ◽  
Isabel Versmissen ◽  
Nanique Prins ◽  
Daisy Jonkers ◽  
Jessica Gubbels ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Online Survey ◽  
Significant Risk ◽  
Cross Sectional Study ◽  
Nutritional Deficiencies ◽  
Dietary Habit ◽  
Sectional Study ◽  
Optimal Care ◽  
Cross Sectional ◽  
In Pregnancy

With an growing number of people on a strict plant-based diet, its potential effect on pregnancy and lactation becomes increasingly important. It is, however, unclear how obstetric caregivers currently handle and think about a strict plant-based diet in pregnancy. The aim of the study was therefore to evaluate the self-reported knowledge and advice given by Dutch obstetric caregivers and dietitians when treating pregnant women on a strict plant-based diet. A cross-sectional study was performed by sending an online survey to Dutch midwife practices, obstetricians, and dietitian practices. Descriptive statistics are reported. A total of 121 midwives, 179 obstetricians, and 111 dietitians participated in this study. The majority of midwives (80.2%) and obstetricians (93.9%) considered a strict plant-based diet to be a significant risk factor for nutrient deficiency during pregnancy. Maternal dietary preferences, including a potential strict plant-based diet, were discussed at the first prenatal appointment by 59.5% of midwives and 24.1% of obstetricians. A self-reported lack of knowledge concerning the strict plant-based diet was mentioned by 66.1% of midwives and 75.4% of obstetricians. Obstetric caregivers mostly considered the identification of this dietary habit and subsequent referral to a dietitian or a reliable website as optimal care for pregnant women on the strict plant-based diet. However, only 38.7% of dietitians indicated to have sufficient knowledge to counsel these women. Although obstetric caregivers thought that a strict plant-based diet in pregnancy may lead to increased risks of nutritional deficiencies, the majority report to have insufficient knowledge to provide adequate advice. Only a minority referred these women to dietitians, of whom a minority indicated to have adequate knowledge on this specific diet. These results suggest that current care is suboptimal for an increasing number of pregnant women. Women on a strict plant-based diet could benefit from increased knowledge about this topic among obstetric caregivers and dietitians, as well as from clear guidelines regarding this diet during pregnancy.

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