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Published on: November 20, 2015
The relationship between neonatal developmental dysplasia of the hip and maternal hyperthyroidism
1Department of Pediatrics, Yukiguni-Yamato General Hospital, Niigata, Japan. yamato_i@mail.tiara.or.jp
Insights
First-trimester maternal hyperthyroidism is linked to developmental dysplasia of the hip (DDH). Infants born to mothers with hyperthyroidism require close monitoring for hip abnormalities.
Area of Science:
- Obstetrics and Gynecology
- Pediatric Orthopedics
- Endocrinology
Background:
- Hip joint development is completed by 11 weeks of gestation.
- Thyroid hormones (triiodothyronine and thyroxine) are crucial for early fetal bone and muscle development.
- Elevated maternal thyroid hormone levels in early pregnancy may pose a risk for congenital hip abnormalities.
Purpose of the Study:
- To investigate the association between first-trimester maternal hyperthyroidism and the incidence of neonatal developmental dysplasia of the hip (DDH).
- To determine if maternal thyroxine levels during early pregnancy are a risk factor for DDH.
Main Methods:
- A retrospective cohort study of 2137 infants born between 1996 and 2003.
- Infants were assessed for DDH.
- Pregnancies were categorized into normal, Graves disease, and hyperemesis gravidarum groups.
Main Results:
- 21 out of 2137 infants were diagnosed with DDH.
- The incidence of DDH was significantly higher in infants of mothers with Graves disease (20%) and hyperemesis gravidarum (12.8%) compared to normal pregnancies (0.63%).
- P < 0.0001 for both maternal conditions.
Conclusions:
- First-trimester maternal hyperthyroidism is associated with an increased risk of developmental dysplasia of the hip.
- Infants born to mothers with hyperthyroidism in the first trimester warrant close screening for hip abnormalities.
- Early detection and management of DDH are crucial.
Objective:
Development of the hip joint is complete by 11 weeks of gestation. As triiodothyronine and thyroxine are important regulators of early bone and muscle development, we hypothesized that excessive thyroid hormone in the early fetal period was a congenital risk factor of developmental dysplasia of the hip (DDH). Consequently, it was proposed that elevations of maternal thyroxine in the first trimester could alter the incidence of neonatal DDH.
Methods:
The patient population comprised a retrospective cohort of all children born in Yukiguni-Yamato General Hospital from 1996 to 2003 (n = 2137). All infants were physically assessed for DDH. Pregnancies were divided into normal, Graves disease (n = 15), and severe hyperemesis gravidarum in the first trimester (n = 39, which is associated with gestational transient hyperthyroidism in up to 73%).
Results:
From a total 2137 pregnancies, 21 children (18 female) were diagnosed with DDH. Thirteen affected infants were from normal pregnancies (0.63%), 3 from mothers affected with Graves disease (20%, P < 0.0001), and 5 from mothers with hyperemesis gravidarum (12.8%, P < 0.0001).
Conclusions:
Developmental dysplasia of the hip is associated with first-trimester maternal hyperthyroidism, and infants of these mothers should be closely checked for hip abnormalities.
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