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Screening for Thyroid Dysfunction in Pregnancy With Targeted High-Risk Case Finding: Can It Be Improved?

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Targeted screening for thyroid dysfunction in pregnant women is less effective for subclinical hypothyroidism (SCH) but better for overt hypothyroidism (OH). Including obesity and Caucasian background improves SCH detection rates to match universal screening.

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Area of Science:

  • Endocrinology
  • Obstetrics
  • Public Health

Background:

  • Thyroid dysfunction during pregnancy requires careful management.
  • Universal screening (US) for thyroid dysfunction is common, but targeted screening is proposed as an alternative.
  • American Thyroid Association guidelines (ATA-GL) define risk factors for thyroid dysfunction.

Purpose of the Study:

  • To evaluate the detection rate of subclinical hypothyroidism (SCH) and overt hypothyroidism (OH) using targeted screening in pregnant women.
  • To compare the effectiveness of targeted screening versus universal screening (US) for thyroid dysfunction.
  • To determine if including additional risk factors can improve targeted screening efficacy.

Main Methods:

  • A cross-sectional study involving 1832 pregnant women.
  • Thyroid function (TSH, free T4) and iron status were assessed.
  • Women were categorized into high-risk (HRG) and low-risk groups (LRG) based on ATA-GL risk factors. Additional risk factors included obesity (BMI 30-39.9 kg/m2) and Caucasian background (HRG+), and iron deficiency (HRG++).

Main Results:

  • The HRG comprised 64% of participants, and the LRG comprised 36%.
  • Overall prevalence was 4.5% for SCH and 0.5% for OH.
  • Targeted screening detected SCH and OH comparably between LRG and HRG. However, SCH detection in the HRG was lower than US (54% vs 100%). OH detection was comparable (75%).
  • Including obesity and Caucasian background (HRG+) or iron deficiency (HRG++) as risk factors improved SCH detection rates to 81% and 88%, respectively, comparable to US.

Conclusions:

  • Targeted high-risk screening is not effective for SCH detection but performs better for OH.
  • Expanding risk factors to include obesity (BMI 30-39.9 kg/m2) and Caucasian background significantly improves SCH detection rates, making them comparable to universal screening.