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Hyperthyroidism in pregnancy: evidence and hypothesis in fetal programming and development.

Stine Linding Andersen1,2, Stig Andersen2,3

  • 1Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark.

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|January 14, 2021
PubMed
Summary

Hyperthyroidism in pregnancy requires treatment to prevent complications. While maternal hyperthyroidism may affect fetal development, research also indicates risks associated with antithyroid drugs during early pregnancy.

Keywords:
Graves’ diseaseantithyroid drugsautoimmunityhyperthyroidismpregnancy

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Area of Science:

  • Endocrinology
  • Maternal-Fetal Medicine
  • Developmental Pediatrics

Background:

  • Hyperthyroidism in pregnancy, particularly Graves' disease, necessitates management to mitigate maternal and fetal risks.
  • Evidence supporting current guidelines primarily stems from observations of severe complications in untreated cases.
  • Long-term effects on children and the impact of fetal programming by maternal thyroid hormones require further investigation.

Purpose of the Study:

  • To review the clinical management of hyperthyroidism during pregnancy.
  • To evaluate the evidence regarding maternal hyperthyroidism's impact on fetal development and long-term child outcomes.
  • To analyze the risks associated with antithyroid drug use in early pregnancy.

Main Methods:

  • Literature review of clinical observations and experimental studies.
  • Analysis of human studies on developmental outcomes in children born to mothers with hyperthyroidism.
  • Examination of large observational studies on antithyroid drug teratogenicity.

Main Results:

  • Untreated maternal hyperthyroidism is linked to severe complications.
  • Experimental studies suggest maternal hyperthyroidism may cause fetal developmental abnormalities.
  • Recent human studies indicate a risk of teratogenic effects from antithyroid drugs in early pregnancy.

Conclusions:

  • Managing overt hyperthyroidism in pregnancy is crucial.
  • Distinguishing the effects of hyperthyroidism, its treatment, and thyroid autoimmunity is complex.
  • Further research is needed to elucidate the mechanisms and interactions of various exposures in Graves' disease during pregnancy.