The Impact of Maternal Graves' Disease on Neonatal Thyroid Function: A Systematic Review

Maternal Graves' disease (GD) poses a significant risk to neonatal thyroid function due to the transplacental transfer of thyrotropin receptor antibodies (TRAbs). This systematic review aims to assess the impact of maternal GD on neonatal thyroid outcomes and identify key maternal factors influencing these outcomes. A comprehensive literature search was conducted across PubMed, Scopus, and Cochrane, resulting in the inclusion of 18 studies published from 2014 to 2024. The review focused on neonates born to mothers with active or previous GD and investigated the effects of various maternal treatments, including antithyroid drugs (ATDs), radioactive iodine (RAI) therapy, and thyroidectomy on their offspring. The findings indicate that elevated maternal TRAb levels are a strong predictor of neonatal thyroid dysfunction, with neonates exhibiting conditions such as hyperthyroidism, transient thyrotoxicosis, or hypothyroidism. The incidence of neonatal thyroid dysfunction ranged from 0.1% to 5% in pregnancies complicated by GD, with higher rates observed in cases requiring long-term ATD therapy. Neonatal outcomes varied, with some cases resolving after appropriate treatment, while others necessitated prolonged monitoring due to risks of developmental delays and complications. The review highlights the importance of early third-trimester TRAb screening and regular neonatal thyroid function testing within the first week of life. Although neonatal outcomes were generally favorable with prompt diagnosis and treatment, the review emphasizes the need for standardized protocols to optimize monitoring and management strategies in pregnancies complicated by GD. Further research should explore long-term neurodevelopmental outcomes and evaluate the impact of different maternal treatment strategies on neonatal thyroid health.