Neonatal Surveillance Gaps in Maternal Graves' Disease: Findings From a Queensland Maternity Hospital

Graves' disease presents unique challenges in pregnancy due to the risk of neonatal morbidity and mortality from maternal TSH Receptor antibodies (TRAb). A maternity hospital in Queensland has implemented a policy to identify at-risk neonates and facilitate follow-up, including cord blood TRAb, thyroid function tests (TFTs), and clinic appointments.

To evaluate current neonatal follow-up practices for mothers with Graves' disease, assess missed opportunities for biochemical testing and propose recommendations to improve clinical care.

This retrospective audit covered deliveries between 1st January 2018 to 31st December 2022. Baseline characteristics and follow-up were summarised by frequency and percentage. Maternal records were reviewed for demographic data, ultrasound follow up, TRAb titres, TFTs, and treatment details. Corresponding neonatal charts were then reviewed for cord blood TRAb levels, TFTs on days 3-5 and days 10-14, and phone clinic appointments. Neonatal testing was indicated if the mother was positive for thyroid stimulating immunoglobulin (TSI) or if TRAb titres were > 3 times the upper limit of normal.

Data from 70 mothers with active or previously treated Graves' disease were analysed; 18 pregnancies met criteria for neonatal testing. Compliance with recommended testing was suboptimal, with variable adherence to TFT testing and only 10% undergoing cord blood TRAb measurement.

This audit highlights the importance of standardised protocols and ongoing education to optimise neonatal follow-up and improve outcomes for neonates born to mothers with Graves' disease. Recommendations for education, improved documentation and policy updates have been provided with the aim for further audits to ensure ongoing quality improvement.