() Diagnostic IV 2,411 To determine if thyroid function tests TSH exceeded the 97.5th percentile for the Aim: yield performed with first trimester screening predicts first trimester (2.15 mU/L) in 133 (5.5%) adverse pregnancy outcomes. women, including 22 (1%) with TSH above the nonpregnant reference range (4 mU/L) Setting: Western Australia and 5 (0.2%) above 10 mU/L. Population: Women in with singleton Adverse outcomes occurred in 327 women pregnancies attending first trimester screening (15%). TSH and free T4 did not differ between 9 and 14 weeks gestation. significantly between women with or We evaluated the association Measurements: without adverse pregnancy events. between TSH, free T4, free T3, thyroid antibodies, On the multivariate analysis, neither free beta human chorionic gonadotrophin maternal TSH >2.15 mU/L nor TSH as a (beta-hCG) and pregnancy associated plasma continuous variable predicted primary or protein A (PAPP-A) with a composite of adverse secondary outcomes. pregnancy events as the primary outcome. Secondary outcomes included placenta Adding TSH to first trimester screening tests praevia, placental abruption, pre-eclampsia, identifies mainly minor elevations in TSH, pregnancy loss after 20 weeks gestation, which do not predict adverse pregnancy threatened preterm labour, preterm birth, small outcomes. A small number of women with size for gestational age, neonatal death, and more significant hypothyroidism are also birth defects. detected who should be routinely treated with thyroid replacement therapy. However, it remains uncertain whether testing is justified in order to detect these cases.
() Diagnostic yield IV 2,411 Aim: To determine if thyroid function tests performed with first trimester screening predicts adverse pregnancy outcomes. Setting: Western Australia Population: Women in with singleton pregnancies attending first trimester screening between 9 and 14 weeks gestation. Measurements: We evaluated the association between TSH, free T4, free T3, thyroid antibodies, free beta human chorionic gonadotrophin (beta-hCG) and pregnancy associated plasma protein A (PAPP-A) with a composite of adverse pregnancy events as the primary outcome. Secondary outcomes included placenta praevia, placental abruption, pre-eclampsia, pregnancy loss after 20 weeks gestation, threatened preterm labour, preterm birth, small size for gestational age, neonatal death, and birth defects. TSH exceeded the 97.5th percentile for the first trimester (2.15 mU/L) in 133 (5.5%) women, including 22 (1%) with TSH above the nonpregnant reference range (4 mU/L) and 5 (0.2%) above 10 mU/L. Adverse outcomes occurred in 327 women (15%). TSH and free T4 did not differ significantly between women with or without adverse pregnancy events. On the multivariate analysis, neither maternal TSH >2.15 mU/L nor TSH as a continuous variable predicted primary or secondary outcomes. Adding TSH to first trimester screening tests identifies mainly minor elevations in TSH, which do not predict adverse pregnancy outcomes. A small number of women with more significant hypothyroidism are also detected who should be routinely treated with thyroid replacement therapy. However, it remains uncertain whether testing is justified in order to detect these cases.
Thyroid%20dysfunction%20evidence%20evaluation%2016May17.docx