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Retinol and Pro-Vitamin A Carotenoid Nutritional Status during Pregnancy Is Associated with Newborn Hearing Screen Results. Nutrients 2023; 15:nu15040800. [PMID: 36839158 PMCID: PMC9967333 DOI: 10.3390/nu15040800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 02/09/2023] Open
Abstract
The prenatal period is critical for auditory development; thus, prenatal influences on auditory development may significantly impact long-term hearing ability. While previous studies identified a protective effect of carotenoids on adult hearing, the impact of these nutrients on hearing outcomes in neonates is not well understood. The purpose of this study is to investigate the relationship between maternal and umbilical cord plasma retinol and carotenoid concentrations and abnormal newborn hearing screen (NHS) results. Mother-infant dyads (n = 546) were enrolled at delivery. Plasma samples were analyzed using HPLC and LC-MS/MS. NHS results were obtained from medical records. Statistical analysis utilized Mann-Whitney U tests and logistic regression models, with p ≤ 0.05 considered statistically significant. Abnormal NHS results were observed in 8.5% of infants. Higher median cord retinol (187.4 vs. 162.2 μg/L, p = 0.01), maternal trans-β-carotene (206.1 vs. 149.4 μg/L, p = 0.02), maternal cis-β-carotene (15.9 vs. 11.2 μg/L, p = 0.02), and cord trans-β-carotene (15.5 vs. 8.0 μg/L, p = 0.04) were associated with abnormal NHS. Significant associations between natural log-transformed retinol and β-carotene concentrations and abnormal NHS results remained after adjustment for smoking status, maternal age, and corrected gestational age. Further studies should investigate if congenital metabolic deficiencies, pesticide contamination of carotenoid-rich foods, maternal hypothyroidism, or other variables mediate this relationship.
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Mazzilli R, Medenica S, Di Tommaso AM, Fabozzi G, Zamponi V, Cimadomo D, Rienzi L, Ubaldi FM, Watanabe M, Faggiano A, La Vignera S, Defeudis G. The role of thyroid function in female and male infertility: a narrative review. J Endocrinol Invest 2023; 46:15-26. [PMID: 35945393 PMCID: PMC9829629 DOI: 10.1007/s40618-022-01883-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/25/2022] [Indexed: 01/13/2023]
Abstract
PURPOSE We herein aimed to review the new insights into the impact of impaired thyroid function on male and female fertility, spacing from spontaneous pregnancy to ART, with the objective of providing an updated narrative revision of the literature. METHODS This narrative review was performed for all available prospective, retrospective and review articles, published up to 2021 in PubMed. Data were extracted from the text and from the tables of the manuscript. RESULTS Thyroid dysfunction is frequently associated with female infertility, whereas its link with male infertility is debated. Female wise, impaired function is detrimental to obstetric and fetal outcomes both in spontaneous pregnancies and in those achieved thanks to assisted reproduction technologies (ART). Furthermore, the reference range of TSH in natural pregnancy and ART procedures has recently become a matter of debate following recent reports in this field. On the other hand, the impact of thyroid function on the male reproductive system is less clear, although a possible role is suggested via modulation of Sertoli and Leydig cells function and spermatogenesis. CONCLUSION Thyroid function should be carefully monitored in both male and female, in couples seeking spontaneous pregnancy as well as ART, as treatment is generally immediate and likely to improve chances of success.
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Affiliation(s)
- R Mazzilli
- Endocrinology Unit, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Sant' Andrea Hospital, Rome, Italy
| | - S Medenica
- Department of Endocrinology, Internal Medicine Clinic, Clinical Center of Montenegro, School of Medicine, University of Montenegro, Podgorica, Montenegro
| | - A M Di Tommaso
- Unit of Endocrinology and Diabetes, Department of Medicine, University Campus Bio-Medico di Roma, Rome, Italy
| | - G Fabozzi
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - V Zamponi
- Endocrinology Unit, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Sant' Andrea Hospital, Rome, Italy
| | - D Cimadomo
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - L Rienzi
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - F M Ubaldi
- Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
| | - M Watanabe
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena, 328, 00161, Rome, Italy.
| | - A Faggiano
- Endocrinology Unit, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Sant' Andrea Hospital, Rome, Italy
| | - S La Vignera
- Department of Clinical and Experimental Medicine, Policlinico "G. Rodolico, " University of Catania, Catania, Italy
| | - G Defeudis
- Unit of Endocrinology and Diabetes, Department of Medicine, University Campus Bio-Medico di Roma, Rome, Italy
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3
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GÜRKAN N, ÇALI ÖZTÜRK H. The findings about relationship between autoimmune thyroid disease and first-trimester aneuploidy results. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1179194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Aim: The aim of this study was to investigate the relationship between thyroid autoantibody and first-trimester aneuploidy results. Thyroid autoimmunity (TAI) is the most common autoimmune disorder. Patients with TAI are usually euthyroid. Thyroid peroxidase (TPO-Ab) in patients with or without thyroid dysfunction is associated with infertility, recurrent embryo implantation failure, and early pregnancy loss. The impact of TPO-Ab on first-trimester aneuploidy test results needs to be studied.
Material and Method: This retrospective case-control study was conducted between December 2019 and May 2022. Patients with thyroid autoantibody positivity (n=112) were included in the study as the case group. The control group was selected from age and body mass index (BMI)-matched patients (n=130). Nuchal translucency (NT), crown rump length (CRL), pregnancy-associated plasma protein A (PAPP-A) and free beta subunit of human chorionic gonadotropin (β-hCG)) values were compared between the two groups.
Results: This study included two hundred forty two age-matched (29.86±4.51) and BMI-matched (23.96±2.34) women. There was no statistically significant difference between groups in terms of free thyroxine (FT4), PAPP-A and free β-hCG (p>0.05). NT as a marker for major chromosomal defects and CRL were comparable in case and control groups (p>0.05).
Conclusion: There is no statistically significant relationship between thyroid autoimmune diseases and the first-trimester aneuploidy results.
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Affiliation(s)
| | - Halime ÇALI ÖZTÜRK
- BEZM-İ ÂLEM VAKIF ÜNİVERSİTESİ, TIP FAKÜLTESİ, CERRAHİ TIP BİLİMLERİ BÖLÜMÜ, KADIN HASTALIKLARI VE DOĞUM ANABİLİM DALI
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4
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Amouzegar A, Pearce EN, Mehran L, Lazarus J, Takyar M, Azizi F. TPO antibody in euthyroid pregnant women and cognitive ability in the offspring: a focused review. J Endocrinol Invest 2022; 45:425-431. [PMID: 34515961 DOI: 10.1007/s40618-021-01664-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 08/13/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE A link between maternal thyroid dysfunction during pregnancy and the risk of cognitive and behavioral problems in the offspring has previously been established; however, the potential effects of maternal thyroid autoimmunity on neurodevelopment in the absence of maternal hypothyroidism are less clear. The present review aims to highlight the gaps in knowledge in this regard and provide a thorough assessment of relevant literature. METHOD Related keywords searched in MEDLINE, Web of Science, and Scopus till January 2021. RESULTS There is some evidence that neuropsychological and intellectual developments of offspring are adversely affected by maternal thyroid autoimmunity, although the results of available studies are not concordant. The tools and measurements that have been applied in different studies to assess neurodevelopment or IQ vary widely and the children born to mothers with thyroid autoimmunity have been assessed at different chronological stages of life. Such variations may explain some of the differences across studies. In addition, the definition of thyroid autoimmunity has been based on TPOAb cut points provided by manufacturers in most cases, but it is preferable to define these values based on age, trimester, and method-specific reference ranges. CONCLUSION Well-designed studies are needed to assess verbal and non-verbal neurocognition of offspring born to mothers with autoimmune thyroid disease before or during pregnancy.
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Affiliation(s)
- A Amouzegar
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, 19395-4763, Tehran, Iran
| | - E N Pearce
- Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine, 88 East Newton Street, Evans 201, Boston, MA, 02118, USA
| | - L Mehran
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, 19395-4763, Tehran, Iran
| | - J Lazarus
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, UK
| | - M Takyar
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, 19395-4763, Tehran, Iran
| | - F Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, 19395-4763, Tehran, Iran.
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Medenica S, Žarković M. Thyroid autoimmunity and reproduction: Bidirectional relationship that continues to intrigue. MEDICINSKI GLASNIK SPECIJALNE BOLNICE ZA BOLESTI ŠTITASTE ŽLEZDE I BOLESTI METABOLIZMA 2022. [DOI: 10.5937/mgiszm2287007m] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Today, infertility is not only a serious health but also a psycho-social problem, one that is on the rise in the world. Thyroid autoimmunity (TAI) is the most common disease of the thyroid gland in the reproductive period, which can affect spontaneous conception as well as conception through assisted reproduction technology (ART), but also the maintenance of healthy pregnancy. It can also cause numerous maternal and fetal complications. There is a wide array of publications on the topic of the mechanisms of association between TAI and reproduction, with the question of whether thyroid autoantibodies are solely tissue-specific antibodies, whether and when to start levothyroxine treatment, and that we require more fundamental research on the direct effect of thyroid autoantibodies starting from folliculogenesis to embryogenesis and implantation as well as the post-implantation embryo development, but also the composition of the follicular fluid as a microenvironment of enormous importance for the maturation of the oocytes which thyroid autoantibodies reach via the blood-follicle barrier.
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Thyroid Autoimmunity in Adverse Fertility and Pregnancy Outcomes: Timing of Assisted Reproductive Technology in AITD Women. J Transl Int Med 2021; 9:76-83. [PMID: 34497747 PMCID: PMC8386333 DOI: 10.2478/jtim-2021-0001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Thyroid autoimmunity (TAI) is prevalent in women of live-birthing age and has independently been associated with complications of fertility and pregnancy, in the case of spontaneous conception or after assisted reproductive technology (ART) treatment. However, it remains challenging to identify causation between infertility and TAI, even interventional trials looking at the impact of levothyroxine (LT4) treatment on fertility and pregnancy outcomes due to differences among study results which related to small scales, impropriate study designs, enrollment criteria of infertility cause and titer/hormone concentration measurements. Furthermore, many questions remain unsettled in ART management in AITD infertile women attempt pregnancy. Therefore, further observational and interventional trials are needed more comprehensive multiple-center, double blinded, and randomized.
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7
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Ge GM, Leung MTY, Man KKC, Leung WC, Ip P, Li GHY, Wong ICK, Kung AWC, Cheung CL. Maternal Thyroid Dysfunction During Pregnancy and the Risk of Adverse Outcomes in the Offspring: A Systematic Review and Meta-Analysis. J Clin Endocrinol Metab 2020; 105:5893988. [PMID: 32810262 DOI: 10.1210/clinem/dgaa555] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/13/2020] [Indexed: 12/21/2022]
Abstract
CONTEXT Previous studies suggested a potential link of maternal thyroid dysfunction with adverse neurocognitive outcomes and impaired development of internal organs in offspring. OBJECTIVE To review the association between maternal thyroid dysfunction and the risk of adverse outcomes in offspring. DATA SOURCES PubMed, EMBASE, and Cochrane Library. STUDY SELECTIONS Eligible studies reported the association between maternal thyroid hormone function and the risk of adverse outcomes in their children. DATA EXTRACTION Reviewers extracted data on study characteristics and results independently. DATA SYNTHESIS Estimates were pooled and reported as odds ratio (OR) with 95% confidence interval (CI). I2 tests were applied to assess the heterogeneity across studies. RESULTS We identified 29 eligible articles and found an association between maternal hyperthyroidism and attention deficit hyperactivity disorder (ADHD) (OR: 1.18, 95% CI: 1.04-1.34, I2 = 0%) and epilepsy (OR: 1.19, 95% CI: 1.08-1.31, I2 = 0%) in offspring; as well as an association of maternal hypothyroidism with increased risk of ADHD (OR: 1.14, 95% CI: 1.03-1.26, I2 = 25%), autism spectrum disorder (OR: 1.41, 95% CI: 1.05-1.90, I2 = 63%), and epilepsy (OR: 1.21, 95% CI: 1.06-1.39, I2 = 0%) in offspring. CONCLUSION Routine measurement and timely treatment on thyroid function should be considered for pregnant women.
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Affiliation(s)
- Grace Mengqin Ge
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Miriam T Y Leung
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Kenneth K C Man
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
- Research Department of Practice and Policy, UCL, School of Pharmacy, London, UK
| | - Wing Cheong Leung
- Department of Obstetrics and Gynecology, Kwong Wah Hospital, Hong Kong
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Gloria H Y Li
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Ian C K Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
- Research Department of Practice and Policy, UCL, School of Pharmacy, London, UK
| | - Annie W C Kung
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Ching-Lung Cheung
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
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8
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The Clinical Value and Variation of Antithyroid Antibodies during Pregnancy. DISEASE MARKERS 2020; 2020:8871951. [PMID: 33144894 PMCID: PMC7599418 DOI: 10.1155/2020/8871951] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/15/2020] [Accepted: 07/31/2020] [Indexed: 01/03/2023]
Abstract
Antithyroid antibodies, which include thyroid-stimulating hormone receptor antibodies (TRAbs), thyroid peroxidase antibodies (TPOAbs), and thyroid globulin antibodies (TgAbs), are widely known for their tight association with thyroid autoimmune diseases. The variation in all three kinds of antibodies also showed different trends during and after pregnancy (Weetman, 2010). This article reviewed the the physiological changes, while focusing on the variation of thyroid antibodies concentration in women during and after pregnancy, and adverse consequences related to their elevation. Since abnormal elevations of these antithyroid antibodies may lead to adverse outcomes in both mothers and fetuses, special attention must be paid to the titer of the antibodies during pregnancy. The molecular mechanisms of the variations in those antibodies have yet to be explained. The frequency and timing of thyroid antibody measurement, as well as different reference levels, also remain to be elucidated.
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Abstract
Thyroid autoimmunity (TAI) and/or thyroid dysfunction are prevalent in women of reproductive age and have independently been associated with adverse fertility and pregnancy outcomes, in the case of spontaneous conception or after assisted reproductive technology (ART). Thus, it seems reasonable to screen for thyrotropin (TSH) and thyroid peroxidase autoantibodies (TPO-abs) in infertile women attempting pregnancy. However, even if the relationship between fertility and thyroid dysfunction and/or TAI persists when properly controlled for other variables, it remains challenging to claim causation. Several studies with different designs (cross sectional, case -control, prospective and retrospective cohort studies) have looked at the association between thyroid autoimmunity, thyroid function and fertility. Heterogeneity among study results are related to small numbers of included patients, poor study design, selection of causes of infertility and different assays used to measure TAI, thyroid hormones and TSH reference values. Indeed, there is no consensus regarding the upper limit of normal for TSH to define thyroid dysfunction and the cut-off levels for intervention. Furthermore, data from interventional trials looking at the impact of levothyroxine treatment on fertility outcome in randomised controlled studies are scarce. Despite the recent update of the guidelines by the American Thyroid Association (ATA) for the Diagnosis and Management of Thyroid Disease during Pregnancy and the postpartum, many questions remain unsettled in ART.
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Affiliation(s)
- David Unuane
- Department of Endocrinology, Universitair Ziekenhuis Brussel, UZ Brussel, Vrije Universiteit Brussel, Belgium
| | - Brigitte Velkeniers
- Department of Endocrinology, Universitair Ziekenhuis Brussel, UZ Brussel, Vrije Universiteit Brussel, Belgium.
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Abstract
Thyroid autoimmunity (TAI) is prevalent amongst women of reproductive age. TAI describes the presence of circulating anti-thyroid autoantibodies that are targeted against the thyroid, with or without thyroid dysfunction. Thyroid peroxidase antibodies (TPOAb) are the most common anti-thyroid autoantibodies. Around 10% of biochemically euthyroid individuals also have an elevated TPOAb titre. Many studies have linked the presence of TPOAb to adverse maternal and fetal outcomes in pregnancy, in particular miscarriage and pre-term birth, even in the absence of thyroid dysfunction. The causal pathway is poorly understood and few trials have looked to find treatments to reduce adverse outcomes. This review discusses in detail the associated adverse outcomes of TPOAb in pregnancy and the results of trials exploring methods to reduce such outcomes. Recommendations for counselling and monitoring of women with TPOAb and suggested areas for future work are also outlined.
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Affiliation(s)
- R K Dhillon-Smith
- Institute of Metabolism and Systems Research, College of Medical & Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK; Tommy's Centre for Miscarriage Research, College of Medical & Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK; Centre for Women's and Newborn Health, Birmingham Women's and Children's Foundation Trust, Edgbaston, Birmingham, B15 2TG, UK.
| | - A Coomarasamy
- Institute of Metabolism and Systems Research, College of Medical & Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK; Tommy's Centre for Miscarriage Research, College of Medical & Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK; Centre for Women's and Newborn Health, Birmingham Women's and Children's Foundation Trust, Edgbaston, Birmingham, B15 2TG, UK
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11
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Huget-Penner S, Feig DS. Maternal thyroid disease and its effects on the fetus and perinatal outcomes. Prenat Diagn 2020; 40:1077-1084. [PMID: 32181913 DOI: 10.1002/pd.5684] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 02/06/2020] [Accepted: 03/07/2020] [Indexed: 12/17/2022]
Abstract
Thyroid disease is common in women of childbearing age and can have significant effects on the development of the fetus and perinatal outcomes. Maternal thyroid hormone is critical for proper fetal neurodevelopment, and the fetus relies on thyroid hormone from its mother for the first half of pregnancy. Both overt maternal hypothyroidism and overt maternal hyperthyroidism have been shown to be associated with adverse effects on central nervous system gray matter and neurocognitive development of offspring as well as increased obstetrical risks. Treatment of overt thyroid conditions improves outcomes. Subclinical maternal hypothyroidism may increase adverse neurocognitive and obstetrical outcomes although data are conflicting. To date, treatment of subclinical hypothyroidism has not shown benefit. Subclinical hyperthyroidism is well tolerated in pregnancy. Thyroid autoantibodies alone may also affect neurodevelopment and obstetrical outcomes; however, recent data have shown no improvement with levothyroxine treatment. Several rare maternal genetic thyroid conditions can affect the fetus including a thyroid-stimulating hormone receptor mutation leading to hypersensitivity to human chorionic gonadotropin and thyroid hormone resistance. The thyroid plays a crucial role in fetal health and understanding it is important for optimal care.
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Affiliation(s)
- Sawyer Huget-Penner
- Division of Endocrinology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Division of Endocrinology, Department of Medicine, Fraser Health Authority, New Westminster, British Columbia, Canada
| | - Denice S Feig
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Endocrinology and Metabolism, Department of Medicine, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada.,Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
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12
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De Leo S, Pearce EN. Autoimmune thyroid disease during pregnancy. Lancet Diabetes Endocrinol 2018; 6:575-586. [PMID: 29246752 DOI: 10.1016/s2213-8587(17)30402-3] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 10/09/2017] [Accepted: 10/11/2017] [Indexed: 12/21/2022]
Abstract
Understanding of changes in thyroid function and the consequences of thyroid disease during pregnancy has rapidly grown in the past two decades, and revised American Thyroid Association guidelines on this topic were published in 2017. This Review explores the association between thyroid autoimmunity and complications during and after pregnancy. Thyroid autoimmunity refers to the presence of antibodies to thyroperoxidase or thyroglobulin, or thyroid-stimulating hormone receptor antibodies (TRAbs), or a combination of these, and is present in up to 18% of pregnant women. Thyroid antibodies in pregnant women with normal functioning thyroids (ie, euthyroid) have been associated with several complications, including miscarriage and premature delivery. Treatments to improve pregnancy outcomes are being studied. Whether thyroid antibodies are associated with infertility and assisted reproductive technology outcomes is unclear; although, treatment with low doses of levothyroxine, which is usually used to treat hypothyroidism, can be considered in such situations. Additionally, thyroid antibodies have been associated with other neonatal and maternal complications. All these associations require confirmation in larger prospective studies, and their pathogenic mechanisms need to be better understood. Post-partum thyroiditis is substantially more frequent in women who have thyroid antibodies during pregnancy than in those who do not have thyroid antibodies; however, whether treatment can prevent post-partum thyroiditis in women who are or have been antibody positive is unknown. Finally, TRAbs cross the placenta from the mother to the fetus and can cause fetal or neonatal hyperthyroidism. Therefore, women who are positive for TRAbs during pregnancy should be monitored.
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Affiliation(s)
- Simone De Leo
- Division of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine, Boston MA, USA
| | - Elizabeth N Pearce
- Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine, Boston MA, USA.
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Päkkilä F, Männistö T, Hartikainen AL, Suvanto E. Maternal Thyroid Function During Pregnancy and the Child's Linguistic and Sensory Development in the Northern Finland Birth Cohort 1986. Front Endocrinol (Lausanne) 2018; 9:127. [PMID: 29632517 PMCID: PMC5879546 DOI: 10.3389/fendo.2018.00127] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 03/13/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Maternal hypothyroidism and hypothyroxinemia are associated with poor neuropsychological development in children. Previous research is lacking on whether maternal thyroid dysfunction affects sensory and linguistic development in childhood. METHODS The Northern Finland Birth Cohort 1986 included all births within a year (9,362 women, 9,479 children) from the two northernmost Finnish provinces. Maternal serum samples (n = 5,791) were obtained in early pregnancy and analyzed for TSH, free T4, and thyroid peroxidase antibodies (TPO-Abs). Five thousand three hundred and ninety-one parents evaluated their child's sensory and linguistic development at 7 years old via a questionnaire (excluding children with an intelligence quotient ≤85). The prevalence of sensory and linguistic impairments was compared between mothers with and without thyroid dysfunction. RESULTS There were no statistically significant differences in the prevalence of sensory or linguistic impairment between children of mothers with and without thyroid dysfunction. Children of hypothyroid and hypothyroxinemic mothers had an increased prevalence of vision impairment compared with those of euthyroid mothers (10.8 and 11.7%, respectively, versus 6.5%), but the difference was not significant. All results remained similar after excluding TPO-Ab-positive mothers and premature children. CONCLUSION We did not find an association between maternal thyroid dysfunction during pregnancy and sensory and linguistic development impairment in childhood. A somewhat higher prevalence of vision impairment was seen in children of hypothyroid and hypothyroxinemic mothers, which merits further research.
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Affiliation(s)
- Fanni Päkkilä
- Department of Obstetrics and Gynecology, University of Oulu, Oulu, Finland
- Clinic of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland
- Institute of Health Sciences, University of Oulu, Oulu, Finland
- Department of Children, Young People, and Families, National Institute for Health and Welfare, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
- *Correspondence: Fanni Päkkilä,
| | - Tuija Männistö
- Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Oulu, Finland
- Northern Finland Laboratory Center Nordlab, Oulu University Hospital, University of Oulu, Oulu, Finland
- Department of Clinical Chemistry, University of Oulu, Oulu, Finland
| | - Anna-Liisa Hartikainen
- Department of Obstetrics and Gynecology, University of Oulu, Oulu, Finland
- Clinic of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Eila Suvanto
- Department of Obstetrics and Gynecology, University of Oulu, Oulu, Finland
- Clinic of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
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Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, Grobman WA, Laurberg P, Lazarus JH, Mandel SJ, Peeters RP, Sullivan S. 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid 2017; 27:315-389. [PMID: 28056690 DOI: 10.1089/thy.2016.0457] [Citation(s) in RCA: 1282] [Impact Index Per Article: 183.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Thyroid disease in pregnancy is a common clinical problem. Since the guidelines for the management of these disorders by the American Thyroid Association (ATA) were first published in 2011, significant clinical and scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid disease in women during pregnancy, preconception, and the postpartum period. METHODS The specific clinical questions addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of task force members. Task force panel members were educated on knowledge synthesis methods, including electronic database searching, review and selection of relevant citations, and critical appraisal of selected studies. Published English language articles were eligible for inclusion. The American College of Physicians Guideline Grading System was used for critical appraisal of evidence and grading strength of recommendations. The guideline task force had complete editorial independence from the ATA. Competing interests of guideline task force members were regularly updated, managed, and communicated to the ATA and task force members. RESULTS The revised guidelines for the management of thyroid disease in pregnancy include recommendations regarding the interpretation of thyroid function tests in pregnancy, iodine nutrition, thyroid autoantibodies and pregnancy complications, thyroid considerations in infertile women, hypothyroidism in pregnancy, thyrotoxicosis in pregnancy, thyroid nodules and cancer in pregnant women, fetal and neonatal considerations, thyroid disease and lactation, screening for thyroid dysfunction in pregnancy, and directions for future research. CONCLUSIONS We have developed evidence-based recommendations to inform clinical decision-making in the management of thyroid disease in pregnant and postpartum women. While all care must be individualized, such recommendations provide, in our opinion, optimal care paradigms for patients with these disorders.
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Affiliation(s)
- Erik K Alexander
- 1 Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - Elizabeth N Pearce
- 2 Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine , Boston, Massachusetts
| | - Gregory A Brent
- 3 Department of Medicine, VA Greater Los Angeles Healthcare System and David Geffen School of Medicine at UCLA , Los Angeles, California
| | - Rosalind S Brown
- 4 Division of Endocrinology, Boston Children's Hospital , Harvard Medical School, Boston, Massachusetts
| | - Herbert Chen
- 5 Department of Surgery, University of Alabama at Birmingham , Birmingham, Alabama
| | - Chrysoula Dosiou
- 6 Division of Endocrinology, Stanford University School of Medicine , Stanford, California
| | - William A Grobman
- 7 Department of Obstetrics and Gynecology, Northwestern University , Chicago, Illinois
| | - Peter Laurberg
- 8 Departments of Endocrinology & Clinical Medicine, Aalborg University Hospital , Aalborg, Denmark
| | - John H Lazarus
- 9 Institute of Molecular Medicine, Cardiff University , Cardiff, United Kingdom
| | - Susan J Mandel
- 10 Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Robin P Peeters
- 11 Department of Internal Medicine and Rotterdam Thyroid Center, Erasmus Medical Center , Rotterdam, The Netherlands
| | - Scott Sullivan
- 12 Department of Obstetrics and Gynecology, Medical University of South Carolina , Charleston, South Carolina
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Springer D, Jiskra J, Limanova Z, Zima T, Potlukova E. Thyroid in pregnancy: From physiology to screening. Crit Rev Clin Lab Sci 2017; 54:102-116. [PMID: 28102101 DOI: 10.1080/10408363.2016.1269309] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Thyroid hormones are crucial for the growth and maturation of many target tissues, especially the brain and skeleton. During critical periods in the first trimester of pregnancy, maternal thyroxine is essential for fetal development as it supplies thyroid hormone-dependent tissues. The ontogeny of mature thyroid function involves organogenesis, and maturation of the hypothalamus, pituitary and the thyroid gland; and it is almost complete by the 12th-14th gestational week. In case of maternal hypothyroidism, substitution with levothyroxine must be started in early pregnancy. After the 14th gestational week, fetal brain development may already be irreversibly affected by lack of thyroid hormones. The prevalence of manifest hypothyroidism in pregnancy is about 0.3-0.5%. The prevalence of subclinical hypothyroidism varies between 4 and 17%, strongly depending on the definition of the upper TSH cutoff limit. Hyperthyroidism occurs in 0.1-1% of all pregnancies. Positivity for antibodies against thyroid peroxidase (TPOAb) is common in women of childbearing age with an incidence rate of 5.1-12.4%. TPOAb-positivity may be regarded as a manifestation of a general autoimmune state which may alter the fertilization and implantation processes or cause early missed abortions. Women positive for TPOAb are at a significant risk of developing hypothyroidism during pregnancy and postpartum. Laboratory diagnosis of thyroid dysfunction during pregnancy is based upon serum TSH concentration. TSH in pregnancy is physiologically lower than the non-pregnant population. Results of multiple international studies point toward creation of trimester-specific reference intervals for TSH in pregnancy. Screening for hypothyroidism in pregnancy is controversial and its implementation varies from country to country. Currently, the case-finding approach of screening high-risk women is preferred in most countries to universal screening. However, numerous studies have shown that one-third to one-half of women with thyroid disorders escape the case-finding approach. Moreover, the universal screening has been shown to be more cost-effective. Screening for thyroid disorders in pregnancy should include assessment of both TSH and TPOAb, regardless of the screening approach. This review summarizes the current knowledge on physiology of thyroid hormones in pregnancy, causes of maternal thyroid dysfunction and its effects on pregnancy course and fetal development. We discuss the question of case-finding versus universal screening strategies and we display an overview of the analytical methods and their reference intervals in the assessment of thyroid function and thyroid autoimmunity in pregnancy. Finally, we present our results supporting the implementation of universal screening.
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Affiliation(s)
- Drahomira Springer
- a Institute of Medical Biochemistry and Laboratory Medicine, 1st Faculty of Medicine, Charles University and General University Hospital , Prague , Czech Republic
| | - Jan Jiskra
- b 3rd Department of Medicine - Clinical Department of Endocrinology and Metabolism , 1st Faculty of Medicine, Charles University and General University Hospital , Prague , Czech Republic , and
| | - Zdenka Limanova
- b 3rd Department of Medicine - Clinical Department of Endocrinology and Metabolism , 1st Faculty of Medicine, Charles University and General University Hospital , Prague , Czech Republic , and
| | - Tomas Zima
- a Institute of Medical Biochemistry and Laboratory Medicine, 1st Faculty of Medicine, Charles University and General University Hospital , Prague , Czech Republic
| | - Eliska Potlukova
- c Division of Internal Medicine , University Hospital Basel , Basel , Switzerland
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THE INFLUENCE OF GOITROGENS AND ENVIRONMENTAL FACTORS ON THE REPRODUCTIVE SYSTEM OF WOMEN WITH ENDEMIC THYROID DISEASES. WORLD OF MEDICINE AND BIOLOGY 2017. [DOI: 10.26724/2079-8334-2017-4-62-66-71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Aghajanian P, Spencer CA, Wilson ML, Lee RH, Goodwin TM, Mestman JH. Evaluation of risk-factor-based screening for thyroid peroxidase antibody positivity in pregnancy. Clin Endocrinol (Oxf) 2016; 84:417-22. [PMID: 25823873 DOI: 10.1111/cen.12782] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 03/02/2015] [Accepted: 03/24/2015] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To determine whether risk-factor-based screening for thyroid dysfunction in pregnancy performs well for detecting thyroid peroxidase antibodies (TPOAb), a marker for autoimmune thyroid disease. STUDY DESIGN We prospectively evaluated pregnant women for thyroid dysfunction using The Endocrine Society's eleven screening questions. Serum was analysed for TPOAb. RESULT We enrolled 546 women. TPOAb positivity was higher in women with a personal (odds ratio (OR) = 8·0; 95% confidence interval (CI) = 1·7-37·4; P = 0·02) or family history of thyroid disease (OR = 2·7; 95% CI = 1·3-5·7; P = 0·02). There was no association between the number of positive responses and TPOAb positivity (P = 0·41). Risk-factor-based screening missed 18 women (33%) with TPOAb. CONCLUSION One-third of women with TPOAb were missed by the case-finding method. A personal or family history of thyroid disease was most strongly associated with TPOAb positivity.
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Affiliation(s)
- Paola Aghajanian
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Carole A Spencer
- Department of Endocrinology, Keck School of Medicine, University Southern California, Los Angeles, CA, USA
| | - Melissa L Wilson
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University Southern California, Los Angeles, CA, USA
| | - Richard H Lee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University Southern California, Los Angeles, CA, USA
| | - Thomas M Goodwin
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University Southern California, Los Angeles, CA, USA
| | - Jorge H Mestman
- Department of Endocrinology, Keck School of Medicine, University Southern California, Los Angeles, CA, USA
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Wang P, Gao J, Zhao S, Guo Y, Wang Z, Qi F. Maternal Thyroxine Levels During Pregnancy and Outcomes of Cognitive Development in Children. Mol Neurobiol 2015; 53:2241-8. [DOI: 10.1007/s12035-015-9189-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 04/22/2015] [Indexed: 12/31/2022]
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Brown AS, Surcel HM, Hinkka-Yli-Salomäki S, Cheslack-Postava K, Bao Y, Sourander A. Maternal thyroid autoantibody and elevated risk of autism in a national birth cohort. Prog Neuropsychopharmacol Biol Psychiatry 2015; 57:86-92. [PMID: 25445476 PMCID: PMC4276336 DOI: 10.1016/j.pnpbp.2014.10.010] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 10/01/2014] [Accepted: 10/22/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Autoimmune disruption may contribute to risk for autism; however, since previous studies relied upon clinical diagnoses, exposure misclassification and recall bias are limitations. Thyroid peroxidase antibody (TPO-Ab) is an autoantibody involved in autoimmune thyroiditis. We aimed to test the a priori hypothesis that positivity to maternal serum TPO-Ab (TPO-Ab+) (defined as >156 IU/ml) during pregnancy is related to childhood autism. METHOD The study was based on a nested case-control design of the Finnish Prenatal Study of Autism (FiPS-A), a national birth cohort that includes prospectively drawn archived maternal serum specimens from virtually the entire pregnant population of Finland beginning in 1983. Cases of childhood autism (ICD-10F84.0) born from 1987 to 2005 were ascertained by performing linkages between national birth and inpatient/outpatient registries. All diagnosed cases in Finland over the birth years, and comparison subjects without ASD or severe/profound intellectual disability were matched 1:1 on date of birth, sex, birthplace, and residence in Finland. Maternal serum specimens were assayed in 967 matched case-control pairs for TPO-Ab by a chemiluminescent microparticle immunoassay blind to case/control status. Data were analyzed by conditional logistic regression for matched sets. RESULTS The prevalence of maternal TPO-Ab+ was significantly increased in pregnancies giving rise to autism cases (6.15%) compared to controls (3.54%). The odds of autism were increased by nearly 80% among offspring of mothers who were TPO-Ab+ during pregnancy (OR=1.78, 95% CI=1.16-2.75, p=0.009), compared to mothers negative for this autoantibody. There was also a significant relationship between maternal TPO-Ab defined as a continuous variable and odds of autism (OR=1.09, 95% CI=1.01, 1.17, p=0.02). Measures of maternal thyroid hormones did not differ between groups. CONCLUSIONS These findings provide the first biomarker-based evidence that a class of known maternal autoimmune disorders is related to autism in offspring.
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Affiliation(s)
- Alan S. Brown
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States,Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168 Street, New York, NY 10032, United States
| | | | | | - Keely Cheslack-Postava
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168 Street, New York, NY 10032, United States
| | - Yuanyuan Bao
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States
| | - Andre Sourander
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States,Department of Child Psychiatry, Faculty of Medicine, University of Turku, Turku Finland,Department of Child Psychiatry, Turku University Hospital, Turku Finland
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Impact of maternal thyroperoxidase status on fetal body and brain size. J Thyroid Res 2014; 2014:872410. [PMID: 24624307 PMCID: PMC3929063 DOI: 10.1155/2014/872410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 11/05/2013] [Accepted: 11/23/2013] [Indexed: 11/30/2022] Open
Abstract
The obstetric consequences of abnormal thyroid function during pregnancy have been established. Less understood is the influence of maternal thyroid autoantibodies on infant outcomes. The objective of this study was to examine the influence of maternal thyroperoxidase (TPO) status on fetal/infant brain and body growth. Six-hundred thirty-one (631) euthyroid pregnant women were recruited from prenatal clinics in Tampa Bay, Florida, and the surrounding area between November 2007 and December 2010. TPO status was determined during pregnancy and fetal/infant brain and body growth variables were assessed at delivery. Regression analysis revealed maternal that TPO positivity was significantly associated with smaller head circumference, reduced brain weight, and lower brain-to-body ratio among infants born to TPO+ white, non-Hispanic mothers only, distinguishing race/ethnicity as an effect modifier in the relationship. No significant differences were noted in body growth measurements among infants born to TPO positive mothers of any racial/ethnic group. Currently, TPO antibody status is not assessed as part of the standard prenatal care laboratory work-up, but findings from this study suggest that fetal brain growth may be impaired by TPO positivity among certain populations; therefore autoantibody screening among high-risk subgroups may be useful for clinicians to determine whether prenatal thyroid treatment is warranted.
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Benros ME, Laursen TM, Dalton SO, Nordentoft M, Mortensen PB. The risk of schizophrenia and child psychiatric disorders in offspring of mothers with lung cancer and other types of cancer: a Danish nationwide register study. PLoS One 2013; 8:e79031. [PMID: 24223877 PMCID: PMC3815227 DOI: 10.1371/journal.pone.0079031] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 09/19/2013] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Maternal immune responses and brain-reactive antibodies have been proposed as possible causal mechanisms for schizophrenia and some child psychiatric disorders. According to this hypothesis maternal antibodies may cross the placenta and interact with the developing CNS of the fetus causing future neurodevelopmental disorders. Therefore, we investigated if children of mothers with cancer might be at higher risk of developing psychiatric disorders, with particular focus on small-cell lung cancer, which is known to induce production of antibodies binding to CNS elements. METHODS Nationwide population-based registers were linked, including the Danish Psychiatric Central Register and The Danish Cancer Registry. Data were analyzed as a cohort study using survival analysis techniques. Incidence rate ratios (IRRs) and accompanying 95% confidence intervals (CIs) were used as measures of relative risk. RESULTS In general, parental cancer was not associated with schizophrenia in the offspring (IRR, 0.98; 95% CI, 0.95-1.01). Furthermore, we found no temporal associations with maternal cancer in general; neither around the pregnancy period. However, maternal small-cell lung cancer increased the risk of early-onset schizophrenia and maternal small-cell lung cancer diagnosed within 20 years after childbirth increased the risk of schizophrenia. Parental cancer was not associated with child psychiatric disorders (IRR, 1.01; 95% CI, 0.98-1.05) except for the smoking related cancers. There was a significantly increased risk of child psychiatric disorders in offspring of both mothers (IRR, 1.35; 95% CI, 1.16-1.58) and fathers (IRR, 1.47; 95% CI, 1.30-1.66) with lung cancer of all types. CONCLUSIONS In general, parental cancer did not increase the risk of schizophrenia nor of child psychiatric disorders. However, maternal small-cell lung cancer increased the risk of schizophrenia in subgroups; and lung cancer in general increased the risk of child psychiatric disorders, which could be due to risk factors associated with parental smoking.
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Affiliation(s)
- Michael Eriksen Benros
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- Mental Health Centre Copenhagen, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- ,* E-mail:
| | - Thomas Munk Laursen
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
| | | | - Merete Nordentoft
- Mental Health Centre Copenhagen, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
| | - Preben Bo Mortensen
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
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Abstract
The senses are our window to the world, our interface with the habitat in which we live in and the basis for our communication with each other. Although sensory systems are not generally viewed as major targets of endocrine regulation, sensory development is profoundly influenced by thyroid hormone (T(3)) signalling. In this article, we discuss this developmental role of T(3) and highlight the auditory system as the best-studied example of the interplay between systemic and local tissue mechanisms by which T(3) stimulates the onset of sensory function. Several genes that mediate the action of T(3) are known to promote sensory development in mice, including genes that encode T(3) receptors and deiodinase enzymes that amplify or deplete levels of T(3). We also discuss the current knowledge of sensory defects in human genetic disorders in which T(3) signalling is impaired. As sensory input provides the only means of acquiring information from the environment, the stimulation of sensory development is one of the most fundamental functions of T(3) signalling.
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Affiliation(s)
- Lily Ng
- National Institute of Diabetes and Digestive and Kidney Disease, Laboratory of Endocrinology and Receptor Biology, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892, USA
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Wasserman EE, Pillion JP, Duggan A, Nelson K, Rohde C, Seaberg EC, Talor MV, Yolken RH, Rose NR. Childhood IQ, hearing loss, and maternal thyroid autoimmunity in the Baltimore Collaborative Perinatal Project. Pediatr Res 2012; 72:525-30. [PMID: 22918523 DOI: 10.1038/pr.2012.117] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Maternal thyroid autoantibodies during pregnancy have been implicated in neurodevelopmental delays, including early childhood cognitive deficits. We evaluated whether maternal autoantibodies to thyroid peroxidase (TPOaAbs) during late pregnancy were associated with childhood intelligence quotient (IQ) scores in their offspring and how the children's TPOaAb-associated sensorineural hearing loss (HL) might affect the result. METHODS We evaluated banked third-trimester sera corresponding to 1,733 children for whom childhood cognitive test scores and audiology data were available. The mothers and their children participated in the National Institutes of Health (NIH)-sponsored Collaborative Perinatal Project (CPP) that ran from 1959 to 1974. RESULTS A modest, statistically significant, effect of TPOaAbs on cognitive performance observed at 4 y of age lessened in both magnitude and P value by the age of 7 y. Children with sensorineural HL (SNHL) had lower IQ scores at both ages. CONCLUSION Our data suggest that the reported effect of maternal TPOaAbs on IQ may involve early developmental delays or transient effects rather than permanent deficits. Reports associating TPOaAbs directly with IQ may reflect a portion with unexamined TPOaAb-associated SNHL. Whether the TPOaAb-associated SNHL is in the neurodevelopmental pathway of later cognitive delays or is independently associated with IQ requires investigation in other studies.
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Affiliation(s)
- Ellen E Wasserman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Fang Q, Giordimaina AM, Dolan DF, Camper SA, Mustapha M. Genetic background of Prop1(df) mutants provides remarkable protection against hypothyroidism-induced hearing impairment. J Assoc Res Otolaryngol 2011; 13:173-184. [PMID: 22143287 PMCID: PMC3298611 DOI: 10.1007/s10162-011-0302-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Accepted: 11/03/2011] [Indexed: 12/30/2022] Open
Abstract
Hypothyroidism is a cause of genetic and environmentally induced deafness. The sensitivity of cochlear development and function to thyroid hormone (TH) mandates understanding TH action in this sensory organ. Prop1(df) and Pou1f1(dw) mutant mice carry mutations in different pituitary transcription factors, each resulting in pituitary thyrotropin deficiency. Despite the same lack of detectable serum TH, these mutants have very different hearing abilities: Prop1(df) mutants are mildly affected, while Pou1f1(dw) mutants are completely deaf. Genetic studies show that this difference is attributable to the genetic backgrounds. Using embryo transfer, we discovered that factors intrinsic to the fetus are the major contributor to this difference, not maternal effects. We analyzed Prop1(df) mutants to identify processes in cochlear development that are disrupted in other hypothyroid animal models but protected in Prop1(df) mutants by the genetic background. The development of outer hair cell (OHC) function is delayed, but Prestin and KCNQ4 immunostaining appear normal in mature Prop1(df) mutants. The endocochlear potential and KCNJ10 immunostaining in the stria vascularis are indistinguishable from wild type, and no differences in neurofilament or synaptophysin staining are evident in Prop1(df) mutants. The synaptic vesicle protein otoferlin normally shifts expression from OHC to IHC as temporary afferent fibers beneath the OHC regress postnatally. Prop1(df) mutants exhibit persistent, abnormal expression of otoferlin in apical OHC, suggesting delayed maturation of synaptic function. Thus, the genetic background of Prop1(df) mutants is remarkably protective for most functions affected in other hypothyroid mice. The Prop1(df) mutant is an attractive model for identifying the genes that protect against deafness.
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Affiliation(s)
- Qing Fang
- Department of Human Genetics, University of Michigan, 4945 Buhl, 1241 E Catherine St., Ann Arbor, MI, 48109-5618, USA
| | - Alicia M Giordimaina
- Health Behavior & Health Education Department, School of Public Health, University of Michigan, Ann Arbor, MI, 48109, USA
| | - David F Dolan
- Kresge Hearing Research Institute, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Sally A Camper
- Department of Human Genetics, University of Michigan, 4945 Buhl, 1241 E Catherine St., Ann Arbor, MI, 48109-5618, USA.
| | - Mirna Mustapha
- Department of Otolaryngology-Head & Neck Surgery, Stanford University, Stanford, CA, 94305, USA
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Wasserman EE, Nelson K, Rose NR, Rhode C, Pillion JP, Seaberg E, Talor MV, Burek L, Eaton W, Duggan A, Yolken RH. Infection and thyroid autoimmunity: A seroepidemiologic study of TPOaAb. Autoimmunity 2009; 42:439-46. [DOI: 10.1080/08916930902787716] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Current world literature. Curr Opin Pediatr 2009; 21:553-60. [PMID: 19622920 DOI: 10.1097/mop.0b013e3283300b10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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