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Zhang S, Zhou L, Zhang L, Wang Y, Wang H. Molecular genetic screening of full-term small for gestational age. BMC Pediatr 2023; 23:217. [PMID: 37147621 PMCID: PMC10161501 DOI: 10.1186/s12887-023-04030-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 04/24/2023] [Indexed: 05/07/2023] Open
Abstract
OBJECTIVE To examine the clinical application of genomic screening in newborns small for gestational age (SGA), hoping to provide an efficient technique for early discovery of neonatal diseases, which is necessary to elevate survival rates and the quality of life in infants. METHODS Totally 93 full-term SGA newborns were assessed. Dried blood spot (DBS) samples were obtained at 72 h after birth, and tandem mass spectrometry (TMS) and Angel Care genomic screening (GS, using Targeted next generation sequencing) were carried out. RESULTS All 93 subjects were examined by Angel Care GS and TMS. No children showing inborn errors of metabolism (IEM) were detected by TMS, while 2 pediatric cases (2.15%, 2/93) were confirmed as thyroid dyshormonogenesis 6 (TDH6) by Angel Care GS. Additionally, 45 pediatric cases (48.4%) had one or more variants conferring a carrier status for recessive childhood-onset disorders, with 31 genes and 42 variants associated with 26 diseases. The top three gene-related diseases with carrier status were autosomal recessive deafness (DFNB), abnormal thyroid hormone and Krabbe disease. CONCLUSIONS SGA is tightly associated with genetic variation. Molecular Genetic Screening allows early detection of congenital hypothyroidism and may be a potent genomic sequencing technique for screening newborns.
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Affiliation(s)
- Shuman Zhang
- Department of Neonatology, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu Province, China
| | - Lingna Zhou
- Department of Medical Genetics, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu Province, China
| | - Lin Zhang
- Department of Neonatology, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu Province, China
| | - Yu Wang
- Department of Neonatology, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu Province, China.
| | - Huaiyan Wang
- Department of Neonatology, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu Province, China.
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Yan X, Wang L, Chen X, Wang A. Analysis of Risk Factors and Screening Results of Neonatal Congenital Hypothyroidism in a Tertiary Care Center of Southern China. J Multidiscip Healthc 2023; 16:741-749. [PMID: 36969736 PMCID: PMC10032214 DOI: 10.2147/jmdh.s400804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/01/2023] [Indexed: 03/19/2023] Open
Abstract
Objective To explore the risk factors for neonatal congenital hypothyroidism (CH) and the influencing factors of false-positive results in CH screening. Methods In this study, 255 neonatal patients with CH who completed the screening and further diagnosis and 366 neonates with positive CH screening results and normal thyroid function were selected as the case group. 246 healthy neonates with normal thyroid function were selected as the control group. Gestational age, birth-weight, maternal age, small for gestational age (SGA), perinatal factors (gestational thyroid dysfunction, gestational diabetes mellitus, etc.) were used as influencing factors, using χ 2 tests were performed for comparison. The statistically significant variables were analyzed with Logistic multiple regression models, and the difference was considered statistically significant (P<0.05). Results There were statistical differences in the SGA, maternal gestational diabetes mellitus, thyroid disease, and the proportion using assisted reproduction technology among the case group, false-positive screening group, and control group (χ 2 was 11.943, 6.857, 6.999, 9.732, respectively, P < 0.05). The results of multivariate logistic regression analysis showed that the gestational thyroid disease (OR = 8.452, 95% CI:1.051-67.982), gestational diabetes mellitus (OR = 2.654, 95% CI:1.051-6.706), and assisted reproduction (OR = 0.194, 95% CI:0.041-0.911) were the influencing factors for neonatal CH, and the difference was statistically significant (P < 0.05). The SGA (OR = 2.556, 95% CI:1.027-6.361), gestational thyroid disease (OR = 7.801, 95% CI:1.03-59.057), gestational diabetes mellitus (OR = 2.731, 95% CI:1.18-6.322), and assisted reproduction (OR = 0.28, 95% CI:0.102-0.765) were the influencing factors of the false-positive screening results of neonatal CH. The difference was statistically significant (P < 0.05). Conclusion Neonatal CH and positive screening results are influenced by assisted reproduction, gestational thyroid dysfunction, gestational diabetes mellitus, and SGA.
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Affiliation(s)
- Xueqin Yan
- Department of Child Health Care, Boai Hospital of Zhongshan Affiliated to Southern Medical University, Zhongshan, 528400, People’s Republic of China
- Xueqin Yan, Department of Child Health Care, Boai Hospital of Zhongshan Affiliated to Southern Medical University, No. 6 of Chenggui Road, Zhongshan, 528400, People’s Republic of China, Tel +86 760-88776567, Fax +86 760-88306163, Email
| | - Li Wang
- Department of Child Health Care, Boai Hospital of Zhongshan Affiliated to Southern Medical University, Zhongshan, 528400, People’s Republic of China
| | - Xiaolan Chen
- Department of Child Health Care, Boai Hospital of Zhongshan Affiliated to Southern Medical University, Zhongshan, 528400, People’s Republic of China
| | - Anru Wang
- Department of Pediatrics, The Second of Affiliated Hospital of Nanjing Medical University, Nanjing, 210003, People’s Republic of China
- Correspondence: Anru Wang, Department of Pediatrics, The Second of Affiliated Hospital of Nanjing Medical University, No. 262 of Zhongshan North Road, Nanjing, 210003, People’s Republic of China, Tel +86 25 83575027, Fax +86 25 58509975, Email
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Dash SC, Sahoo N, Rout U, Mishra SP, Swain J, Mazumder AG. Outcomes With Levothyroxine Treatment in Early Pregnancy With Subclinical Hypothyroidism. Cureus 2022; 14:e24984. [PMID: 35719785 PMCID: PMC9191263 DOI: 10.7759/cureus.24984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Adverse pregnancy outcomes in women with subclinical hypothyroidism (SCH) are well documented, whereas data regarding the risk and benefit of levothyroxine treatment in such cases are insufficient and inconsistent. Our study aimed to evaluate the effects of levothyroxine treatment on pregnancy outcomes in these women. Materials and methods Healthy women with a singleton pregnancy were screened before 12 weeks of gestation for subclinical hypothyroidism using 2017 American Thyroid Association guidelines. They were treated with an initial dose of 50 mcg of levothyroxine and the dose was adjusted at six-week intervals to achieve a normal thyrotropin level. All the participants were followed up with thyroid function tests and ultrasonography till delivery. Pregnancy outcomes were compared with those of healthy pregnant women with normal thyroid function. Results A total of 1058 women were screened and 5.1% (n=54) were found to have subclinical hypothyroidism, out of which 57.4% (n=31) were thyroid peroxidase antibody positive. The median gestational age at the initiation of levothyroxine treatment was nine weeks. The risks for miscarriage (odds ratio (OR): 1.284, p=0.811), gestational hypertension (OR: 1.993, p=0.365), intra-uterine growth restriction (OR: 1.688, p=0.488), low birth weight (OR: 1.591, p=0.392), and preterm birth (OR: 1.606, p=0.529) were not significantly higher in women with subclinical hypothyroidism as compared to euthyroid women. However, the risk of gestational diabetes mellitus was significantly higher in women with SCH (OR: 3.432, 95% confidence interval (95% CI): 1.115-10.562). Conclusion Levothyroxine therapy initiated in the first trimester of pregnancy has possible beneficial effects in subclinical hypothyroidism but with a higher risk for gestational diabetes.
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Habib C, Maor I, Shoris I, Tsuprun S, Bader D, Riskin A. Umbilical Cord and Neonatal Transthyretin and Their Relationship to Growth and Nutrition in Preterm Infants. Rambam Maimonides Med J 2022; 13:RMMJ.10470. [PMID: 35482459 PMCID: PMC9049153 DOI: 10.5041/rmmj.10470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Transthyretin (TTR), also known as prealbumin, has been suggested as an indicator of protein and nutritional status. OBJECTIVE The aim of this study was to examine the maternal and umbilical cord (UC) TTR in relation to intrauterine growth, and the serum TTR of preterm infants in relation to nutritional status and growth. METHODS After application of exclusion criteria, 49 preterm infants (mean gestational age and birth-weight 32.9±2.9 weeks and 1822±556 g) were included in the study. Transthyretin was sampled at birth and on days 14, 28, and at discharge with growth parameters and nutritional laboratory test results. RESULTS Mean UC and maternal TTR were positively correlated (8.5±2.4 mg/dL and 20.4±7.0 mg/dL, r=0.31, P=0.07). Umbilical cord TTR was neither an index of maturity nor of intrauterine growth. Umbilical cord TTR was higher in females (9.4±2.6 versus 7.6±1.8 mg/dL, P=0.015). Maternal TTR was lower in twin pregnancies (16.8±4.9 versus 22.5±7.3 mg/dL, P=0.007). Although TTR levels gradually increased over time in correlation with post-menstrual and chronological ages (r=0.24, P=0.011 and r=0.40, P<0.001, respectively), there was no correlation to weight gain (r=0.10, P=0.41), nutritional status, protein intake, or nutritional laboratory test results. The only significant correlations were between TTR and glucose and triglycerides levels (r=0.51, P<0.001 for both). CONCLUSIONS Although TTR levels increased over time, we could not demonstrate significant correlations between TTR and indices of the nutritional status in preterm infants at birth or during the neonatal course.
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Affiliation(s)
- Clair Habib
- Genetics Institute and Pediatric Metabolic Unit, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
- Department of Neonatology, Bnai Zion Medical Center, Haifa, Israel
| | - Irit Maor
- Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
- Biochemistry Laboratory, Bnai Zion Medical Center, Haifa, Israel
| | - Irit Shoris
- Department of Neonatology, Bnai Zion Medical Center, Haifa, Israel
| | - Svetlana Tsuprun
- Department of Neonatology, Bnai Zion Medical Center, Haifa, Israel
| | - David Bader
- Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
- Department of Neonatology, Bnai Zion Medical Center, Haifa, Israel
| | - Arieh Riskin
- Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
- Department of Neonatology, Bnai Zion Medical Center, Haifa, Israel
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Yilmaz A, Ozer Y, Kaya N, Turan H, Acar HC, Ercan O, Perk Y, Evliyaoglu O, Vural M. The factors associated with transient hypothyroxinemia of prematurity. BMC Pediatr 2021; 21:344. [PMID: 34388993 PMCID: PMC8363484 DOI: 10.1186/s12887-021-02826-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/25/2021] [Indexed: 12/28/2022] Open
Abstract
Background Hypothyroxinemia is defined by low levels of thyroxine (T4) despite low or normal levels of thyroid-stimulating hormone (TSH). This study aimed to evaluate the factors associated with transient hypothyroxinemia of prematurity (THOP) in newborns admitted to the neonatal intensive care unit (NICU). Method This is a single center, retrospective, case-control study. Premature newborns, between 24 and 34 weeks of gestation, hospitalised between January 2014–December 2019 in Istanbul University-Cerrahpasa Faculty of Medicine NICU were analyzed through their medical records. Thyroid function tests were routinely performed between the 10th and 20th days of postnatal life and were evaluated according to the gestational age references. Thirty six possible associated factors (prenatal and postnatal parameters, medical treatments, clinical diagnoses and applications in NICU) were searched in the patient group with THOP (n = 71) and the control group with euthyroid prematures (n = 73). The factors for THOP were identified by univariate analysis, followed by multivariate analysis. Results Mean gestational ages of the study and the control groups were 29.7 ± 2.48 and 30.5 ± 2.30 weeks, respectively (p = 0.606). The birth weight, small for gestational age (SGA), intraventricular hemorrhage (IVH), congenital heart disease (CHD) were found to be the possible associated factors for THOP in the univariate analysis and CHD (p = 0.007, odds ratio [OR]:4.9, 95% confidence interval [CI]: 1.5–15.8), BW (p = 0.004, OR:0.999, 95% CI: 0.9–1.0) and SGA (p = 0.010, OR:4.6, 95% CI: 1.4–14.7) were found to be factors associated with THOP determined by univariate logistic regression analysis. Conclusıons Although some treatment practices might have had direct effects on pituitary–thyroid axis, related with the severity of the newborn clinical conditions, non of them was found to be a associated factor for THOP. However, CHD and SGA may be considered as associated factors with THOP detected in preterm infants.
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Affiliation(s)
- Aslan Yilmaz
- Department of Neonatology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa, Fatih, 34098, Istanbul, Turkey.
| | - Yavuz Ozer
- Department of Pediatric Endocrinology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa, Fatih, 34098, Istanbul, Turkey
| | - Nesrin Kaya
- Department of Neonatology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa, Fatih, 34098, Istanbul, Turkey
| | - Hande Turan
- Department of Pediatric Endocrinology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa, Fatih, 34098, Istanbul, Turkey
| | - Hazal Cansu Acar
- Department of Public Health, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa, Fatih, 34098, Istanbul, Turkey
| | - Oya Ercan
- Department of Pediatric Endocrinology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa, Fatih, 34098, Istanbul, Turkey
| | - Yildiz Perk
- Department of Neonatology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa, Fatih, 34098, Istanbul, Turkey
| | - Olcay Evliyaoglu
- Department of Pediatric Endocrinology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa, Fatih, 34098, Istanbul, Turkey
| | - Mehmet Vural
- Department of Neonatology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa, Fatih, 34098, Istanbul, Turkey
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Vrachnis N, Tsonis O, Vrachnis D, Antonakopoulos N, Paltoglou G, Barbounaki S, Mastorakos G, Paschopoulos M, Iliodromiti Z. The Effect of Thyrotropin-Releasing Hormone and Antithyroid Drugs on Fetal Thyroid Function. CHILDREN (BASEL, SWITZERLAND) 2021; 8:454. [PMID: 34071168 PMCID: PMC8228147 DOI: 10.3390/children8060454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/21/2021] [Accepted: 05/25/2021] [Indexed: 01/06/2023]
Abstract
A euthyroid pregnant woman will normally have a fetus that displays normal fetal development. However, studies have long demonstrated the role of T3 (Triiodothyronine), T4 (Thyroxine), and TSH (Thyroid Stimulating Hormone) and their degree of penetrability into the fetal circulation. Maternal thyrotropin-releasing hormone (TRH) crosses the placental site and, from mid-gestation onward, is able to promote fetal TSH secretion. Its origin is not only hypothalamic, as was believed until recently. The maternal pancreas, and other extraneural and extrahypothalamic organs, can produce TRH variants, which are transported through the placenta affecting, to a degree, fetal thyroid function. Antithyroid drugs (ATDs) also cross the placenta and, because of their therapeutic actions, can affect fetal thyroid development, leading in some cases to adverse outcomes. Furthermore, there are a number of TRH analogues that share the same properties as the endogenous hormone. Thus, in this narrative review, we highlight the interaction of all the above with fetal growth in uncomplicated pregnancies.
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Affiliation(s)
- Nikolaos Vrachnis
- Third Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens Medical School, Attikon Hospital, 157 72 Athens, Greece;
- Vascular Biology, Molecular and Clinical Sciences Research Institute, St George’s University of London, London SW17 0RE, UK
| | - Orestis Tsonis
- Department of Obstetrics and Gynecology, University of Ioannina Medical School, University Hospital of Ioannina, 455 00 Ioannina, Greece; (O.T.); (M.P.)
| | - Dionisios Vrachnis
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, 157 72 Athens, Greece;
| | - Nikolaos Antonakopoulos
- Third Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens Medical School, Attikon Hospital, 157 72 Athens, Greece;
| | - George Paltoglou
- Endocrinology Unit, 2nd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens Medical School, Aretaieio Hospital, 157 72 Athens, Greece; (G.P.); (G.M.)
| | | | - George Mastorakos
- Endocrinology Unit, 2nd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens Medical School, Aretaieio Hospital, 157 72 Athens, Greece; (G.P.); (G.M.)
| | - Minas Paschopoulos
- Department of Obstetrics and Gynecology, University of Ioannina Medical School, University Hospital of Ioannina, 455 00 Ioannina, Greece; (O.T.); (M.P.)
| | - Zoi Iliodromiti
- Department of Neonatology, National and Kapodistrian University of Athens Medical School, Aretaieio Hospital, 157 72 Athens, Greece;
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Lucaccioni L, Ficara M, Cenciarelli V, Berardi A, Predieri B, Iughetti L. Long term outcomes of infants born by mothers with thyroid dysfunction during pregnancy. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 92:e2021010. [PMID: 33682817 PMCID: PMC7975942 DOI: 10.23750/abm.v92i1.9696] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 05/03/2020] [Indexed: 01/07/2023]
Abstract
According to Barker’s hypothesis, sub-optimal conditions during gestation might affect the predisposition for diseases in adulthood. Alteration in endocrine functions during pregnancy, such us thyroid function or glucose metabolism, are not exempt. It is well known that subclinical hypothyroidism and thyroperoxidase antibodies-positive euthyroidism during early pregnancy are associated with increased risk of gestational diabetes mellitus and both conditions influence pregnancy outcome and newborn development and metabolism at short and long terms. Fetal production of thyroid hormones starts from the 12th week of gestational age. The transplacental passage of maternal thyroxine (T4) is therefore essential for the fetal neurological development, especially during the first half of pregnancy. If this passage is interrupted, such as in premature birth, neonates are more susceptible to develop impaired thyroid function, because of physiological immaturity of their hypothalamic-pituitary-thyroid axis, acute illnesses and stressful events (sepsis, invasive procedures, drugs). The aim of this review is to investigate the short and long term effects of maternal dysthyroidisms on term and preterm newborns, with particular attention to the metabolic and thyroid consequences. Metabolic syndrome, higher body mass index and greater waist circumference, seem to be more prevalent in children of TPO-Ab-positive mothers. Maternal hypothyroidism may be associated with higher risk of gestational diabetes and adverse birth outcomes, such as preeclampsia, preterm delivery, fetal death and low birth weight offspring. In adulthood, preterm (< 37 weeks of gestational age) or low birth weight (<2.500 g) newborns seem to be more susceptible to develop gestational diabetes, preeclampsia, type 2 diabetes mellitus and behavioral alterations. (www.actabiomedica.it)
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Liu C, Wang K, Guo J, Chen J, Chen M, Xie Z, Chen P, Wu B, Lin N. Small for gestational age is a risk factor for thyroid dysfunction in preterm newborns. BMC Pediatr 2020; 20:179. [PMID: 32326888 PMCID: PMC7178556 DOI: 10.1186/s12887-020-02089-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 04/15/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Thyroid hormones play an important role in the normal growth and maturation of the central nervous system. However, few publications addressed the altered thyroid hormone levels in preterm small for gestational age (SGA) newborns. We hypothesized preterm SGA infants have higher thyroid-stimulating hormone (TSH) concentrations than appropriate for gestational age (AGA) ones within the normal range and an increased incidence of thyroid dysfunction. METHODS The study was designed to compare thyroid hormone levels within the normal range and the incidence of thyroid dysfunction in the SGA and AGA groups to test the hypothesis. The medical records of all preterm infants admitted to the neonatal intensive care unit (NICU) at the First Affiliated Hospital of Shantou University Medical College, Shantou, China, between January 1, 2015 and December 31, 2018, were reviewed. Blood samples were collected between 72 and 96 h of life and analyzed with TSH, free thyroxine (FT4) and free triiodothyronine (FT3) assays. Thyroid function test (TFT) results, and neonatal demographic and clinical factors were analyzed to identify the associations between SGA birth and altered thyroid concentrations and thyroid dysfunction. RESULTS TSH and FT4 concentrations were significantly higher in the SGA group than the AGA group ((3.74(interquartile range (IQR):2.28 ~ 6.18) vs. 3.01(IQR: 1.81 ~ 5.41) mU/L, p = 0.018), and (17.76 ± 3.94 vs. 17.42 ± 3.71 pmol/L, p = 0.371), respectively). The higher TSH levels were associated with being SGA or Z-score of birth weight (BW) for GA after adjusting for potential confounders ((βSGA = 0.68 (95% confidence interval (CI) 0.15 ~ 1.21), p = 0.013) or (βZ-score = - 0.25 (95%CI -0.48 ~ - 0.03), p = 0.028), respectively). However, we did not find a significant association between SGA birth and altered FT4 concentrations. Furthermore, compared with the AGA group, the SGA group presented an increased incidence of transient hypothyroxinemia with delayed TSH elevation (dTSHe), a higher percentage receiving levothyroxine (L-T4) therapy, and a higher rate of follow-up within the first 6 months of life. CONCLUSIONS Preterm SGA newborns had significantly higher TSH concentrations within the normal range and an increased incidence of thyroid dysfunction. The SGA newborns with these features should be closely followed up with periodical TFTs and endocrinologic evaluation.
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Affiliation(s)
- Chunhua Liu
- Neonatal Intensive Care Unit, Department of Pediatrics, The First Affiliated Hospital of Shantou University Medical College, 57 Changping Road, Shantou, 515041 Guangdong People’s Republic of China
| | - Kaiyan Wang
- Medical Informatics Research Center, Shantou University Medical College, 22 Xinlin Road, Shantou, 515041 Guangdong People’s Republic of China
| | - Jizhong Guo
- Neonatal Intensive Care Unit, Department of Pediatrics, The First Affiliated Hospital of Shantou University Medical College, 57 Changping Road, Shantou, 515041 Guangdong People’s Republic of China
| | - Jiru Chen
- Neonatal Intensive Care Unit, Department of Pediatrics, The First Affiliated Hospital of Shantou University Medical College, 57 Changping Road, Shantou, 515041 Guangdong People’s Republic of China
| | - Mei Chen
- Neonatal Intensive Care Unit, Department of Pediatrics, The First Affiliated Hospital of Shantou University Medical College, 57 Changping Road, Shantou, 515041 Guangdong People’s Republic of China
| | - Zhexi Xie
- Neonatal Intensive Care Unit, Department of Pediatrics, The First Affiliated Hospital of Shantou University Medical College, 57 Changping Road, Shantou, 515041 Guangdong People’s Republic of China
| | - Pu Chen
- Neonatal Intensive Care Unit, Department of Pediatrics, The First Affiliated Hospital of Shantou University Medical College, 57 Changping Road, Shantou, 515041 Guangdong People’s Republic of China
| | - Beiyan Wu
- Neonatal Intensive Care Unit, Department of Pediatrics, The First Affiliated Hospital of Shantou University Medical College, 57 Changping Road, Shantou, 515041 Guangdong People’s Republic of China
| | - Niyang Lin
- Neonatal Intensive Care Unit, Department of Pediatrics, The First Affiliated Hospital of Shantou University Medical College, 57 Changping Road, Shantou, 515041 Guangdong People’s Republic of China
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Iodine Status, Thyroid Function, and Birthweight: A Complex Relationship in High-Risk Pregnancies. J Clin Med 2020; 9:jcm9010177. [PMID: 31936405 PMCID: PMC7019691 DOI: 10.3390/jcm9010177] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 12/31/2019] [Accepted: 01/06/2020] [Indexed: 12/18/2022] Open
Abstract
(1) Background: The consequences of iodine deficiency and/or thyroid dysfunction during pregnancy have been extensively studied, emphasizing on infant neurodevelopment. However, the available information about the relationship between iodine, thyroid hormones, and fetal growth in high-risk pregnancies is limited. We aim to investigate if iodine metabolism and/or thyroid parameters can be affected by adverse antenatal/perinatal conditions. (2) Methods: A cross-sectional study examined differences in iodine status, thyroid function, and birthweight between high-risk (HR group; n = 108)) and low-risk pregnancies (LR group; n = 233) at the time of birth. Urinary iodine concentration (UIC), iodine levels in amniotic fluid, and thyroid parameters [thyroid-stimulating hormone (TSH), free thyroxine (FT4)] were measured in mother–baby pairs. (3) Results: There were significant differences between HR and LR groups, free thyroxine (FT4) concentration in cord blood was significantly higher in the LR group compared with HR pregnancies (17.06 pmol/L vs. 15.30 pmol/L, respectively; p < 0.001), meanwhile iodine concentration in amniotic fluid was significantly lower (13.11 µg/L vs. 19.65 µg/L, respectively; p < 0.001). (4) Conclusions: Our findings support the hypothesis that an adverse intrauterine environment can compromise the availability of FT4 in cord blood as well as the iodine metabolism in the fetus. These differences are more noticeable in preterm and/or small fetuses.
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Jonker SS, Louey S, Roselli CE. Cardiac myocyte proliferation and maturation near term is inhibited by early gestation maternal testosterone exposure. Am J Physiol Heart Circ Physiol 2018; 315:H1393-H1401. [PMID: 30095996 PMCID: PMC6297822 DOI: 10.1152/ajpheart.00314.2018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/19/2018] [Accepted: 08/06/2018] [Indexed: 12/27/2022]
Abstract
Polycystic ovary syndrome is a complex and common disorder in women, and those affected experience an increased burden of cardiovascular disease. It is an intergenerational syndrome, as affected women with high androgen levels during pregnancy "program" fetal development, leading to a similar phenotype in their female offspring. The effect of excess maternal testosterone exposure on fetal cardiomyocyte growth and maturation is unknown. Pregnant ewes received biweekly injections of vehicle (control) or 100 mg testosterone propionate between 30 and 59 days of gestation (early T) or between 60 and 90 days of gestation (late T). Fetuses were delivered at ~135 days of gestation, and their hearts were enzymatically dissociated to measure cardiomyocyte growth (dimensional measurements), maturation (proportion binucleate), and proliferation (nuclear Ki-67 protein). Early T depressed serum insulin-like growth factor 1 and caused intrauterine growth restriction (IUGR; P < 0.0005). Hearts were smaller with early T ( P < 0.001) due to reduced cardiac myocyte maturation ( P < 0.0005) and proliferation ( P = 0.017). Maturation was also lower in male than female fetuses ( P = 0.004) independent of treatment. Late T did not affect cardiac growth. Early excess maternal testosterone exposure depresses circulating insulin-like growth factor 1 near term and causes IUGR in both female and male offspring. These fetuses have small, immature hearts with reduced proliferation, which may reduce cardiac myocyte endowment and predispose to adverse cardiac growth in postnatal life. While excess maternal testosterone exposure leads to polycystic ovary syndrome and cardiovascular disease in female offspring, it may also predispose to complications of IUGR and cardiovascular disease in male offspring. NEW & NOTEWORTHY Using measurements of cardiac myocyte growth and maturation in an ovine model of polycystic ovary syndrome, this study demonstrates that early gestation excess maternal testosterone exposure reduces near-term cardiomyocyte proliferation and maturation in intrauterine growth-restricted female and male fetuses. The effect of testosterone is restricted to exposure during a specific period early in pregnancy, and the effects appear mediated through reduced insulin-like growth factor 1 signaling. Furthermore, male fetuses, regardless of treatment, had fewer mature cardiomyocytes than female fetuses.
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Affiliation(s)
- Sonnet S Jonker
- Center for Developmental Health, Oregon Health & Science University , Portland, Oregon
- Knight Cardiovascular Institute, Oregon Health & Science University , Portland, Oregon
| | - Samantha Louey
- Center for Developmental Health, Oregon Health & Science University , Portland, Oregon
- Knight Cardiovascular Institute, Oregon Health & Science University , Portland, Oregon
| | - Charles E Roselli
- Department of Physiology and Pharmacology, Oregon Health & Science University , Portland, Oregon
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Tonyushkina KN, Krug S, Ortiz-Toro T, Mascari T, Karlstrom RO. Low Thyroid Hormone Levels Disrupt Thyrotrope Development. Endocrinology 2017; 158:2774-2782. [PMID: 28658938 PMCID: PMC5659672 DOI: 10.1210/en.2016-1935] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 06/22/2017] [Indexed: 11/19/2022]
Abstract
Low thyroid hormone (TH) conditions caused by a variety of prenatal and perinatal problems have been shown to alter postnatal regulatory thyrotropin (TSH) responsiveness to TH in humans and rodents. The mechanisms underlying this pituitary TH resistance remain unknown. Here we use the evolutionarily conserved zebrafish model to examine the effects of low TH on thyrotrope development and function. Zebrafish were exposed to the goitrogen 6-propyl-2-thiouracil (PTU) to block TH synthesis, and this led to an approximately 50% increase in thyrotrope numbers and an 8- to 10-fold increase in tshb mRNA abundance in 2-week-old larvae and 1-month-old juveniles. Thyrotrope numbers returned to normal 3 weeks after cessation of PTU treatment, demonstrating that these effects were reversible and revealing substantial plasticity in pituitary-thyroid axis regulation. Using a T4 challenge assay, we found that development under low-TH conditions did not affect the ability of T4 to suppress tshb mRNA levels despite the thyrotrope hyperplasia that resulted from temporary low-TH conditions. Together, these studies show that low developmental TH levels can lead to changes in thyrotrope number and function, providing a possible cellular mechanism underlying elevated TSH levels seen in neonates with either permanent or transient congenital hypothyroidism.
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Affiliation(s)
- Ksenia N. Tonyushkina
- Division of Pediatric Endocrinology, Baystate Children’s Hospital, Baystate Health, Springfield, Massachusetts 01199
- Department of Biology, University of Massachusetts, Amherst, Massachusetts 01003
| | - Stefanie Krug
- Division of Pediatric Endocrinology, Baystate Children’s Hospital, Baystate Health, Springfield, Massachusetts 01199
- Department of Biology, University of Massachusetts, Amherst, Massachusetts 01003
| | - Theresa Ortiz-Toro
- Division of Pediatric Endocrinology, Baystate Children’s Hospital, Baystate Health, Springfield, Massachusetts 01199
- Department of Biology, University of Massachusetts, Amherst, Massachusetts 01003
| | - Tibor Mascari
- Department of Biology, University of Massachusetts, Amherst, Massachusetts 01003
| | - Rolf O. Karlstrom
- Department of Biology, University of Massachusetts, Amherst, Massachusetts 01003
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Tong Z, Xiaowen Z, Baomin C, Aihua L, Yingying Z, Weiping T, Zhongyan S. The Effect of Subclinical Maternal Thyroid Dysfunction and Autoimmunity on Intrauterine Growth Restriction: A Systematic Review and Meta-Analysis. Medicine (Baltimore) 2016; 95:e3677. [PMID: 27175703 PMCID: PMC4902545 DOI: 10.1097/md.0000000000003677] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 03/31/2016] [Accepted: 04/12/2016] [Indexed: 12/21/2022] Open
Abstract
The objective of this study was to evaluate the association between maternal subclinical thyroid dysfunction and autoimmunity with the risk for intrauterine growth restriction (IUGR).Design is a systematic review and meta-analysis.A literature search was conducted using PubMed, Embase, and Cochrane database. A combination of 2 key words was used to search for the eligible studies: one indexed thyroid dysfunction or antithyroid antibodies; and the other one indexed the adverse neonatal outcomes of pregnancy, such as IUGR, small for gestational age, fetal growth restriction, or low birth weight.Two reviewers selected the studies, and eligible studies met the following criteria: prospective cohort studies or case control studies, studies of maternal thyroid dysfunction and positive antithyroid antibodies as the exposure of interest, and studies of IUGR or small for gestational age as the outcome of interest.Data were recorded, including data from maternal thyroid disorders and IUGR, and compared with a reference group.There were 22 individual data from the 13 cohort articles. Among these, 7 were focused on subclinical hypothyroidism (SCH), 4 on subclinical hyperthyroidism, 7 on positivity for thyroid peroxidase antibody (TPOAb), and 4 on isolated hypothyroxinemia. Meta-analysis showed that there was no effect of subclinical hyperthyroidism (odds ratio (OR) = 0.98; 95% confidence interval (CI), 0.40-2.41), TPOAb positivity (OR = 1.57; 95% CI, 0.77-3.18), or isolated hypothyroxinemia (OR = 1.05, 95% CI: 0.37-2.92) on IUGR. However, SCH is associated with IUGR (OR = 1.54; 95% CI, 1.06-2.25).SCH is associated with IUGR; however, subclinical hyperthyroidism, TPOAb positivity, or isolated hypothyroxinemia do not affect the risk of IUGR.
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Affiliation(s)
- Zhao Tong
- From the Endocrine Institute and the Liaoning Provincial Key Laboratory of Endocrine Diseases (ZT, ZX, LA, ZY, TW, SZ), Department of Endocrinology and Metabolism; and Department of Hepatobiliary Surgery (CB), First Hospital of China Medical University, Shenyang, Liaoning, China
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