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Antenatal thyroid screening and childhood cognitive function

Lazarus, John Henry, Bestwick, Jonathan P., Channon, Susan Jane, Paradice, Ruth, Maina, Aldo, Rees, Rhian Eleri, Chiusano, Elisabetta, John, Rhys, Guaraldo, Varvara, George, Lynne M., Perona, Marco, Dall'Amico, Daniela, Parkes, Arthur Burnham, Joomun, Mohammed and Wald, Nicholas J. 2012. Antenatal thyroid screening and childhood cognitive function. New England Journal of Medicine 366 (6) , pp. 493-501. 10.1056/NEJMoa1106104

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Abstract

Background. Children born to women with low thyroid hormone levels have been reported to have decreased cognitive function. Methods. We conducted a randomized trial in which pregnant women at a gestation of 15 weeks 6 days or less provided blood samples for measurement of thyrotropin and free thyroxine (T4). Women were assigned to a screening group (in which measurements were obtained immediately) or a control group (in which serum was stored and measurements were obtained shortly after delivery). Thyrotropin levels above the 97.5th percentile, free T4 levels below the 2.5th percentile, or both were considered a positive screening result. Women with positive findings in the screening group were assigned to 150 μg of levothyroxine per day. The primary outcome was IQ at 3 years of age in children of women with positive results, as measured by psychologists who were unaware of the group assignments. Results. Of 21,846 women who provided blood samples (at a median gestational age of 12 weeks 3 days), 390 women in the screening group and 404 in the control group tested positive. The median gestational age at the start of levothyroxine treatment was 13 weeks 3 days; treatment was adjusted as needed to achieve a target thyrotropin level of 0.1 to 1.0 mIU per liter. Among the children of women with positive results, the mean IQ scores were 99.2 and 100.0 in the screening and control groups, respectively (difference, 0.8; 95% confidence interval [CI], −1.1 to 2.6; P=0.40 by intention-to-treat analysis); the proportions of children with an IQ of less than 85 were 12.1% in the screening group and 14.1% in the control group (difference, 2.1 percentage points; 95% CI, −2.6 to 6.7; P=0.39). An on-treatment analysis showed similar results. Conclusions. Antenatal screening (at a median gestational age of 12 weeks 3 days) and maternal treatment for hypothyroidism did not result in improved cognitive function in children at 3 years of age.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Psychology
Subjects: R Medicine > R Medicine (General)
Additional Information: Funded by the Wellcome Trust UK and Compagnia di San Paulo, Turin; Current Controlled Trials number, ISRCTN46178175
Publisher: Massachusetts Medical Society
ISSN: 0028-4793
Last Modified: 12 Feb 2020 15:45
URI: http://orca.cf.ac.uk/id/eprint/51777

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