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dc.contributor.authorMaraka, Spyridoula
dc.contributor.authorMwangi, Raphael
dc.contributor.authorMcCoy, Rozalina G
dc.contributor.authorYao, Xiaoxi
dc.contributor.authorSangaralingham, Lindsey R
dc.contributor.authorSingh Ospina, Naykky M
dc.contributor.authorO’Keeffe, Derek T
dc.contributor.authorDe Ycaza, Ana E Espinosa
dc.contributor.authorRodriguez-Gutierrez, Rene
dc.contributor.authorCoddington, Charles C
dc.contributor.authorStan, Marius N
dc.contributor.authorBrito, Juan P
dc.contributor.authorMontori, Victor M
dc.date.accessioned2018-09-20T16:15:56Z
dc.date.available2018-09-20T16:15:56Z
dc.date.issued2017-01-25
dc.identifier.citationMaraka, Spyridoula; Mwangi, Raphael; McCoy, Rozalina G; Yao, Xiaoxi; Sangaralingham, Lindsey R; Singh Ospina, Naykky M; O’Keeffe, Derek T; De Ycaza, Ana E Espinosa; Rodriguez-Gutierrez, Rene; Coddington, Charles C; Stan, Marius N; Brito, Juan P; Montori, Victor M (2017). Thyroid hormone treatment among pregnant women with subclinical hypothyroidism: us national assessment. BMJ 356 ,
dc.identifier.issn0959-8138,1756-1833
dc.identifier.urihttp://hdl.handle.net/10379/12637
dc.description.abstractOBJECTIVE To estimate the effectiveness and safety of thyroid hormone treatment among pregnant women with subclinical hypothyroidism. DESIGN Retrospective cohort study. SETTING Large US administrative database between 1 January 2010 and 31 December 2014. PARTICIPANTS 5405 pregnant women with subclinical hypothyroidism, defined as untreated thyroid stimulating hormone (TSH) concentration 2.5-10 mIU/L. EXPOSURE Thyroid hormone therapy. MAIN OUTCOME MEASURE Pregnancy loss and other pre-specified maternal and fetal pregnancy related adverse outcomes. RESULTS Among 5405 pregnant women with subclinical hypothyroidism, 843 with a mean pre-treatment TSH concentration of 4.8 (SD 1.7) mIU/L were treated with thyroid hormone and 4562 with a mean baseline TSH concentration of 3.3 (SD 0.9) mIU/L were not treated (P< 0.01). Compared with the untreated group, treated women had lower adjusted odds of pregnancy loss (odds ratio 0.62, 95% confidence interval 0.48 to 0.82) but higher odds of preterm delivery (1.60, 1.14 to 2.24), gestational diabetes (1.37, 1.05 to 1.79), and pre-eclampsia (1.61, 1.10 to 2.37); other pregnancy related adverse outcomes were similar between the two groups. The adjusted odds of pregnancy loss were lower in treated women than in untreated women if their pre-treatment TSH concentration was 4.1-10 mIU/L (odds ratio 0.45, 0.30 to 0.65) but not if it was 2.5-4.0 mIU/L (0.91, 0.65 to 1.23) (P< 0.01). CONCLUSION Thyroid hormone treatment was associated with decreased risk of pregnancy loss among women with subclinical hypothyroidism, especially those with pre-treatment TSH concentrations of 4.1-10 mIU/L. However, the increased risk of other pregnancy related adverse outcomes calls for additional studies evaluating the safety of thyroid hormone treatment in this patient population.
dc.publisherBMJ
dc.relation.ispartofBMJ
dc.subjectmanagement
dc.subjectpostpartum
dc.subjectguidelines
dc.subjectmetaanalysis
dc.subjectmiscarriage
dc.subjectdysfunction
dc.subjectadherence
dc.subjectdiagnosis
dc.subjectoutcomes
dc.subjecttherapy
dc.titleThyroid hormone treatment among pregnant women with subclinical hypothyroidism: us national assessment
dc.typeArticle
dc.identifier.doi10.1136/bmj.i6865
dc.local.publishedsourcehttp://www.bmj.com/content/bmj/356/bmj.i6865.full.pdf
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