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#Grand Rounds

Does Thyroid Hormone Replacement Therapy During Pregnancy Impact Child Language and Speech Development?

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BACKGROUND AND PURPOSE:

  • Thyroid hormone replacement therapy (THRT) is recommended during pregnancy for women with hypothyroidism and (according to some professional societies) subclinical hypothyroidism
  • It remains unclear if THRT improves cognitive function and language abilities in offspring
  • Frank et al. (JAMA Network Open, 2019) assessed associations between prenatal THRT and communication skills in exposed children

METHODS:

  • Prospective population-based cohort study
    • Norwegian Mother, Father and Child Cohort Study (MoBa)
    • Links to several nationwide registries including Norwegian Patient Registry (NPR)
  • Participants
    • Singleton pregnancies resulting in a live-born infant
    • Child follow up ongoing
  • Mother-child pairs were categorized into 3 mutually exclusive groups
    • THRT exposure during pregnancy (based on dispensed prescription records)
    • Unexposed to THRT during pregnancy (population comparison – no hypothyroidism)
    • Mothers initiating THRT after delivery (incident postnatal hypothyroidism)
  • Data analysis
    • Hazard ratio (HR) was calculated for language impairment diagnosis
    • Standardized mean score (β) was calculated for parent-reported symptoms of language and communication deficits
  • Primary outcomes
    • Diagnosis of language and speech impairment
      • NPR sample: Based on diagnoses
      • MoBa sample: Based on parental self-completed questionnaires at follow-up until 8-years of age

RESULTS:

  • NPR sample: 53,862 mother-child pairs
    • Mean age: 30.4 years
    • Exposure to THRT: 2.2%
  • MoBa sample: 23,686 mother-child pairs
    • Mean age, 30.8 years
    • Exposure to THRT: 2.2%
  • NPR sample: There was no significant association between language and speech impairment diagnosis and prenatal THRT exposure (NPR database)
    • Compared to unexposed group
      • Adjusted HR 0.75 (95% CI, 0.38 to 1.43)
    • Compared to the THRT after delivery group
      • Adjusted HR 0.63 (95% CI, 0.26 to 1.53)
  • MoBa study sample: There were no significant differences in mean language scores vs unexposed group reported by parents
    • Pronunciation problems:  Mean difference −0.01 (95% CI, −0.10 to 0.08)
    • Autism: Mean difference 0.05 (95% CI, −0.03 to 0.13)

CONCLUSION:

  • At 8 years of age, there was no difference in language and communication skills between children born to women taking THRT vs a normal control group  
    • Study looked at outcomes based on diagnoses as well as parental questionnaires
  • The results of this study support continuing recommendations for hypothyroidism treatment during pregnancy
  • Future studies should perform a comparison to a disease group (children from untreated mothers)

Learn More – Primary Sources:

Maternal Thyroid Hormone Replacement Therapy Exposure and Language and Communication Skills of Offspring at 8 Years of Age

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Related ObG Topics:

Subclinical Hypothyroidism and Pregnancy Outcome – Is There a Relationship?
Are Thyroid Test Abnormalities a Risk Factor for Preterm Birth?
Childhood Brain Development: Is There a Critical Window for Maternal TSH Measurement?

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