Levothyroxine and the risk of adverse pregnancy outcomes in women with subclinical hypothyroidism: a systematic review and meta-analysis.
Levothyroxine
Pregnancy outcomes
Subclinical hypothyroidism
Journal
BMC endocrine disorders
ISSN: 1472-6823
Titre abrégé: BMC Endocr Disord
Pays: England
ID NLM: 101088676
Informations de publication
Date de publication:
27 Feb 2021
27 Feb 2021
Historique:
received:
18
06
2020
accepted:
11
02
2021
entrez:
28
2
2021
pubmed:
1
3
2021
medline:
3
11
2021
Statut:
epublish
Résumé
Levothyroxine replacement therapy may decrease the risk of adverse pregnancy outcomes among women with subclinical hypothyroidism (SCH). The aim of this study is to conduct a systematic review and meta-analysis to examine the risk of adverse pregnancy, perinatal, and early childhood outcomes among women with SCH treated with levothyroxine. A systematic literature search was conducted using Ovid-Medline, Ovid-EMBASE, Pubmed (non-Medline), Ebsco-CINAHL Plus with full text and Cochrane Library databases. Randomized controlled studies (RCTs) and observational studies examining the association between treatment of SCH during pregnancy and our outcomes of interest were included. Studies that compared levothyroxine treatment versus no treatment were eligible for inclusion. Data from included studies were extracted and quality assessment was performed by two independent reviewers. Seven RCTs and six observational studies met our inclusion criteria. A total of 7342 individuals were included in these studies. RCTs demonstrated several sources of bias, with lack of blinding of the participants or research personnel; only one study was fully blinded. In the observational studies, there was moderate to serious risk of bias due to lack of adjustment for certain confounding variables, participant selection, and selective reporting of results. Pooled analyses showed decreased risk of pregnancy loss (RR: 0.79; 95% CI: 0.67 to 0.93) and neonatal death (RR: 0.35; 95% CI: 0.17 to 0.72) associated with levothyroxine treatment during pregnancy among women with SCH. There were no associations between levothyroxine treatment and outcomes during labour and delivery, or cognitive status in children at 3 or 5 years of age. Treatment of SCH with levothyroxine during pregnancy is associated with decreased risks of pregnancy loss and neonatal death. Given the paucity of available data and heterogeneity of included studies, additional studies are needed to address the benefits of levothyroxine use among pregnant women with SCH.
Sections du résumé
BACKGROUND
BACKGROUND
Levothyroxine replacement therapy may decrease the risk of adverse pregnancy outcomes among women with subclinical hypothyroidism (SCH). The aim of this study is to conduct a systematic review and meta-analysis to examine the risk of adverse pregnancy, perinatal, and early childhood outcomes among women with SCH treated with levothyroxine.
METHODS
METHODS
A systematic literature search was conducted using Ovid-Medline, Ovid-EMBASE, Pubmed (non-Medline), Ebsco-CINAHL Plus with full text and Cochrane Library databases. Randomized controlled studies (RCTs) and observational studies examining the association between treatment of SCH during pregnancy and our outcomes of interest were included. Studies that compared levothyroxine treatment versus no treatment were eligible for inclusion. Data from included studies were extracted and quality assessment was performed by two independent reviewers.
RESULTS
RESULTS
Seven RCTs and six observational studies met our inclusion criteria. A total of 7342 individuals were included in these studies. RCTs demonstrated several sources of bias, with lack of blinding of the participants or research personnel; only one study was fully blinded. In the observational studies, there was moderate to serious risk of bias due to lack of adjustment for certain confounding variables, participant selection, and selective reporting of results. Pooled analyses showed decreased risk of pregnancy loss (RR: 0.79; 95% CI: 0.67 to 0.93) and neonatal death (RR: 0.35; 95% CI: 0.17 to 0.72) associated with levothyroxine treatment during pregnancy among women with SCH. There were no associations between levothyroxine treatment and outcomes during labour and delivery, or cognitive status in children at 3 or 5 years of age.
CONCLUSION
CONCLUSIONS
Treatment of SCH with levothyroxine during pregnancy is associated with decreased risks of pregnancy loss and neonatal death. Given the paucity of available data and heterogeneity of included studies, additional studies are needed to address the benefits of levothyroxine use among pregnant women with SCH.
Identifiants
pubmed: 33639909
doi: 10.1186/s12902-021-00699-5
pii: 10.1186/s12902-021-00699-5
pmc: PMC7912520
doi:
Substances chimiques
Thyrotropin
9002-71-5
Thyroxine
Q51BO43MG4
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
34Références
Endocr Pract. 2010 Sep-Oct;16(5):792-7
pubmed: 20350920
Thyroid. 2011 Oct;21(10):1081-125
pubmed: 21787128
Am J Epidemiol. 2007 Nov 15;166(10):1203-9
pubmed: 17712019
N Engl J Med. 2019 Apr 4;380(14):1316-1325
pubmed: 30907987
J Endocrinol. 2014 Jun;221(3):R87-R103
pubmed: 24648121
BMJ. 2009 Jul 21;339:b2535
pubmed: 19622551
Thyroid. 2017 Mar;27(3):315-389
pubmed: 28056690
Gynecol Obstet Invest. 2012;74(4):265-73
pubmed: 23147711
Control Clin Trials. 1986 Sep;7(3):177-88
pubmed: 3802833
Best Pract Res Clin Endocrinol Metab. 2004 Jun;18(2):225-48
pubmed: 15157838
J Clin Endocrinol Metab. 2010 Apr;95(4):1699-707
pubmed: 20130074
PLoS One. 2017 Apr 17;12(4):e0175708
pubmed: 28414788
Clin Endocrinol (Oxf). 2011 Apr;74(4):513-9
pubmed: 21198746
BMJ Open. 2018 Sep 8;8(9):e022837
pubmed: 30196268
JAMA. 2017 Dec 12;318(22):2190-2198
pubmed: 29234808
Gynecol Endocrinol. 2018 Oct;34(10):845-848
pubmed: 29560762
BMJ. 2017 Jan 25;356:i6865
pubmed: 28122781
Thyroid. 2016 Apr;26(4):580-90
pubmed: 26837268
J Clin Epidemiol. 2016 Jul;75:40-6
pubmed: 27005575
J Clin Endocrinol Metab. 2006 Jul;91(7):2587-91
pubmed: 16621910
Curr Opin Clin Nutr Metab Care. 2013 May;16(3):298-309
pubmed: 23340010
Eur J Endocrinol. 2017 Feb;176(2):253-265
pubmed: 27879326
J Endocrinol Invest. 2012 Mar;35(3):322-5
pubmed: 21642766
Lancet Diabetes Endocrinol. 2013 Nov;1(3):228-37
pubmed: 24622371
JAMA. 2019 Aug 20;322(7):632-641
pubmed: 31429897
J Clin Endocrinol Metab. 2018 Mar 1;103(3):926-935
pubmed: 29126290
BMJ. 2016 Oct 12;355:i4919
pubmed: 27733354
JAMA. 2019 May 21;321(19):1928-1929
pubmed: 31050702
Clin Endocrinol (Oxf). 2010 Jun;72(6):825-9
pubmed: 19878506
JAMA. 1990 Sep 19;264(11):1422-5
pubmed: 2118190
N Engl J Med. 1999 Aug 19;341(8):549-55
pubmed: 10451459
N Engl J Med. 2012 Feb 9;366(6):493-501
pubmed: 22316443
Clin Endocrinol (Oxf). 2018 Apr;88(4):575-584
pubmed: 29325223
Fertil Steril. 2013 Nov;100(5):1326-31
pubmed: 23954357
Obstet Gynecol. 2005 Feb;105(2):239-45
pubmed: 15684146
Indian J Endocrinol Metab. 2012 Dec;16(Suppl 2):S350-1
pubmed: 23565424
Res Synth Methods. 2013 Sep;4(3):220-9
pubmed: 26053842
Thyroid. 2016 Jul;26(7):980-6
pubmed: 27112035
BMJ. 2011 Oct 18;343:d5928
pubmed: 22008217
Stat Med. 2001 Dec 30;20(24):3875-89
pubmed: 11782040
BMJ. 2014 Oct 06;349:g4929
pubmed: 25288580
N Engl J Med. 2017 Mar 2;376(9):815-825
pubmed: 28249134
Neuroscience. 2017 Feb 7;342:68-100
pubmed: 26434624
J Matern Fetal Neonatal Med. 2017 Sep;30(18):2174-2178
pubmed: 27677438
Hum Reprod Update. 2011 Sep-Oct;17(5):605-19
pubmed: 21622978
Endocr Rev. 1997 Jun;18(3):404-33
pubmed: 9183570
Arch Gynecol Obstet. 2019 Oct;300(4):805-819
pubmed: 31399840
Fertil Steril. 2011 Apr;95(5):1650-4
pubmed: 21193190
Thyroid. 2002 Jan;12(1):63-8
pubmed: 11838732
Clin Endocrinol (Oxf). 2015 Mar;82(3):313-26
pubmed: 25200555
Genet Mol Res. 2016 Nov 21;15(4):
pubmed: 27886341
Hum Reprod Update. 2019 May 1;25(3):344-361
pubmed: 30951172