BALTIMORE — Fewer than 50% of pregnant patients who met risk factor criteria for thyroid disease, as defined by the guidelines, were adequately screened, a retrospective real-world study shows.
Among 1,025 new obstetric consultations, only 87 of 198 patients who met American College of Obstetricians and Gynecologists (ACOG) criteria were screened, and only 108 of 826 who met American Thyroid Association (ATA) criteria were screened, reported Allan Dong , MD , of Advocate Lutheran General Hospital in Park Ridge, Illinois, during his poster presentation at the ACOG annual meeting.
Notably, of the women who met the ATA criteria, those who were properly screened had significantly higher live birth rates compared to those who were not screened (92.6% vs 83.3%, P=0.006), as well as significantly lower miscarriage rates (4.6% vs 12.4%, P=0.009).
Although a difference of similar magnitude was observed for patients meeting ACOG criteria, there were no statistically significant differences between screened and unscreened patients for live birth rates (92% vs 83.8%, P=0.065) or miscarriage rates (5.8% vs 12.6%, P=0.082).
Preterm birth rates were also not significantly different between women who were screened and unscreened based on either organization’s criteria.
In its guidance, the ATA noted that pregnancy has a significant effect on thyroid gland function, and thyroid disease is common in pregnant women.
According to the ACOG, thyrotoxicosis and hypothyroidism are associated with adverse pregnancy outcomes. In addition, there are concerns about the effects of overt maternal thyroid disease on fetal development. Also, drugs that affect the maternal thyroid gland can cross the placenta and affect the fetal thyroid.
However, ACOG recommends that only certain patients be screened for thyroid disease, including patients with a history of thyroid disease, a family history of thyroid disease, a history of type 1 diabetes, or suspected thyroid disease. based on symptoms.
The ATA guidelines are broader, which is why the sample size that met these criteria in this study was larger. In addition to ACOG risk groups, the ATA also recommends screening anyone over age 30, people with any autoimmune disorder, people with a body mass index (BMI) greater than 40, anyone with a history of radiation to the head or neck and those with a history of pregnancy loss or premature birth, among others.
“ACOG is saying we should screen these people with these risk factors – do we do that? And it doesn’t seem like we do,” Dong said. MedPage Today. “If the guidelines recommend targeted screening, we as clinicians need to follow the guidelines, otherwise we’re not helping anybody.”
In his presentation, Dong said that improving adherence to thyroid disease screening could lead to better pregnancy outcomes, with previous studies showing benefits for universal screening.
For this study, researchers included all new Advocate Lutheran General obstetric patients in 2020. Hospital policy is to follow ACOG guidelines for screening for thyroid disease. Only 199 patients did not meet criteria based on the ATA or ACOG guidelines.
Although the study was conducted at a hospital in Illinois, Dong said he suspects the findings apply more widely in the US.
Disclosures
primary source
American College of Obstetricians and Gynecologists
Reference Source: Dong A, Lott M “Do clinicians adequately screen for thyroid disease in pregnancy using targeted screening guidelines? A retrospective real-world study” ACOG 2023.