Chevy Chase, MDThe Endocrine Society has made revisions to its 2007 Clinical Practice Guideline (CPG) for management of thyroid disease during pregnancy and postpartum. The CPG provides recommendations for diagnosis and treatment of patients with thyroid-related medical issues just before and during pregnancy and in the postpartum interval.
Thyroid hormone contributes critically to normal fetal brain development and having too little or too much of this hormone can impact both mother and fetus. Hypothyroid women are more likely to experience infertility and have an increased prevalence of anemia, gestational hypertension and postpartum hemorrhage. If left untreated, maternal hypothyroidism is associated with premature birth, low birth-weight and neonatal respiratory distress. Higher than normal thyroid hormone levels are associated with increased fetal loss.
"Pregnancy may affect the course of thyroid diseases and conversely, thyroid diseases may affect the course of pregnancy," said Leslie De Groot, M.D., lead researcher from the University of Rhode Island. "Pregnant women may be under the care of multiple health care professionals including obstetricians, nurse midwives, family practitioners and endocrinologists making the development of guidelines all the more critical."
Revisions from the CPG include:
The committee that developed the CPG could not reach agreement on screening recommendations for all newly pregnant women. Some members recommend screening of all pregnant women for serum TSH abnormalities by the 9th week or at the time of their first visit. Other members recommend neither for nor against universal screening of pregnant women at the time of their first visit and support aggressive case finding to identify and test high-risk women. In some situations, ascertainment of an individual's risk status may not be feasible and in such cases, testing of all women by 9 weeks of pregnancy or at the first prenatal visit is reasonable.
The Society established the Clinical Practice Guideline (CPG) Program to provide endocrinologists and other clinicians with evidence-based recommendations in the diagnosis and treatment of endocrine-related conditions. Each CPG is created by a task force of topic-related experts in the field. Task forces rely on scientific reviews of the literature in the development of CPG recommendations. The Endocrine Society does not solicit or accept corporate support for its CPGs. All CPGs are supported entirely by Society funds.
Other members of The Endocrine Society task force that developed this CPG include: Marcos Abalovich of Durand Hospital and Favaloro University in Buenos Aires, Argentina; Erik K. Alexander of Brigham and Women's Hospital and Harvard Medical School in Boston, MA; Nobuyuki Amino of Kuma Hospital in Kobe, Japan; Linda Barbour of University of Colorado School of Medicine in Auroroa; Rhoda H. Cobin of Mount Sinai School of Medicine in New York, NY; Creswell J. Eastman of University of Sydney Medical School in Australia; John H. Lazarus of Cardiff University Medical School and University Hospital of Wales in the United Kingdom; Dominique Luton of Hospital Bichat and Beaujon Assistance Publique-Hospitaux de Paris, Universite Paris in France; Susan J. Mandel of University of Pennsylvania School of Medicine in Philadelphia; Jorge Mestman of Keck School of Medicine, University of Southern California; Joanne Rovet of the Hospital for Sick Children in Toronto, Canada; and Scott Sullivan of Medical University of South Carolina in Charleston.
The guideline entitled "Management of Thyroid Dysfunction during Pregnancy and Postpartum: An Endocrine Society Clinical Practice Guideline" appears in the August 2012 issue of the Journal of Clinical Endocrinology and Metabolism (JCEM), a publication of The Endocrine Society.
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