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Inconsistencies in the management of neonates born to mothers with “thyroid diseases”

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Abstract

Although thyroid medications are frequently prescribed during pregnancy, paediatricians treating the respective neonates often have no information about the underlying maternal thyroid disease, and inconsistencies in postnatal diagnostics may result. We analysed a cohort of 1819 mothers admitted for delivery in 1 year to one hospital. We analysed the pre- and postpartum diagnostics in the mothers, the postnatal diagnostics in the neonates and their postnatal auxological development. Two hundred thirteen mothers (11.7%) had “thyroid disease”; 37 (2.0%) had Hashimoto thyroiditis, seven (0.4%) Graves’ disease and 169 (9.3%) “thyroid disease of other origins”. One hundred eighty-eight out of 213 (88%, 10.3% of the entire cohort) took levothyroxine. Pre- and postpartum diagnostics of the mothers and postnatal diagnostics of the neonates revealed striking inconsistencies. For example, 39 % of the gynaecologists routinely determined TSH, while only 59% carried out a dosage adjustment for known hypothyroidism. Second specialists were consulted in 86%. Unnecessary postpartum diagnostics were initiated in 19/213 neonates (9%). TRAb was analysed, however, in only one neonate born from the mothers with Graves’ disease—a condition in which further diagnostic efforts are mandatory.

Conclusion: Although many pregnant women have thyroid dysfunction, we observed a lack of uniformity in the diagnostic approach of the women and their neonates.

What is Known:

• Disturbed maternal thyroid function in pregnancy often has an adverse impact on both the mother and the foetus.

• Although detailed guidelines for managing impaired maternal thyroid function during pregnancy have been published, their application in clinical practice varies widely.

What is New:

• Recommendations for managing the newborn of a mother presenting with thyroid disease of unknown entity are remarkably inconsistent.

• This leads to a possible over-diagnosis in general and a potentially life-threatening failure to note neonatal hyperthyroidism requiring rapid treatment.

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Abbreviations

Ab:

Antibody

ATA:

American Thyroid Association

fT3:

Free Triiodothyronine

fT4:

Free Tetraiodothyronine

SDS:

Standard deviation score

Tg:

Thyreoglobulin

TPO:

Thyroid peroxidase

TRAb:

Thyrotropin (TSH)-receptor-antibodies

TSH:

Thyroid-stimulating hormone

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Author information

Authors and Affiliations

  1. Department of Paediatric Endocrinology and Diabetology, University Hospital Bonn, Adenauerallee 119, 53113, Bonn, Germany

    Patricia C. Weissenfels, Joachim Woelfle & Bettina Gohlke

  2. Paediatric Hospital, Cologne, Germany

    Eckhard Korsch

  3. Department of Obstetrics and Gynaecology, University of Frankfurt, Frankfurt, Germany

    Matthias Joergens

Authors
  1. Patricia C. Weissenfels
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  2. Joachim Woelfle
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  3. Eckhard Korsch
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  4. Matthias Joergens
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  5. Bettina Gohlke
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Contributions

Patricia C. Weissenfels conducted the data collection, was involved in data analysis and wrote the initial manuscript.

Prof Joachim Woelfle was involved in data analysis and interpretation and carried out a critical revision of the article.

Dr. Eckhard Korsch was involved in extensive literature research data analysis and interpretation and carried out a critical revision of the article.

Dr. Mathias Joergens was involved in data collection and analysis and interpretation and carried out a critical revision of the article.

Prof Bettina Gohlke developed the study concept and design, wrote the final version of the manuscript and carried out data analysis and interpretation.

All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Bettina Gohlke.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Informed consent

Informed consent was obtained from all individual participants in the study.

Additional information

Communicated by Peter de Winter

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Weissenfels, P.C., Woelfle, J., Korsch, E. et al. Inconsistencies in the management of neonates born to mothers with “thyroid diseases”. Eur J Pediatr 177, 1711–1718 (2018). https://doi.org/10.1007/s00431-018-3232-9

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  • DOI: https://doi.org/10.1007/s00431-018-3232-9

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