Abstract
Use of thyroxine substitution at hypothyroidism seems not to be associated with any major teratogenic risk—the effects which have been found seem to be explained by concomitant drug use.
Use of propylthiouracil at hyperthyroidism is probably not associated with a major malformation risk. Suggested effects on specific, mainly less severe, malformations are based on low numbers and different studies identified different malformations in excess. Probably propylthiouracil has a low if any teratogenic potential, and it may be the drug of choice in early pregnancy. Methimazole and related drugs are linked to a specific constellation of malformations, notably scalp defects, choanal atresia, esophageal atresia, and omphalocele. The risk for these malformations is much increased, resulting in an about doubling of the risk of any major malformation. If possible, this drug should be avoided in early pregnancy. If it has been used, prenatal diagnosis may at least be able to identify omphalocele early enough to permit an interruption of pregnancy.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Andersen SL, Olsen J, Wu CS, Laurberg P. Birth defects after early pregnancy use of antithyroid drugs: a Danish nationwide study. J Clin Endocrinol Metab. 2013;98:4373–81.
Andersen SL, Olsen J, WU CS, Laurberg P. Severity of birth defects after propylthiouracil exposure in early pregnancy. Thyroid. 2014;24:1533–40.
Clementi M, Di Gianantonio E, Pelo E, Mammi I, Basile RT, Tenconi R. Methimazole embryopathy: delineation of the phenotype. Am J Med Genet. 1999;83:43–6.
Clementi M, DiGianantonio E, Cassina M, Leoncini E, Botto LO, Mastrioacovo P. Treatment of hyperthyroidism in pregnancy and birth defects. J Clin Endocrinol Metab. 2010;95:E337–41.
DiGianantonio E, Schaefer C, Mastroiacovo P, Cournot MP, Benedicenti F, Reuvers M, Occupati B, Robert E, Bellemin B, Addis A, Amon J, Clementi M. Adverse effects of prenatal methimazole exposure. Teratology. 2001;64:262–6.
Ferraris S, Valenzise M, Lerone M, Divizia MT, Rosaia L, Blaid D, Nemelka O, Ferrero GB, Silengo M. Malformations following methimiazole exposure in utero: an open issue. Birth Defects Res A Clin Mol Teratol. 2003;67:989–92.
Heinonen OP, Slone D, Shapiro S. Birth defects and drugs in pregnancy. Littleton, MA: Publishing Sciences Group; 1977.
Källén B, Norstedt Wikner B. Maternal hypothyroidism in early pregnancy and infant structural malformations. J Thyroid Res. 2014;2014:160780. https://doi.org/10.1144/2014/160780.
Khoury MJ, Becerra JE, d’Almada PJ. Maternal thyroid disease and risk or birth defects in offspring: a population-based case-control study. Paediatr Perinat Epidemiol. 1989;3:402–20.
Milham S, Elledge W. Maternal methimazole and congenital defects in children. Teratology. 1972;5:125.
Mujtaba Q, Burrow GN. Treatment of hyperthyroidism in pregnancy with propylthiouracil and methimazole. Obstet Gynecol. 1975;46:282–6.
Norstedt Wikner B, Skjöldebrand Sparre L, Stiller C-O, Källén B, Asker C. Maternal use of thyroid hormones in pregnancy and neonatal outcome. Acta Obstet Gynecol Scand. 2008;87:617–27.
Ordóñes MP, Nazer J, Aguilla A, Cifuentes L. Malformaciones congénitass y patologia crónica de la madre. Estudio ECLAMC 1971–1999. Rev Méd Chile. 2003;131:404–11.
Schumann L, Hansen AV, Garne E. Pregnancy outcomes after fetal exposure to antithyroid medications or levothyroxine. Early Hum Dev. 2016;101:73–7.
Su P-Y, Huang K, Hao J-H, Xu Y-Q, Yan S-Q, Li T, Xu Y-H, Tao F-B. Maternal thyroid function in the first twenty weeks of pregnancy and subsequent fetal and infant development: a prospective population-based cohort study in China. J Clin Endocrinol Metab. 2011;96:3234–41.
Yoshihara A, Noh JY, Yamaguchi T, Ohye H, Sato S, Sekiya Y, Suzuki M, Matsumoto M, Kunii Y, Watanabe N, Mukasa K, Ito K, Ito K. Treatment of Graves’ disease with antithyroid drugs in the first trimester of pregnancy and the prevalence of congenital malformation. J Clin Endocrinol Metab. 2012;97:2396–403.
Author information
Authors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Källén, B. (2019). Maternal Use of Drugs for Thyroid Disease and Infant Congenital Malformations. In: Maternal Drug Use and Infant Congenital Malformations. Springer, Cham. https://doi.org/10.1007/978-3-030-17898-7_12
Download citation
DOI: https://doi.org/10.1007/978-3-030-17898-7_12
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-17897-0
Online ISBN: 978-3-030-17898-7
eBook Packages: MedicineMedicine (R0)