Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Obstet Gynecol. Jul 10, 2018; 7(1): 1-16
Published online Jul 10, 2018. doi: 10.5317/wjog.v7.i1.1
Hypothyroidism during pregnancy: Controversy over screening and intervention
AbdelHameed Mirghani Dirar, Atul Kalhan
AbdelHameed Mirghani Dirar, Endocrinology and Diabetes Center, Prince Abdel Aziz Bin Musaad Hospital, Arar 91421, Saudi Arabia
Atul Kalhan, Department of Diabetes and Endocrinology, Royal Glamorgan Hospital, Llantrisant CF72 8TA, United Kingdom
Author contributions: Mirghani Dirar A and Kalhan A contributed equally to this work; Mirghani Dirar A and Kalhan A designed the format; Mirghani Dirar A wrote the paper; Kalhan A revised and approved the paper.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Dr. AbdelHameed Mirghani Dirar, MBBS, MSc, Endocrinology and Diabetes Center, Prince Abdel Aziz Bin Musaad Hospital, King Fahad Road, Arar 91421, Saudi Arabia.
Telephone: +966-5-08494973
Received: February 16, 2018
Peer-review started: February 16, 2018
First decision: April 3, 2018
Revised: April 13, 2018
Accepted: June 2, 2018
Article in press: June 2, 2018
Published online: July 10, 2018

Thyroid hormones are critical for foetal neurological development and maternal health. Maternal hypothyroidism during pregnancy is associated with adverse impact on health of the mother as well as the progeny. Reduced thyroid hormone levels predispose the child to develop mental retardation and cognitive delay in early life. In the mother, hypothyroidism during pregnancy is associated with spontaneous abortion, placental abruption, preterm delivery and hypertensive disorders. Therefore, screening and therapeutic intervention is justified to prevent foetal as well as maternal co-morbidities. In view of impact of such a large-scale screening and intervention program on limited healthcare resources, it is debatable if a targeted rather than universal screening program will result in comparable outcomes. In addition, there is an ongoing debate regarding best evidence-based practice for the management of isolated hypothyroxinaemia, subclinical hypothyroidism and euthyroid women with autoimmune hypothyroidism. We have carried out a review of the literature; firstly, to determine whether universal screening for asymptomatic women in early pregnancy would be cost-effective. Secondly, we have retrospectively reviewed the literature to analyse the evidence regarding the impact of therapeutic intervention in women with subclinical hypothyroidism.

Keywords: Targeted screening, Thyroid peroxidase antibodies, Isolated hypothyroxinaemia, Spontaneous abortion, Overt hypothyroidism, Placental abruption, Universal screening, Hypothyroidism during pregnancy, Subclinical hypothyroidism, Autoimmune hypothyroidism

Core tip: Hypothyroidism during pregnancy poses a significant health challenge as it is associated with adverse health outcomes for mother as well as the child. There is evidence that supports increased maternal and neonatal morbidity, even in absence of a clinically overt maternal hypothyroid state. However, in view of limited available healthcare resources, the jury is still divided regarding use of universal vs targeted screening programs in pregnant women. In addition, there is a lack of consensus regarding the best management approach for isolated hypothyroxinaemia and subclinical hypothyroidism. Keeping these contentious issues in mind, we have carried out a review of the literature.