Okay, mounting my soap box here... Maternal hypothyroidism and autoimmune thyroid disease – like Hashimoto's thyroiditis, a type of hypothyroidism, or underactive thyroid – increase the risk of pregnancy complications, such as miscarriage, prematurity, gestational hypertension, and pre-eclampsia in the mother.
In the child there are other things to consider.. deficiency in T4 during brain development results in an increased chance of a deficit in the intellectual development and motor skills of the child/children. Now instead of manditory testing for the mother.. the tst children at birth for congenital hypothyroidism to prevent the condition’s harmful effects. I would think it would be more helpful to mother and child to test the mother each trimester. As well as the child at birth. But I am not an MD.
The experts have described in many studies why maternal thyroid hormone is so important to the developing fetus and why it should be monitored.. .but there are those out there not listening. The fetus depends solely on the mother in the first half of gestation for thyroid hormone (T4) needed for the developing brain and cognitive motor and reasoning skills. Pregnant women who are under producing thyroxine (T4) are, therefore, at risk of having children with lower IQs and learning problems, such as attention-deficit hyperactivity disorder, whether or not their circulating thyroid-stimulating hormone (TSH) concentrations are increased. Thus many recommend screening of the FT3 and FT4 levels in pregnant woman every 4 weeks. The most frequent cause of the inability of the maternal thyroid to produce enough thyroxine for fetal brain development is an inadequate supply of iodine. Or underlying thyroid condition. Amounts of this micronutrient (Iodine), a necessary component of thyroid hormone, are needed with the onset of pregnancy and are almost double those needed by children and non-pregnant adults. The ATA has issued statements emphasizing that pregnant and nursing women should take daily vitamin supplements that contain iodine, at least 220 micrograms a day for pregnant women and 290 micrograms daily for lactating women. Only 35 percent of prenatal vitamins contain iodine. So check your bottles!
There are environmental agents that effect thyroid function and iodine nutrition. Ammonium perchlorate, a contaminant in some water supplies, is known to reduce the ability of the body to use existing iodine. Moreover, PCBs (polychlorinated biphenyls) are known to influence thyroid function and thyroid hormone action, which can alter iodine uptake during pregnancy and lactation. PCBs also appear to influence thyroid hormone action in tissues, including the developing brain. Thiocyanates in cigarette smoke are as a negative factor as well.
Five percent to 8 percent of women carry thyroid autoantibodies for either Hashi's or Graves. These autoantibodies are strongly linked to the occurrence of miscarriage as well as a condition that occurs after delivery, called post-partum thyroiditis. Humm.. how many endos and Obs are up on this Gem I wonder. Symptoms include depression, fatigue, and difficulty nursing. Subclinical hypothyroidism – when the person has no visible symptoms and the condition is only detectable through labortary tests – is often undiagnosed, and the severity of hypothyroidism increases with gestational time. Five percent to 10 percent of the young female population could be affected and undiagnosed.. what does this mean to the future generations?
On big whig in OB -GYN basically says it is not worth the time and money to test all pregnant women.. because only 2.5 % are truely at risk. WHAT? In this persons statement. "Given that the prevalence of subclinical hypothyroidism is about 2.5 percent in the United States and there are about 4 million births each year, appoximately 100,000 pregnant women would have to be treated. To do this is unjustified at this time." Okay so I guess when looking at only 100,000 our of 4 million it is an acceptable loss? Not if you are one of the 100,000. We should lock him in a stadium with them.
The ATA states that "pregnant mothers with overt or subclinical hypothyroidism are at increased risk for premature delivery." Other important research findings highlighted by the ATA statement include –
* Pregnant mothers with detectable thyroid autoantibodies and normal thyroid function are at an increased risk for miscarriage and for postpartum thyroid disease (antibodies cross the placenta barrier and can cause a passage of the disease, groiters and suppression of the thyroid function in AIT patients),
* Pregnant mothers with thyroid hormone deficiency or TSH elevation during pregnancy may have children at risk of mild impairment in their intellectual function and motor skills, and
* Pregnant women being treated with thyroid hormone replacement often require a 30-percent to 50-percent increase in their thyroid hormone dose.
The ATA believes that the magnitude of these problems should be clarified, and programs should be developed to manage these health issues.
The ATA has emphasized that the "threshold should be low for identifying at-risk" and in need of screening. These factors include women who have a family or personal history of thyroid disease, goiter, diabetes, history of miscarriage, or symptoms suggesting hypothyroidism."
As for women who have known hypothyroidism before conception, it is advised that physicians should provide pre-pregnancy counseling about the risks and changes in therapy that are needed. It is also important that these women have their thyroid hormone levels – TSH, in particular – checked as soon as pregnancy is confirmed and routinely during pregnancy. Hormone demands can change every two weeks in early development of the fetus. Studies have shown that many of women will need to increase their thyroxine replacement as much as 50 percent in the first trimester. With careful monitoring and availability of T4 in the mother.. risks are no more than those of a normal functioning thyroid mother.
Other studies show substantial evidence from both retrospective and prospective studies suggesting that early gestational low maternal circulating thyroxine concentrations adversely affect neonatal and child development at least to age 7. And children of hypothyroid or AIT mothers should be monitored yearly with at least a TSH alone.. to ensure no complications arise from suppressed thyroid function.
The advocates of saving money say.. the statistics are not in favor of testing all the mothers.. but even these individuals say that current testing standards are insufficient. My personal take is.. what is the health and development of my child worth.. and I know many mothers would be willing to go out of pocket to protect their children from one more issue. Unfortunately.. most of us do not learn until it is well after the fact.
The main clain to fame and clearly documented health issues of hypothyroid fetus exposed childre.. are low birth weight, low IQ, low cognitive reasoning and motor skills, ADD/ADHD, sleep apnea and a few other know hypothyroid symptoms. Other things are up for debate, but not proven. Early testing and identification of ChypoT children allows for combat of many of these things.. but I would spare my children if I could. Wouldn't you?