Maternal hypothyroidism and future pediatric neurological morbidity of the offspring

Gil Gutvirtz; Asnat Walfisch; Tamar Wainstock; Daniella Landau; Eyal Sheiner

doi:10.1007/s00404-019-05092-1

Maternal hypothyroidism and future pediatric neurological morbidity of the offspring

Arch Gynecol Obstet. 2019 Apr;299(4):975-981. doi: 10.1007/s00404-019-05092-1. Epub 2019 Feb 18.

Authors

Gil Gutvirtz¹, Asnat Walfisch², Tamar Wainstock³, Daniella Landau⁴, Eyal Sheiner²

Affiliations

¹ Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, 151 Izak Rager Ave., 84101, Beer-Sheva, Israel. Giltzik@gmail.com.
² Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, 151 Izak Rager Ave., 84101, Beer-Sheva, Israel.
³ Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
⁴ Department of Neonatology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

PMID: 30778727
DOI: 10.1007/s00404-019-05092-1

Abstract

Background: Maternal hypothyroidism in pregnancy has been associated with neurocognitive impairment in exposed children, ranging from psychomotor-developmental delay to lower IQ scores.

Objective: To investigate the long-term neurological morbidity of children to hypothyroid mothers during pregnancy.

Study design: A population-based cohort study was performed including all deliveries occurring in a period of 20 years at a tertiary medical center. We excluded multiple pregnancies, fetuses with congenital malformations, perinatal mortality cases and women lacking prenatal care from the study. Neurological-related hospitalizations of children (up to 18 years) were evaluated using neurological morbidities that were predefined by ICD-9 codes. Kaplan-Meier survival curve was used to compare cumulative hospitalization rate in exposed and unexposed children. A Cox regression model was used to control for confounders.

Results: During the study period, 217,910 deliveries met the inclusion criteria. Of them, 1.1% (n = 2403) were in mothers with known hypothyroidism during pregnancy. The Kaplan-Meier survival curve demonstrated a significantly higher cumulative incidence of neurological-related hospitalizations in the hypothyroidism group (log rank p = 0.007). Total hospitalization rate per person years was significantly higher in the maternal hypothyroidism group (5.5 vs. 3.1, HR =1.37, 95% CI 1.10-1.73, p = 0.007). The Cox regression model controlled for various possible confounders including maternal age, maternal obesity, birth weight, preterm birth, maternal diabetes, hypertensive disorders, induction of labor and mode of delivery, found maternal hypothyroidism to be independently associated with pediatric neurological morbidity in these children (adjusted HR =1.33, 95% CI 1.05-1.68, p = 0.01).

Conclusion: Maternal hypothyroidism in pregnancy is independently associated with long-term pediatric neurological morbidity of the offspring.

Keywords: Follow-up; Hypothyroidism; Long term; Neurological disease; Pediatric hospitalization; Pregnancy.

MeSH terms

Adult
Central Nervous System Diseases / etiology*
Cohort Studies
Female
Humans
Hypothyroidism / complications*
Infant, Newborn
Male
Maternal Age
Pregnancy
Pregnancy Complications / epidemiology*
Retrospective Studies