Prenatal Testing of Thyroid Debated

Hypothyroidism may harm fetal brain development. Ten years ago, researchers in Maine analyzed blood samples from 25,216 pregnant women and identified 62 with hypothyroidism. Their children, by then 7 to 9 years old, were given intelligence tests. Nineteen percent of the children born to women with an untreated underactive thyroid had an I.Q. of 85 or lower, compared with 5 percent of those whose mothers had a healthy thyroid. “At about 85 or below, that’s where you begin to have trouble in school and in life in general,” said Dr. James E. Haddow, a pediatrician at Brown University who was an author of the study. But if mothers had their hypothyroidism treated, their children’s intelligence was not impaired.

In reaction, the American Association of Clinical Endocrinologists endorsed routine T.S.H. testing in all women considering pregnancy. But other organizations, including the American College of Obstetricians and Gynecologists, have said wide-scale screening is premature until more data prove that treating subclinical hypothyroidism would prevent adverse effects in women and their offspring.

Studies do suggest that T4-replacement therapy is protective. But few large clinical trials have rigorously tested this intervention in mildly thyroid-deficient women. So far, promising results have come from one major, well-designed Italian study that showed miscarriage and preterm delivery rates dropped sharply when thyroid hormone pills were given to pregnant women who tested positive for thyroid antibodies.