Abnormalities of Maternal Thyroid Function During Pregnancy Affect Neuropsychological Development of Their Children at 25-30 Months

Author: Li Y, et al.
Clinical Endocrinology
Published on line 10/31/09

Study Summary: To examine the relationship between specific thyroid abnormalities (subclinical hypothyroidism, hypothyroidism, hypothyroxinaemia or elevated thyroid peroxidase antibody titers) in women during pregnancy and the subsequent neuropsychological development of their offspring.

Design/patients: Serum was collected from 1268 women at 16-20 weeks of gestation and thyroid stimulating hormone (TSH), total thyroxine (tT(4)), free thyroxine (fT(4)), and Thyroid peroxidase antibodies (TPOAb) levels were measured. Thyroid function reference ranges specific for pregnancy were used to screen for thyroid abnormalities. Patients with isolated subclinical hypothyroidism (18 cases: elevated TSH > 5 and normal fT(4)), hypothyroxinaemia (19 cases: low fT(4)), and those who were euthyroid patients with elevated titres of TPOAb (34 cases: normal TSH, normal fT(4) and the presence of anti-thyroid antibodies) were identified. One hundred and forty two euthyroid and TPOAb-negative women matched for gestational age from the same cohort were selected as controls.



Measurements: Intellectual and motor development score evaluations were performed on the children from the pregnancies at 25-30 months of age. Results: Children of women with subclinical hypothyroidism, hypothyroxinemia and elevated TPOAb titres had mean intelligence scores 8.88, 9.30 and 10.56 points lower than those of the control group (p=0.008 p=0.004 and p=0.001 respectively); mean motor scores were 9.98, 7.57 and 9.03 points lower than those of the controls (p<0.001 p="0.007">Conclusions: Intellectual and motor development of children at 25-30 months of age is separately associated with abnormalities of maternal thyroid at 16-20 weeks gestation. Maternal subclinical hypothyroidism, hypothyroxinaemia or euthyroidism with elevated TPOAb titres were all statistically significant predictors of lower motor and intellectual development at 25-30 months.

Message: Maternal thyroid dysfunction affects motor and intellectual development of their offspring.

A Walk to Beautiful - Revisited

A Walk to Beautiful is a documentary about an amazing program in Ethiopia developed in 1974 by Drs. Catherine and Reginald Hamlin to assist women with the birth-related injury: obstetrical fistula. This Emmy award-winning documentary was initially shown in its shorter version on PBS in 2008.

There is now a feature length film: A Walk to Beautiful, 85 minutes in length available on DVD. The new version contains a wealth of special features. These include deleted scenes, commentaries, and two additional films, one of which revisits some of the women featured in the film three years after their inspiring journey. It is available exclusively through the website www.walktobeautiful.com, or by calling 212-413-9200.

Please consider purchasing and viewing A Walk to Beautiful DVD. Proceeds of the sales will help support this very worthy cause.

From the original MaternaCare 101 post:

A Walk to Beautiful is a documentary about five women and their journey from their rural Ethiopian villages to the Addis Ababa Fistula Hospital. It is a journey of healing and hope: Healing of their untreated obstetric fistulas, hope of returning to a “normal” life.

Ethiopian women frequently marry as children and become pregnant early in puberty. Because of poor nutrition, excessive hard labor, and their young age, many will suffer from an obstructed labor due to a small pelvis. If so, it is common for the baby to die and the woman to suffer from birth injuries, such as the formation of a fistula.

A fistula is a passageway between two organs that shouldn’t be connected. After a traumatic vaginal delivery, fistulas can form between a woman’s vagina and bladder (causing spontaneous leaking of urine from the vagina) or between her rectum and the vagina (causing spontaneous leaking of stool from the vagina).

The World Health Organization (WHO) estimates that at least 2 million women live with untreated obstetrical fistulas around the world. In Ethiopia, just 10% of births are attended by either a local midwife or another medical professional that are trained to repair damaged vaginal tissues. Those who have difficult deliveries may develop a fistula because of unrepaired injuries. In Ethiopia if a girl or woman suffers this injury, her life as a wife, mother – and human being – is often over. Her husband typically removes her from the household or leaves her because of embarrassment. She may be banished by her family and shunned by the community.

The Addis Ababa Fistula Hospital was established by Australian obstetrician, Catherine Hamlin, and her husband Reginald in 1974 to operate on women with fistulas. Since, they have opened three additional “mini-fistula hospitals” in Ethiopia with plans to build two more. Theirs is a story of restoring health and hope to the women of Ethiopia...

Please consider purchasing and viewing A Walk to Beautiful. Proceeds will directly benefit the Addis Ababa Fistula Hospital and the many women with obstetrical fistulas that need your support.