The Generation R Study, Erasmus Medical University Center, 3000 DR Rotterdam, The Netherlands.
J Clin Endocrinol Metab. 2010 Sep;95(9):4227-34. doi: 10.1210/jc.2010-0415. Epub 2010 Jun 9.
Thyroid hormones are essential for neurodevelopment from early pregnancy onward. Yet population-based data on the association between maternal thyroid function in early pregnancy and children's cognitive development are sparse.
Our objective was to study associations of maternal hypothyroxinemia and of early pregnancy maternal TSH and free T(4)(FT(4)) levels across the entire range with cognitive functioning in early childhood.
We conducted a population-based cohort in The Netherlands.
Participants included 3659 children and their mothers.
In pregnant women with normal TSH levels at 13 wk gestation (SD = 1.7), mild and severe maternal hypothyroxinemia were defined as FT(4) concentrations below the 10th and 5th percentile, respectively. Children's expressive vocabulary at 18 months was reported by mothers using the MacArthur Communicative Development Inventory. At 30 months, mothers completed the Language Development Survey and the Parent Report of Children's Abilities measuring verbal and nonverbal cognitive functioning.
Maternal TSH was not related to the cognitive outcomes. An increase in maternal FT(4) predicted a lower risk of expressive language delay at 30 months only. However, both mild and severe maternal hypothyroxinemia was associated with a higher risk of expressive language delay across all ages [odds ratio (OR) = 1.44; 95% confidence interval (CI) = 1.09-1.91; P = 0.010 and OR = 1.80; 95% CI = 1.24-2.61; P = 0.002, respectively]. Severe maternal hypothyroxinemia also predicted a higher risk of nonverbal cognitive delay (OR = 2.03; 95% CI = 1.22-3.39; P = 0.007).
Maternal hypothyroxinemia is a risk factor for cognitive delay in early childhood.
甲状腺激素对妊娠早期开始的神经发育至关重要。然而，关于妊娠早期母亲甲状腺功能与儿童认知发育之间关系的基于人群的数据却很少。
我们旨在研究妊娠早期母亲亚临床甲状腺功能减退症以及整个范围内的 TSH 和游离甲状腺素（FT4）水平与儿童早期认知功能的相关性。
我们在荷兰进行了一项基于人群的队列研究。
参与者包括 3659 名儿童及其母亲。
在妊娠 13 周时 TSH 水平正常的孕妇中（标准差=1.7），将 FT4 浓度分别低于第 10 百分位和第 5 百分位定义为轻度和重度亚临床甲状腺功能减退症。母亲使用麦克阿瑟发育沟通量表报告儿童 18 个月时的表达性词汇量。在 30 个月时，母亲使用语言发展调查和父母报告儿童能力量表完成语言和非语言认知功能的测量。
母亲 TSH 与认知结果无关。FT4 水平升高预示着仅在 30 个月时表达性语言延迟的风险较低。然而，轻度和重度亚临床甲状腺功能减退症均与所有年龄段的表达性语言延迟风险增加相关[比值比（OR）=1.44；95%置信区间（CI）=1.09-1.91；P=0.010 和 OR=1.80；95%CI=1.24-2.61；P=0.002，分别]。重度亚临床甲状腺功能减退症也预示着非语言认知延迟的风险更高（OR=2.03；95%CI=1.22-3.39；P=0.007）。
母亲亚临床甲状腺功能减退症是儿童早期认知延迟的危险因素。
