Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
Endocrine. 2015 Feb;48(1):116-23. doi: 10.1007/s12020-014-0385-9. Epub 2014 Aug 31.
Thyroid dysfunction in pregnancy is associated with significant maternal, fetal, and neonatal complications. Early treatment of thyroid disorders can effectively reduce the risk of such complications. The results of different clinical trials have demonstrated that screening pregnant women for thyroid dysfunctions is cost-effective and should be encouraged. However, there is no consensus over the advantages of universal versus case-finding screening for thyroid disorders during pregnancy. A systematic review was performed by searching PubMed, Scopus, and Web of Science databases for studies having been carried out to make a comparison between universal and case-finding screening methods during pregnancy in terms of the loss rate. The main search criteria were related to thyroid function, pregnancy, and adverse outcomes. All articles in English language are included. We analyzed by random effect method due to between-study heterogeneity. Among 241 articles found using the search terms, 40 articles were included out of which 10 were considered as acceptable and relevant. Five articles showed that case-finding screening missed between 30 and 55% of pregnant women with thyroid dysfunction. 4 studies demonstrated that universal screening and detection of thyroid dysfunction may lead to less miscarriage and pregnancy complications. The results of 2 studies demonstrated that universal screening in pregnancy with a focus on hypothyroidism would be cost-effective. Early detection of thyroid dysfunction in pregnancy can minimize the adverse maternal and fetal outcomes and is demonstrated to be cost-effective. Meta-analysis confirmed that case-based screening may miss up to 49% of pregnant women with thyroid dysfunction. This provides further support for the argument in favor of universal screening of thyroid disorders in pregnancy. In order to shed more light on the advantages of universal screening for thyroid disorders in pregnancy, more comprehensive randomized controlled trials with larger cohorts are required.
妊娠期间甲状腺功能障碍与母体、胎儿和新生儿的重大并发症相关。早期治疗甲状腺疾病可以有效降低此类并发症的风险。不同临床试验的结果表明，筛查妊娠期间的甲状腺功能障碍具有成本效益，应予以鼓励。然而，对于妊娠期间甲状腺疾病的普遍筛查与病例发现筛查哪种更具优势，目前尚无共识。我们通过搜索 PubMed、Scopus 和 Web of Science 数据库，对妊娠期间进行普遍筛查和病例发现筛查以比较失访率的研究进行了系统回顾。主要搜索标准与甲状腺功能、妊娠和不良结局相关。纳入所有英文文章。由于研究间存在异质性，我们采用随机效应方法进行分析。通过搜索术语共找到 241 篇文章，其中纳入了 40 篇，其中 10 篇被认为是可接受的和相关的。有 5 篇文章表明，病例发现筛查会遗漏 30%至 55%的甲状腺功能障碍孕妇。4 项研究表明，普遍筛查和检测甲状腺功能障碍可能会减少流产和妊娠并发症。2 项研究的结果表明，妊娠期间针对甲状腺功能减退症的普遍筛查具有成本效益。早期发现妊娠期间的甲状腺功能障碍可以最大限度地减少母婴不良结局，并且具有成本效益。荟萃分析证实，基于病例的筛查可能会遗漏多达 49%的甲状腺功能障碍孕妇。这为支持妊娠期间甲状腺疾病普遍筛查的论点提供了进一步的证据。为了更清楚地了解妊娠期间甲状腺疾病普遍筛查的优势，需要进行更多具有更大队列的全面随机对照试验。
