Tzoraki Maria, Karampas Grigorios, Sarantaki Antigoni, Lykeridou Aikaterini, Kanaka-Gantenbein Christina, Metallinou Dimitra
Medical Service Department, Hygeia Hospital, Athens, GRC.
Second Department of Obstetrics and Gynaecology, Aretaieio University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, GRC.
Cureus. 2024 Dec 3;16(12):e75041. doi: 10.7759/cureus.75041. eCollection 2024 Dec.
Maternal Graves' disease (GD) poses a significant risk to neonatal thyroid function due to the transplacental transfer of thyrotropin receptor antibodies (TRAbs). This systematic review aims to assess the impact of maternal GD on neonatal thyroid outcomes and identify key maternal factors influencing these outcomes. A comprehensive literature search was conducted across PubMed, Scopus, and Cochrane, resulting in the inclusion of 18 studies published from 2014 to 2024. The review focused on neonates born to mothers with active or previous GD and investigated the effects of various maternal treatments, including antithyroid drugs (ATDs), radioactive iodine (RAI) therapy, and thyroidectomy on their offspring. The findings indicate that elevated maternal TRAb levels are a strong predictor of neonatal thyroid dysfunction, with neonates exhibiting conditions such as hyperthyroidism, transient thyrotoxicosis, or hypothyroidism. The incidence of neonatal thyroid dysfunction ranged from 0.1% to 5% in pregnancies complicated by GD, with higher rates observed in cases requiring long-term ATD therapy. Neonatal outcomes varied, with some cases resolving after appropriate treatment, while others necessitated prolonged monitoring due to risks of developmental delays and complications. The review highlights the importance of early third-trimester TRAb screening and regular neonatal thyroid function testing within the first week of life. Although neonatal outcomes were generally favorable with prompt diagnosis and treatment, the review emphasizes the need for standardized protocols to optimize monitoring and management strategies in pregnancies complicated by GD. Further research should explore long-term neurodevelopmental outcomes and evaluate the impact of different maternal treatment strategies on neonatal thyroid health.
由于促甲状腺素受体抗体（TRAbs）的胎盘转运，妊娠合并格雷夫斯病（GD）对新生儿甲状腺功能构成重大风险。本系统评价旨在评估妊娠合并GD对新生儿甲状腺结局的影响，并确定影响这些结局的关键母体因素。通过对PubMed、Scopus和Cochrane进行全面的文献检索，纳入了2014年至2024年发表的18项研究。该评价聚焦于患有活动性或既往GD的母亲所生的新生儿，并研究了各种母体治疗方法，包括抗甲状腺药物（ATD）、放射性碘（RAI）治疗和甲状腺切除术对其后代的影响。研究结果表明，母体TRAb水平升高是新生儿甲状腺功能障碍的有力预测指标，新生儿会出现甲状腺功能亢进、短暂甲状腺毒症或甲状腺功能减退等情况。在妊娠合并GD的情况下，新生儿甲状腺功能障碍的发生率为0.1%至5%，在需要长期ATD治疗的病例中观察到更高的发生率。新生儿结局各不相同，一些病例在适当治疗后得到缓解，而另一些病例由于存在发育迟缓及并发症风险而需要长期监测。该评价强调了在孕晚期进行TRAb筛查以及在出生后第一周内定期进行新生儿甲状腺功能检测的重要性。尽管及时诊断和治疗后新生儿结局总体良好，但该评价强调需要标准化方案，以优化妊娠合并GD的监测和管理策略。进一步的研究应探索长期神经发育结局，并评估不同母体治疗策略对新生儿甲状腺健康的影响。
