Abstract | BACKGROUND: METHODS: In an integrated health care delivery system, we examined the prevalence of thyrotoxicosis and gestational ATD use ( propylthiouracil [PTU] or methimazole [MMI]) in women with delivered pregnancies from 1996 to 2010. Birth outcomes were compared among all infants and those born to mothers with diagnosed thyrotoxicosis or ATD therapy during gestation, with examination of ATD-associated hepatotoxicity and congenital malformations in the latter subgroups. RESULTS: Among 453,586 mother-infant pairs (maternal age 29.7±6.0 years, 57.1% nonwhite), 3.77 per 1000 women had diagnosed thyrotoxicosis and 1.29 per 1000 had gestational ATD exposure (86.5% PTU, 5.1% MMI, 8.4% both). Maternal PTU-associated hepatotoxicity occurred with a frequency of 1.80 per 1000 pregnancies. Infants of mothers with diagnosed thyrotoxicosis (odds ratio [OR] 1.28, 95% confidence interval [CI 1.05-1.55]) or gestational ATD use (OR 1.31 [1.00-1.72]) had an increased risk of preterm birth compared to those born to mothers without thyrotoxicosis or ATD. The risk of neonatal intensive care unit (NICU) admission was also higher with maternal thyrotoxicosis (OR 1.30 [1.07-1.59]) and ATD exposure (OR 1.64 [CI 1.26-2.13]), adjusting for prematurity. Congenital malformation rates were low and similar among infants born to mothers with thyrotoxicosis or ATD exposure (30-44 per 1000 infants). CONCLUSIONS: Gestational ATD exposure occurred in 1.29 per 1000 mother-infant pairs while a much larger number had maternal diagnosed thyrotoxicosis but no drug exposure during pregnancy. Infants of mothers with gestational ATD use or diagnosed thyrotoxicosis were more likely to be preterm and admitted to the NICU. The rates of congenital malformation were low for mothers diagnosed with thyrotoxicosis and did not differ by ATD use. Among women with gestational PTU therapy, the frequency of PTU-associated hepatotoxicity was 1.8 per 1000 delivered pregnancies. These findings from a large, population-based cohort provide generalizable estimates of maternal and infant risks associated with maternal thyrotoxicosis and related pharmacotherapy.
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Authors | Joan C Lo, Scott A Rivkees, Malini Chandra, Joel R Gonzalez, James J Korelitz, Michael W Kuzniewicz |
Journal | Thyroid : official journal of the American Thyroid Association
(Thyroid)
Vol. 25
Issue 6
Pg. 698-705
(Jun 2015)
ISSN: 1557-9077 [Electronic] United States |
PMID | 25747892
(Publication Type: Journal Article, Research Support, N.I.H., Extramural)
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Chemical References |
- Antithyroid Agents
- Methimazole
- Propylthiouracil
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Topics |
- Adult
- Antithyroid Agents
(therapeutic use)
- Chemical and Drug Induced Liver Injury
(epidemiology, etiology)
- Cohort Studies
- Congenital Abnormalities
(epidemiology)
- Delivery of Health Care, Integrated
- Female
- Humans
- Infant, Newborn
- Intensive Care Units, Neonatal
(statistics & numerical data)
- Methimazole
(therapeutic use)
- Pregnancy
- Pregnancy Complications
(drug therapy)
- Premature Birth
(epidemiology)
- Prevalence
- Propylthiouracil
(adverse effects, therapeutic use)
- Thyrotoxicosis
(drug therapy, epidemiology)
- Young Adult
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