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. 2018 Feb 1;103(2):660-670.
doi: 10.1210/jc.2017-02171.

Maternal Thyroid Function in Early Pregnancy and Neuropsychological Performance of the Child at 5 Years of Age

Stine Linding Andersen  1   2 , Stig Andersen  3   4 , Zeyan Liew  5 , Peter Vestergaard  2   4 , Jørn Olsen  6
Affiliations

Maternal Thyroid Function in Early Pregnancy and Neuropsychological Performance of the Child at 5 Years of Age

Stine Linding Andersen et al. J Clin Endocrinol Metab. .

Abstract

Context: Abnormal maternal thyroid function in pregnancy may impair fetal brain development, but more evidence is needed to refine and corroborate the hypothesis.

Objective: To estimate the association between maternal thyroid function in early pregnancy and neuropsychological performance of the child at 5 years of age.

Design: Follow-up study.

Participants: A cohort of 1153 women and their children sampled from the Danish National Birth Cohort. Maternal thyroid-stimulating hormone (TSH) and free thyroxine (fT4) were measured in stored biobank sera from early pregnancy.

Main outcomes measures: Child neuropsychological test results (Wechsler Intelligence Scale/Test of Everyday Attention), test of motor function (Movement Assessment Battery), and results of parent and teacher reports (Behavior Rating Inventory of Executive Function/Strengths and Difficulties Questionnaire).

Results: Altogether 145 children (12.6%) were born to mothers with abnormal thyroid function in the early pregnancy. High maternal TSH and low fT4 were associated with lower child verbal intelligence quotient (adjusted mean difference TSH ≥ 10 mIU/L vs 0.1 to 2.49 mIU/L, -8.9 [95% confidence interval (CI), -15 to -2.4]; fT4 < 10 pmol/l vs 12.0 to 18.99 pmol/l, -13 [95% CI, -19 to -7.3]). Abnormal maternal thyroid function was also associated with adverse motor function and teacher-reported problems of executive function and behavior, and these associations were dominated by exposure to maternal hypothyroxinemia.

Conclusions: Maternal thyroid hormone abnormalities were associated with adverse neuropsychological function of the child at 5 years of age. For intelligence, marked hypothyroidism was important, whereas for motor function and executive and behavior problems, maternal hypothyroxinemia was predominant.

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Figures

Figure 1.
Figure 1.
Flowchart illustrating the eligible cohort of children and the number of children invited for follow-up and participating in neuropsychological assessment, as well as the number of children with available measurement of maternal thyroid function in early pregnancy.
Figure 2.
Figure 2.
Adjusted mean difference with 95% confidence interval in child verbal IQ by maternal TSH (top) and fT4 (bottom) measured in an early pregnancy blood sample. Reference group was maternal TSH in the range from 0.1 to 2.49 mIU/L (top) and maternal fT4 in the range from 12.0 to 18.99 (bottom). The adjusted model included maternal IQ, maternal prepregnancy BMI, child’s age at testing, and testing psychologist. In the bottom panel, all women with fT4 < 10 pmol/L (n = 4) had TSH ≥ 10 mIU/L. Among women with fT4 in the range from 10 to 12 pmol/L, 11 women had overt hypothyroidism; the exclusion of this group revealed the following associations: fT4 10.0 to 10.99 pmol/L (n = 14): adjusted mean difference, 1.14 (95% CI, −4.91 to 7.18), fT4 11.0 to 11.99 pmol/L (n = 62): adjusted mean difference, 1.10 (95% CI, −2.17 to 4.37).
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References

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