New Clinical Trial Will Study Thyroid Disease in Pregnancy and Risks to a Child's Development
There's a lot of attention being paid this week to a new clinical trial being launched by the National Institute of Child Health and Human Development. The study will look at pregnant women who have mild hypothyroidism -- a slightly underactive thyroid condition -- and evaluate the effects of treating that thyroid condition on the development of the children after delivery and up to the age of five. The purpose of the research is to determine whether thyroid treatment has an effect on the intellectual development of the children of mothers who are mildly hypothyroid during pregnancy. The media reports point out that the value of treating mild hypothyroidism is a controversial topic, and that this clinical trial is meant to determine, once and for all, whether a child benefits from treating the pregnant mother's mild hypothyroidism. Ultimately, the results will drive a decision whether universal screening of all women during pregnancy is needed.
Find out more about the study, and how to participate. Before you sign up, however, find out why I feel that this trial is unfair to women and their children.
- About the Study: New Study Will Look at Hypothyroidism in Pregnancy
- FAQ / How to Participate?
- Is the New Clinical Trial of Hypothyroidism in Pregnancy Fair to Women and Their Children?
Is the New Clinical Trial of Hypothyroidism in Pregnancy Fair to Women and Their Children?
The study is trying to answer a broader public health question, and help formulate broad guidelines; to that end, it's understandable. But I would urge any pregnant woman who would consider participating in the study to seriously look into what we already know about the negative effects of untreated thyroid disease on pregnancy.
For example, according to a study reported on at the Endocrine Society's 2005 annual meeting, if a mother has Free T4 levels that are less than the 10th percentile at 12 weeks gestation, which is evidence of mild hypothyroidism, her baby faces almost 6 times the risk to have impaired psychomotor development. (Casey. B. "Maternal Hypothyroidism: Maternal Fetal Outcomes." Endocrine Society Annual Meeting, May 2005. [S7-2])
In 2004, the American Thyroid Association (ATA) came out with a public health statement which said, in part: "Pregnant mothers with overt or subclinical hypothyroidism are at an increased risk for premature delivery." It also said "The offspring of mothers with thyroid hormone deficiency or thyroid stimulating hormone elevation during pregnancy may be at risk of mild impairment in their intellectual function and motor skills." (http://www.thyroid.org/professionals/publications/statements/04_04_26_maternalthyroidal.html)
As far back as 1999, we were hearing about well-respected research. One New England Journal of Medicine study found that children born to mothers whose hypothyroidism was not being treated scored several points lower on an IQ test that children of non-thyroid patients. The study noted that children whose mothers were undergoing treatment for an underactive thyroid scored almost the same as children born to mothers with normal thyroid function. (Herzmann, et. Al. "Maternal Thyroid Deficiency during Pregnancy and Subsequent Neuropsychological Development of the Child," New England Journal of Medicine, 1999; 341:2015-2017, Dec 23, 1999).
Now, here it is 2007, and this study is asking women, after being diagnosed with low-level hypothyroidism, to participate in a trial where they have only a 50-50 chance of getting treatment. Half the women will receive thyroid hormone replacement; the other half receive a placebo.
Given that other studies have already demonstrated that a mother's hypothyroidism -- even subclinical or mild -- can have a detrminental effect on her child's cognitive development, why would a woman want to take that chance with her child?
I know I wouldn't!
Comments
Being a hypothyroid mom, and after having gone through monthly checkups of an ever-rising TSH throughout my pregnancy (and subsequent dosage adjustments to constantly correct it), I also cannot imagine why any pregnant woman would want to risk damaging her baby for such a test. It is absurd that doctors would even perform it. Humans are not lab animals!
My thyroid levels were elevated during the first trimester of my pregnancy with my first child. I was working with an incompetent o.b who was not properly monitoring my thyroid despite the fact that I came into her office with that specific concern when we were trying to conceive. She gave me pre-natal vitamins and never bothered to tell me not to take them with my thyroid medication. I got pregnant almost immediately but found the weight suddenly piling on after keeping it off successfully for 5 years so I knew something was wrong with my thyroid. I actually had a tsh level of 5 but was told it was normal. After 6 weeks and 30 pounds, I insisted that she test it again and my levels were then at 11. I don’t know if that is considered mildly elevated or moderately elevated but either way, I now worry ALL THE TIME about my son. His I.Q is pretty average but my daughter is brilliant. He also had to have physical therapy and was behind in his gross motor skills due to low muscle tone. He is now 4 1/2 and is the most agile and coordinated kid on the playground and you would never know he needed any help. In any case, I still wonder if any of this had to do with my thyroid being off in that early part of my pregnancy. I wonder if he would have been a smarter and has been robbed of this by this incompetent doctor. I ended up finding a wonderful endocronologist who treated me for the remainder of my pregnancy and also referred me to a wonderful o.b. Both of those doctors also treated me throughout my second pregnancy during which my levels were never elevated because my meds were immediately raised as soon as I got pregnant. So, the point in telling my story is this… Why purposely subject your baby to this. Why would anyone want to take a chance with their child’s future? Why would anyone want to always wonder if their child could have done more and had certain advantages stolen from him/her. Finally, why not use old data from women whose thyroids were mildly elevated during pregnancy such as myself, by mistake, through incompetence or ignorance etc. It just doesn’t make sense.
Twelve years ago I was preganant with my daughter. My hashis wasn’t considered treatable. My beautiful daughter has asperger’s and reads at a 4th grade level although she’s in 6th grade. A few years ago I read about the effects of untreated hypothyrodism and cognitive ability. The signs of a hypo pregnancy were undeniable with mine. I feel angry and sad, but it won’t change the situation for us. When I was later pregnant with my son I was treated. He’s normal. Coincidence or medical ignorance? If I’d have known, I’d have fought tooth and nail for my baby’s future. The study is outrageous.
When I was pregnant with my first child, I knew something was wrong with my body because of the weight issues I was experiencing. My incompetent OB’s repeatedly told me to “watch your calories” instead of running the blood work to test my thyroid.
My son was diagnosed in 2005 (at the age of 10-1/2) with Asperger’s Syndrome.
Another mother I know with a thyroid problem (diagnosed AFTER her second baby was born) has a child with Asperger’s Syndrome as well.
When are these doctors going to wake up?
The study isn’t just controversial, it should be ILLEGAL!
I too had the misfortune of poor medical monitoring of my first pregnancy. I gained 80 pounds during my pregnancy and was told to watch what I eat. The doctor never suggested that my thyroid should be checked and I was not aware of the threat hypothyroidism posed to my unborn baby. I also ended up with preeclampsia, which may have also been related to the untreated hypothyroidism or maybe the excessive weight I gained, in part because of the hypothyroidism.
My son was born with low muscle tone. He missed every motor skill milepost. He is now in Kindergarten and his teachers still raise concerns about his gross and fine motor skills. Thank God, it does not appear that he has any cognitive or IQ problems. He’s a bright boy. At his age, he doesn’t notice that he is not as coordinated or athletic as his friends and I’m doing everything I can to help him catch up so that hopefully he’ll never notice.
A year after he was born I was finally diagnosed with hypothyroidism. My TSH level at that time was 12. I immediately researched the possible problems the untreated hypothyroidism might cause and was especially alarmed to see the studies, especially since my child’s pediatrician had already raised issues concerning muscle tone and motor skills and my son showed no sign of walking. I was irate!
At my initial endocrinologist appointment I raised my concerns about the risks imposed on my son due to my O.B.’s failure to diangose and treat my hypothyroidism. She of course would not say anything critical of her colleague. When I learned it was a simple, and inexpensive, blood test that could have settled the issue and treatment would have been safe and effective during the pregnancy I could not believe it!
I don’t know where they are going to find women who will knowingly place their children at risk and they shouldn’t be able ask someone to do that. I would never do it.
By the way, I had a second child after I was diagnosed. My thyroid was under control with medication throughout that pregnancy. I easily maintained a reasonable weight gain of only 25 pounds during that pregnancy which came off quickly after delivery. My second child has excellent muscle tone and no problems whatsoever with his gross and fine motor skills. It’s not proof positive, but it’s enough for me.
Considering there are a few studies linking even subclinical hypothyroidism during pregnancy to a higher incidence of pre-eclampsia, placental abruption, and premature delivery, I can’t believe someone thought this study was a good idea.