Screening for thyroid disorders during pregnancy: Results of a survey in Maine

• Published in: American journal of obstetrics and gynecology 2006-02, Vol.194 (2), p.471-474
• Main Authors: Haddow, James E., McClain, Monica R., Palomaki, Glenn E., Kloza, Edward M., Williams, Josephine
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Endocrinopathies; Family Practice - statistics & numerical data; Female; Gynecology. Andrology. Obstetrics; Health Care Surveys; Humans; Maine; Mass Screening - utilization; Medical sciences; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Obstetrics - statistics & numerical data; Practice Patterns, Physicians; Pregnancy; Pregnancy Complications - diagnosis; Prenatal Care - statistics & numerical data; Reference ranges; Reference Values; Thyroid Diseases - diagnosis; Thyroid testing; Thyroid. Thyroid axis (diseases); Thyrotropin - blood; TSH
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2005.07.055

Guidelines regarding prenatal screening for thyroid deficiency are conflicting, and current practice in primary care settings is unknown. Our survey sought to determine the: 1) extent of screening in Maine; 2) factors associated with screening; and 3) laboratory cut-off levels used. In 2004 we surveyed 61 prenatal care practices, representing 246 practitioners and 85% of Maine deliveries. Screening via thyroid-stimulating hormone (TSH) testing was routine in 48% of the practices. Obstetrician practices screened at a significantly higher rate than family practices (56% vs 8%; odds ratio [OR] 15.0, 95% CI 1.9-130.0). Nonsignificant higher rates were found for urban versus rural, and multipractitioner versus solo practices. The lower TSH cut-off levels ranged between 0.1 and 0.5 mU/L among practices; the upper cut-off levels ranged between 3.5 and 5.5 mU/L. Prenatal screening for thyroid deficiency varies among practices, reflecting conflicting guidelines. TSH cut-offs are also variable and might benefit from standardization.