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      Thyroid-Stimulating Hormone (TSH) Concentration at Birth in Belgian Neonates and Cognitive Development at Preschool Age

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          Abstract

          The main objective of the study was to investigate the effect of MID during late pregnancy, assessed by the thyroid-stimulating hormone (TSH) concentration at neonatal screening, on cognitive development of preschool children. A retrospective cohort study including 311 Belgian preschool children of 4–6 years old was conducted. Children were selected at random from the total list of neonates screened in 2008, 2009, and 2010 by the Brussels new-born screening center. Infants with congenital hypothyroidism, low birth weight, and/or prematurity were excluded from the selection. The selected children were stratified by gender and TSH-range (0.45–15 mIU/L). Cognitive abilities were assessed using Wechsler Preschool and Primary Scale of Intelligence—third edition. In addition, several socioeconomic, parental, and child confounding factors were assessed. Neonatal TSH concentration—a surrogate marker for MID—was not associated with Full Scale and Performance IQ scores in children. Lower Verbal IQ scores were found in children with neonatal TSH values comprised between 10–15 mIU/L compared to lower TSH levels in univariate analysis but these results did not hold when adjusting for confounding factors. Current levels of iodine deficiency among pregnant Belgian women may not be severe enough to affect the neurodevelopment of preschool children.

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          Applied Logistic Regression

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            Antenatal thyroid screening and childhood cognitive function.

            Children born to women with low thyroid hormone levels have been reported to have decreased cognitive function. We conducted a randomized trial in which pregnant women at a gestation of 15 weeks 6 days or less provided blood samples for measurement of thyrotropin and free thyroxine (T(4)). Women were assigned to a screening group (in which measurements were obtained immediately) or a control group (in which serum was stored and measurements were obtained shortly after delivery). Thyrotropin levels above the 97.5th percentile, free T(4) levels below the 2.5th percentile, or both were considered a positive screening result. Women with positive findings in the screening group were assigned to 150 μg of levothyroxine per day. The primary outcome was IQ at 3 years of age in children of women with positive results, as measured by psychologists who were unaware of the group assignments. Of 21,846 women who provided blood samples (at a median gestational age of 12 weeks 3 days), 390 women in the screening group and 404 in the control group tested positive. The median gestational age at the start of levothyroxine treatment was 13 weeks 3 days; treatment was adjusted as needed to achieve a target thyrotropin level of 0.1 to 1.0 mIU per liter. Among the children of women with positive results, the mean IQ scores were 99.2 and 100.0 in the screening and control groups, respectively (difference, 0.8; 95% confidence interval [CI], -1.1 to 2.6; P=0.40 by intention-to-treat analysis); the proportions of children with an IQ of less than 85 were 12.1% in the screening group and 14.1% in the control group (difference, 2.1 percentage points; 95% CI, -2.6 to 6.7; P=0.39). An on-treatment analysis showed similar results. Antenatal screening (at a median gestational age of 12 weeks 3 days) and maternal treatment for hypothyroidism did not result in improved cognitive function in children at 3 years of age. (Funded by the Wellcome Trust UK and Compagnia di San Paulo, Turin; Current Controlled Trials number, ISRCTN46178175.).
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              Maternal thyroid function during early pregnancy and cognitive functioning in early childhood: the generation R study.

              Thyroid hormones are essential for neurodevelopment from early pregnancy onward. Yet population-based data on the association between maternal thyroid function in early pregnancy and children's cognitive development are sparse. Our objective was to study associations of maternal hypothyroxinemia and of early pregnancy maternal TSH and free T(4)(FT(4)) levels across the entire range with cognitive functioning in early childhood. We conducted a population-based cohort in The Netherlands. Participants included 3659 children and their mothers. In pregnant women with normal TSH levels at 13 wk gestation (SD = 1.7), mild and severe maternal hypothyroxinemia were defined as FT(4) concentrations below the 10th and 5th percentile, respectively. Children's expressive vocabulary at 18 months was reported by mothers using the MacArthur Communicative Development Inventory. At 30 months, mothers completed the Language Development Survey and the Parent Report of Children's Abilities measuring verbal and nonverbal cognitive functioning. Maternal TSH was not related to the cognitive outcomes. An increase in maternal FT(4) predicted a lower risk of expressive language delay at 30 months only. However, both mild and severe maternal hypothyroxinemia was associated with a higher risk of expressive language delay across all ages [odds ratio (OR) = 1.44; 95% confidence interval (CI) = 1.09-1.91; P = 0.010 and OR = 1.80; 95% CI = 1.24-2.61; P = 0.002, respectively]. Severe maternal hypothyroxinemia also predicted a higher risk of nonverbal cognitive delay (OR = 2.03; 95% CI = 1.22-3.39; P = 0.007). Maternal hypothyroxinemia is a risk factor for cognitive delay in early childhood.
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                Author and article information

                Journal
                Nutrients
                Nutrients
                nutrients
                Nutrients
                MDPI
                2072-6643
                02 November 2015
                November 2015
                : 7
                : 11
                : 9018-9032
                Affiliations
                [1 ]Unit of Public Health and Surveillance, Scientific Institute of Public Health, Rue Juliette Wytsman 14, 1050 Brussels, Belgium; Herman.VanOyen@ 123456wiv-isp.be (H.V.O.); Jean.Tafforeau@ 123456wiv-isp.be (J.T.); Stefanie.Vandevijvere@ 123456wiv-isp.be (S.V.)
                [2 ]Department of Paediatric Endocrinology, UZ Brussel, Vrije Universiteit Brussel, Avenue du Laerbeek 101, 1090 Brussels, Belgium; Jean.DeSchepper@ 123456uzbrussel.be
                [3 ]Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Boulevard de la Plaine 2, 1050 Brussels, Belgium; jvdfaeil@ 123456vub.ac.be
                [4 ]Faculty of Psychology and Educational Sciences, Université Libre de Bruxelles, avenue F.D. Roosevelt 50, 1050 Brussels, Belgium; nvercr@ 123456ulb.ac.be
                [5 ]Department of Nuclear Medicine, Erasmus Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium; rmorenor@ 123456ulb.ac.be
                [6 ]Medical Microbiology Laboratory, Communicable and Infectious Diseases, Scientific Institute of Public Health, Rue Engeland 642, 1180 Brussels, Belgium; Jean.Vanderpas@ 123456wiv-isp.be
                Author notes
                [* ]Correspondence: caroline.trumpff@ 123456wiv-isp.be ; Tel.: +32-2-642-57-24; Fax: +32-2-642-54-10
                Article
                nutrients-07-05450
                10.3390/nu7115450
                4663578
                26540070
                2424acae-cd12-44e1-b2d4-73778baea499
                © 2015 by the authors; licensee MDPI, Basel, Switzerland.

                This article is an open access article distributed under the terms and conditions of the Creative Commons by Attribution (CC-BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 15 June 2015
                : 20 October 2015
                Categories
                Article

                Nutrition & Dietetics
                cognitive development,thyroid-stimulating hormone,preschool children,iodine deficiency,pregnancy

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