Do Clinicians Appropriately Screen for Thyroid Disease in Pregnancy Using Targeted Screening Guidelines? A Real-World Retrospective Study [ID: 1368322]

Abstract

INTRODUCTION: Universal screening for thyroid disease in pregnancy is not currently recommended. Guidelines support targeted screening of high-risk individuals. Prior studies have provided some evidence to the cost-effectiveness of universal screening. We aim to evaluate adherence to targeted screening criteria as well as outcome differences between screened and unscreened patients. METHODS: All patients presenting for new obstetrical visits in 2020 were reviewed. Institutional review board approval was obtained for this study. Risk factors meeting thyroid screening criteria based on American Thyroid Association (ATA) and/or American College of Obstetricians and Gynecologists (ACOG) guidelines, and pregnancy outcomes were extracted. Pregnancy outcomes were compared between patients meeting ATA and/or ACOG criteria who did or did not receive screening via thyroid function testing (TFT). RESULTS: One thousand twenty-five records were included. 87/198 patients meeting ACOG criteria for screening (43.9%) and 108/826 patients meeting ATA criteria (13.1%) had TFT. Patients meeting ATA criteria who underwent TFT had higher live-birth rates and lower miscarriage rates compared to unscreened patients meeting ATA criteria, 92.6% versus 83.26% (P=.006) and 4.63% versus 12.41% (P=.009), respectively. No difference was found between patients meeting ACOG criteria who did or did not receive TFT. No differences were observed in preterm delivery rates. CONCLUSION: In a real-world study of obstetrical practice, less than 50% of patients were appropriately screened for thyroid disease in pregnancy. ATA criteria identified threefold more patients for screening compared to ACOG criteria. Those screened appropriately per ATA criteria had higher live-birth rates and lower miscarriage rates compared to unscreened patients meeting ATA criteria.