Maternal hypothyroxinaemia during early pregnancy and subsequent child development: a 3-year follow-up study

OBJECTIVE To evaluate the impact of maternal hypothyroxinaemia during early gestation (fT4 below the lowest tenth percentile and TSH within the reference range: 0.15-2.0 mIU/I) on infant development, together with any subsequent changes in fT4 during gestation. DESIGN A prospective 3-year follow-up study of pregnant women and their children up to the age of 2 years. MEASUREMENTS Child development was assessed by means of the Bayley Scales of Infant Development in children of women with hypothyroxinaemia (fT4 below the tenth percentile at 12 weeks' gestation) at 12 weeks' gestation (cases), and in children of women with fT4 between the 50th and 90th percentiles at 12 weeks' gestation, matched for parity and gravidity (controls). Maternal thyroid function (fT4 and TSH) was assessed at 12,24 and 32 weeks' gestation. The mental and motor function of 63 cases and 62 controls was compared at the age of 1 year, and of 57 cases and 58 controls at the age of 2 years. RESULTS Children of women with hypothyroxinaemia at 12 weeks' gestation had delayed mental and motor function compared to controls: 10 index points on the mental scale (95% CI: 45-15 points, P= 0003) and eight on the motor scale at the age of 1 year (95% CI: 2.3-12.8 points, P= 0.02), as well as eight index points on the mental (95% CI: 4-12 points, P= 0.02), and 10 on the motor scale (95% CI: 6-16 points, P= 0.005) at the age of 2 years. Children of hypothyroxinaemic women in whom the fT4 concentration was increased at 24 and 32 weeks' gestation had similar scores to controls, while in the controls, the developmental scores were not influenced by further declines in maternal fT4 at 24 and 32 weeks' gestation. CONCLUSIONS Maternal hypothyroxinaemia during early gestation is an independent determinant of a delay in infant neurodevelopment. However, when fT4 concentrations increase during pregnancy in women who are hypothyroxinaemic during early gestation, infant development appears not to be adversely affected.