Maternal hypothyroidism and subsequent metabolic outcomes in children: a systematic review and meta-analysis.

BMC pediatrics. 2024;24(1):490
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Maternal hypothyroidism during pregnancy can have significant implications for foetal development and long-term health outcomes in children. Thyroid hormones are crucial for metabolic processes, and deficiencies during critical developmental periods may lead to adverse metabolic consequences. The primary aim of this study was to evaluate the association between maternal hypothyroidism and subsequent metabolic outcomes in children, including obesity, insulin resistance, and other metabolic disorders. This research is a systematic review and meta-analysis, synthesising data from multiple observational studies that examined the metabolic health of children born to mothers with hypothyroidism. Results showed that there was no association between exposure to maternal hypothyroidism and subsequent obesity, type 2 diabetes, hypertension, and dyslipidaemia in offspring, although estimates from individual studies suggest a potential increased risk of elevated systolic blood pressure and dysglycaemia in offspring exposed to maternal hypothyroidism. Authors concluded that since their findings show inconsistent evidence to infer an association, further longitudinal studies are needed to investigate the role of maternal hypothyroidism on offspring metabolic health.

Abstract

INTRODUCTION As the fetus relies on maternal thyroid hormones in early pregnancy, maternal hypothyroidism plays an important role in fetal development. However, the association between maternal hypothyroidism and metabolic disease in offspring is unclear. OBJECTIVE To examine the association between maternal hypothyroidism in pregnancy and metabolic outcomes (obesity, hypertension, type 2 diabetes mellitus, and dyslipidemia) in children < 18 years. METHODS We systematically searched 5 databases from inception to May 2023. Eligible studies included cohort, case-control, and randomized controlled trials involving children born to mothers with or without hypothyroidism in pregnancy. Data were pooled across studies using random-effects models for outcomes reported in at least three studies. Quality assessment was performed using the ROBINS-E tool for observational studies and the Cochrane Risk of Bias tool for trials. RESULTS The search identified 3221 articles, of which 7 studies were included (1 trial, 6 observational). All studies were conducted outside of North America and ranged in size from 250 to > 1 million children. The follow-up time ranged from 6 to 20 years. Included studies support an increased risk of hypertension and glucose dysregulation in offspring exposed to maternal hypothyroidism (hypertension: OR 1.08, 95% CI 0.75, 1.57 and HR 1.81, 95% CI 1.21, 2.69; diabetes: RR 2.7, 95% CI 0.7, 10). In the pooled analysis, maternal hypothyroidism was not associated with obesity in offspring (OR 1.04, 95% CI 0.64, 1.70). CONCLUSION This study found inconsistent evidence on the association between maternal hypothyroidism in pregnancy and metabolic outcomes in offspring, though associations with hypertension and glucose dysregulation are possible.

Lifestyle medicine

Fundamental Clinical Imbalances : Hormonal ; Structural
Patient Centred Factors : Mediators/Maternal hypothyroidism
Environmental Inputs : Diet
Personal Lifestyle Factors : Nutrition ; Environment
Functional Laboratory Testing : Not applicable

Methodological quality

Jadad score : Not applicable
Allocation concealment : Not applicable

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