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出生前甲状腺スクリーニングと小児期の認知機能

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2012年02月09日(Thu) 12:36 by drharasho

重要論文。取り急ぎアップ。

結論としては、妊娠12週頃に妊婦の甲状腺スクリーニングをして、
甲状腺機能低下症の治療をしても、子どもの発達には明らかな差はない、
ということのようですが、3歳児の検査で差が出たらそれこそ大変なようにも
思われます。

Antenatal Thyroid Screening and Childhood Cognitive Function

John H. Lazarus, M.D., Jonathan P. Bestwick, M.Sc., Sue Channon, D.
Clin.Psych., Ruth Paradice, Ph.D., Aldo Maina, M.D., Rhian Rees, M.Sc.,
Elisabetta Chiusano, M.Psy., Rhys John, Ph.D., Varvara Guaraldo, M.S.
Chem., Lynne M. George, H.N.C., Marco Perona, M.S.Chem.,
Daniela Dall'Amico, M.D., Arthur B. Parkes, Ph.D., Mohammed Joomun, M.Sc.,
and Nicholas J. Wald, F.R.S.

N Engl J Med 2012; 366:493-501February 9, 2012

Background

Children born to women with low thyroid hormone levels have been reported
to have decreased cognitive function.

Methods

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 (T4). 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 T4 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.

Results

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.

Conclusions

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,

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