MedicalResearch.com Interview with:
Dr. Tim Korevaar
Dr. Tim IM Korevaar, MD
Epidemiology, Internal Medicine (General Medicine)
Erasmus University Rotterdam, Rotterdam
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Korevaar: In the medical literature on this topic, many studies have studied risk factors for abnormal thyroid dysfunction during pregnancy – and this is important because it allows clinicians to distinguish high from low risk individuals. However, most studies focused on identifying a single risk factor, for example maternal age or parity. However, this does not translate to clinical practice because a patient sitting in front of you always has multiple characteristics and the combination of these characteristics is likely to be more specific for risk assessment.
In almost 10,000 women, we investigated what clinical characteristics are risk factors for high TSH or low FT4 during pregnancy and subsequently, we investigated to what extent the combination of these risk factors is able to distinguish women with abnormal thyroid function. We found that BMI, ethnicity and non-smoking are risk factors for high TSH, but that overall, these risk factors very poorly predict the risk of high TSH (C-statistic of 0.60). Subsequent analysis showed that the poor predictive ability of risk factors for high TSH was due to the large proportion of TPO antibodies
(TPOAb) positivity in the group of women with high TSH.
For low FT4, maternal age, BMI, smoking, parity and gestational age at presentation were risk factors for low FT4. Overall, these risk factors discriminated women with low FT4 from normal FT4 with good overall discriminative ability (C-statistic 0.76).
MedicalResearch.com: What should clinicians and patients take away from your report?
Dr. Korevaar: First of all, clinicians can use these risk factors for distinguishing high from low risk patients. The identification of these risk factors can help raise awareness amongst patients and hopefully allow for more timely presentation of women with a high risk in clinical practice.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Dr. Korevaar: Further research should focus on investigating optimal cut-offs for our risk score, and the consequences of its potential use for screening modalities.
MedicalResearch.com: Is there anything else you would like to add?
Dr. Korevaar: We also provide an online calculator for the prediction model of FT4 at: http://www.erasmusmc.nl/formulieren/schildklier/?lang=en
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Citation: Abstract presented at the 2016 ENDO meeting April 2016
Identification of Clinical Risk Factors and a Prediction Model for Low Maternal Thyroid Function during Early Pregnancy
Tim IM Korevaar*1, Daan Nieboer2, Peter H Bisschop3, Mariette Goddijn4, Marco Medici5, Layal Chaker1, Yolanda B. de Rijke6, Vincent Jaddoe2, Henning Tiemeier1, Theo J Visser7, Ewout Steyerberg2, Tanja Vrijkotte4 and Robin P. Peeters8
1Erasmus Medical Center, Rotterdam, 2Erasmus MC, 3Academic Medical Center, Netherlands, 4Amsterdam Medical Center, 5Erasmus medical center, Rotterdam, Netherlands, 6Erasmus MC, Rotterdam, Netherlands, 7Erasmus Univ Med Ctr, Rotterdam, Netherlands,8Erasmus Univ Rotterdam, Rotterdam, Netherlands
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Dr. Tim IM Korevaar, MD (2016). Clinical Risk Factors and a Prediction Model for Low Maternal Thyroid Function during Early Pregnancy Identified MedicalResearch.com