Background Thyroid dysfunction in pregnancy is associated with adverse offspring outcomes and recent birth-cohort studies suggest that even mild degrees of thyroid dysfunction may be linked with a range of late cognitive and behavioural effects in childhood and adolescence. Sources of data This review summarizes recent literature of observational studies and critically appraises randomized controlled trials (RCTs) of antenatal thyroid screening and Levothyroxine intervention. Areas of agreement Overt hypothyroidism and hyperthyroidism carry significant risks for unfavourable offspring outcomes and should be appropriately corrected in pregnancy. Areas of controversy The significance of subclinical hypothyroidism and hypothyroxinaemia is still unclear. Meta-analyses of birth-cohort studies show associations of maternal subclinical hypothyroidism and hypothyroxinaemia with intellectual deficits, attention deficit hyperactivity disorder (ADHD) and autism spectrum disorders, while hyperthyroidism and high-normal FT4 were linked with ADHD. RCTs have shown no benefits of screening on neurodevelopmental outcomes although Levothyroxine could have been initiated too late in pregnancy in these trials. Growing points A small number of studies have shown inconsistent associations of maternal thyroid dysfunction with offspring cardiometabolic indices including blood pressure and body weight. Correction of maternal thyroid dysfunction was, however, associated with favourable long-term metabolic profiles in mothers, including lipid profiles, fat mass and body mass index. Antenatal thyroid screening may therefore present opportunities for optimizing a wider range of outcomes than envisaged. Areas for developing research Future trials with early antenatal thyroid screening and intervention are necessary to clarify the impact of screening on late offspring and maternal effects.

中文翻译：

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产前甲状腺筛查对晚期后代的影响

背景 妊娠期甲状腺功能障碍与后代不良结局相关，最近的出生队列研究表明，即使是轻微程度的甲状腺功能障碍也可能与儿童和青春期的一系列晚期认知和行为影响有关。数据来源 本综述总结了近期的观察性研究文献，并对产前甲状腺筛查和左旋甲状腺素干预的随机对照试验 (RCT) 进行了严格评价。共识领域 明显的甲状腺功能减退症和甲状腺功能亢进症对后代不良结局具有重大风险，应在妊娠期适当纠正。争议领域 亚临床甲状腺功能减退症和低甲状腺素血症的意义仍不清楚。出生队列研究的荟萃分析显示，母体亚临床甲状腺功能减退症和低甲状腺素血症与智力缺陷、注意力缺陷多动障碍 (ADHD) 和自闭症谱系障碍有关，而甲状腺功能亢进症和高正常 FT4 与 ADHD 相关。尽管在这些试验中左甲状腺素可能在妊娠期太晚开始使用，但随机对照试验显示筛查对神经发育结果没有益处。生长点 少数研究表明母体甲状腺功能障碍与后代心脏代谢指标（包括血压和体重）之间存在不一致的关联。然而，母亲甲状腺功能障碍的纠正与母亲良好的长期代谢特征相关，包括脂质特征、脂肪量和体重指数。因此，产前甲状腺筛查可能会为优化比预想的更广泛的结果提供机会。开展研究的领域 未来的早期产前甲状腺筛查和干预试验对于阐明筛查对晚期后代和母体影响的影响是必要的。