Ethnic differences in maternal thyroid parameters during pregnancy: the Generation R study

Korevaar, Tim I. M.; Medici, Marco; de Rijke, Yolanda B.; Visser, Willy; de Muinck Keizer-Schrama, Sabine M. P. F.; Jaddoe, Vincent W. V.; Hofman, Albert; Ross, H. Alec; Visser, W. Edward; Hooijkaas, Herbert; Steegers, Eric A. P.; Tiemeier, Henning; Bongers-Schokking, Jacoba J.; Visser, Theo J.; Peeters, Robin P.

doi:10.1210/jc.2013-2005

Cited by 150Thyroid Disorders and TreatmentsClinical Laboratory Practices and Quality ControlThyroid Cancer Diagnosis and Treatment

Ethnic differences in maternal thyroid parameters during pregnancy: the Generation R study

Korevaar, Tim I. M., Medici, Marco, de Rijke, Yolanda B., Visser, Willy, de Muinck Keizer-Schrama, Sabine M. P. F., Jaddoe, Vincent W. V., Hofman, Albert, Ross, H. Alec +7 more·2013·The Journal of Clinical Endocrinology & Metabolism

DOI 10.1210/jc.2013-2005

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Abstract

CONTEXT: Abnormal maternal thyroid function during pregnancy is associated with various complications. International guidelines advocate the use of population-based trimester-specific reference ranges for thyroid function tests. When unavailable, an upper TSH limit of 2.5 for the first trimester and 3.0 mU/L for the second and third trimesters is recommended. Although interindividual differences in thyroid function tests can partially be explained by ethnicity, data on the influence of ethnicity on TSH and free T4 reference ranges during pregnancy are sparse. DESIGN: Serum TSH, free T4, T4, and TPO-antibody levels were determined during early pregnancy in 3944 women from the Generation R study, Rotterdam, The Netherlands. RESULTS: The study population consisted of 2765 Dutch, 308 Moroccan, 421 Turkish, and 450 Surinamese women. Mean TSH levels were higher in Dutch and Turkish women than in Moroccan or Surinamese women (1.50-1.48 vs 1.29-1.33 mU/L; P < .01). Although no differences in free T4 were seen, T4 was lowest in Dutch women (142 vs 150-156 nmol/L; P < .01). Turkish women had the highest frequency of TPO-antibody positivity (9.3% vs 5.0-5.8%; P < .05) and of elevated TSH levels in the second trimester (11.0% vs 3.8-7.3%; P < .01). A comparison of disease prevalence between a population-based vs an ethnicity-specific reference range changed the diagnosis for 18% of women who were initially found to have abnormal thyroid function test results. CONCLUSIONS: We show ethnic differences in serum TSH, T4, and TPO-antibody positivity and found significant diagnostic discrepancies depending on whether population or ethnicity-specific reference ranges were used to diagnose thyroid disease.

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Misclassification of abnormal thyroid function or restoration to euthyroidism can occur when stricter targets are used in pregnancy.
“Although the effect is modest, misclassification of abnormal thyroid function or restoration to euthyroidism can occur when stricter targets are used in pregnancy.21”
From Hypothyroidism (2024) · cites this paper as [21]

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Background
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Background
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Yazbeck, C. F., & Sullivan, S. D. (2012) · Medical Clinics of North America · doi:10.1016/j.mcna.2012.01.004 · Cited by 64 · see citing works
TSH and FT4 reference intervals in pregnancy: a systematic review and individual participant data meta-analysis
Osinga, J. A. J., Derakhshan, A., Palomaki, G. E., Ashoor, G., Männistö, T., Maraka, S., Chen, L., Bliddal, S., Lu, X., Taylor, P. N., et al. (2022) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgac425 · Cited by 54 · see citing works
Self-citation
First trimester thyroid stimulating hormone as an independent risk factor for adverse pregnancy outcome
Arbib, N., Hadar, E., Sneh‐Arbib, O., Chen, R., Wiznitzer, A., & Gabbay‐Benziv, R. (2016) · The Journal of Maternal-Fetal & Neonatal Medicine · doi:10.1080/14767058.2016.1242123 · Cited by 52 · see citing works
Clinical Aspects of Hyperthyroidism, Hypothyroidism, and Thyroid Screening in Pregnancy
Negro, R., & Stagnaro‐Green, A. (2014) · Endocrine Practice · doi:10.4158/ep13350.ra · Cited by 49 · see citing works
“Korevaar et al (42) recently published results from a population study of 2,765 Dutch, 450 Surinamese, 308 Moroccan, and 421 Turkish women during pregnancy.”
Result
Management of overt hypothyroidism during pregnancy
Li, S. W., & Chan, S. (2020) · Best Practice & Research Clinical Endocrinology & Metabolism · doi:10.1016/j.beem.2020.101439 · Cited by 46 · see citing works
Placental Angiogenic Factors Are Associated With Maternal Thyroid Function and Modify hCG-Mediated FT4Stimulation
Korevaar, T. I. M., Steegers, E. A. P., de Rijke, Y. B., Visser, W. E., Jaddoe, V. W. V., Visser, T. J., Medici, M., & Peeters, R. P. (2015) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2015-2553 · Cited by 45 · see citing works
Effects of nongenetic factors on immune cell dynamics in early childhood: The Generation R Study
van den Heuvel, D., Jansen, M. A. E., Nasserinejad, K., Dik, W. A., van Lochem, E. G., Bakker‐Jonges, L. E., Bouallouch-Charif, H., Jaddoe, V. W. V., Hooijkaas, H., van Dongen, J. J. M., et al. (2016) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2016.10.023 · Cited by 44 · see citing works
Physiological and metabolic adaptations in pregnancy: importance of trimester-specific reference intervals to investigate maternal health and complications
Bohn, M. K., & Adeli, K. (2021) · Critical Reviews in Clinical Laboratory Sciences · doi:10.1080/10408363.2021.1978923 · Cited by 41 · see citing works
“Studies have observed ethnic differences in thyroid parameters during pregnancy and have demonstrated diagnostic discrepancies depending on whether ethnicity-specific reference intervals were implemented clinically [26,33].”
Background
Thyroid Disease in Pregnancy: A Descriptive Review of Guidelines
Tsakiridis, I. G., Giouleka, S., Kourtis, A., Mamopoulos, A. M., Athanasiadis, A. P., & Dagklis, T. (2022) · Obstetrical & Gynecological Survey · doi:10.1097/ogx.0000000000000960 · Cited by 42 · see citing works
Hypothyroidism in Pregnancy
Taylor, P. N., & Lazarus, J. H. (2019) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/j.ecl.2019.05.010 · Cited by 39 · see citing works
Subclinical hypothyroidism in pregnancy: controversies on diagnosis and treatment
Gietka‐Czernel, M., & Glinicki, P. (2020) · Polskie Archiwum Medycyny Wewnętrznej · doi:10.20452/pamw.15626 · Cited by 39 · see citing works
Management of subclinical hypothyroidism in pregnancy: are we too simplistic?
Brabant, G. E., Peeters, R. P., Chan, S., Bernal, J., Bouchard, P., Salvatore, D., Boelaert, K., & Laurberg, P. (2015) · European Journal of Endocrinology · doi:10.1530/eje-14-1005 · Cited by 38 · see citing works
Thyroid dysfunction during gestation and gestational diabetes mellitus: a complex relationship
Pinto, S., Croce, L., Lea, C., Cosson, E., & Rotondi, M. (2023) · Journal of Endocrinological Investigation · doi:10.1007/s40618-023-02079-3 · Cited by 39 · see citing works
“Recent evidence suggests that using ethnic-specific reference ranges for thyroid function parameters during pregnancy would allow to correctly identify pregnant patients with a SCH [61, 62].”
Background
Pregnancy Week-Specific Reference Ranges for Thyrotropin and Free Thyroxine in the North Denmark Region Pregnancy Cohort
Andersen, S. L., Andersen, S., Carlé, A., Christensen, P. A., Handberg, A., Karmisholt, J., Knøsgaard, L., Kristensen, S. R., Pedersen, I. B., & Vestergaard, P. (2019) · Thyroid · doi:10.1089/thy.2018.0628 · Cited by 37 · see citing works
“This is in contrast with other reports (40,41).”
Risk factors and a clinical prediction model for low maternal thyroid function during early pregnancy: two population‐based prospective cohort studies
Korevaar, T. I. M., Nieboer, D., Bisschop, P. H. L. T., Goddijn, M., Medici, M., Chaker, L., de Rijke, Y. B., Jaddoe, V. W. V., Visser, T. J., Steyerberg, E. W., et al. (2016) · Clinical Endocrinology · doi:10.1111/cen.13153 · Cited by 36 · see citing works
Age-Specific Reference Intervals for Thyroid-Stimulating Hormones and Free Thyroxine to Optimize Diagnosis of Thyroid Disease
Jansen, H. I., Dirks, N. F., Hillebrand, J. J., ten Boekel, E., Brinkman, J. W., Buijs, M. M., Demir, A. Y., Dijkstra, I. M., Endenburg, S. C., Engbers, P., et al. (2024) · Thyroid · doi:10.1089/thy.2024.0346 · Cited by 35 · see citing works
Early pregnancy thyroid hormone reference ranges in Chilean women: the influence of body mass index
Mosso, L. M., Martínez, A., Rojas, M. P., Latorre, G., Margozzini, P., Lyng, T., Jorge Carvajal, C., Campusano, C., Arteaga, E., & Boucai, L. (2016) · Clinical Endocrinology · doi:10.1111/cen.13127 · Cited by 35 · see citing works
Thyroid Disorders During Pregnancy
Nathan, N., & Sullivan, S. D. (2014) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/j.ecl.2014.02.008 · Cited by 35 · see citing works
“were initially labeled as having an abnormal TFT; however, ethnic-specific reference ranges for TSH are not currently endorsed by the Endocrine Society or the American Thyroid Association (ATA), nor are ethnic-specific ranges commonly used in clinical practice.(3,16,19) According to ATA and Endocrine Society guideline…”
Maternal thyroid parameters in pregnant women with different ethnic backgrounds: Do ethnicity‐specific reference ranges improve the diagnosis of subclinical hypothyroidism?
Veltri, F., Belhomme, J., Kleynen, P., Grabczan, L., Rozenberg, S., Pepersack, T., & Poppe, K. G. (2017) · Clinical Endocrinology · doi:10.1111/cen.13340 · Cited by 32 · see citing works
Maternal thyroid function, prepregnancy obesity and gestational weight gain—The Generation R Study: A prospective cohort study
Collares, F. M., Korevaar, T. I. M., Albert Hofman, D., Steegers, E. A. P., Peeters, R. P., Jaddoe, V. W. V., & Gaillard, R. (2017) · Clinical Endocrinology · doi:10.1111/cen.13412 · Cited by 34 · see citing works
Subclinical hypothyroidism: When to treat
Azim, S., & Nasr, C. E. (2019) · Cleveland Clinic Journal of Medicine · doi:10.3949/ccjm.86a.17053 · Cited by 38 · see citing works
“…TSH levels (2.5–5 mIU/L) 99;104–107 ; risk is as high as 60% with TSH levels > 6 mIU/L and higher with positive thyroid peroxidase antibody 108–110 Improves maternal and fetal outcomes, including risk of low birth weight and low Apgar score, in women with subclinical hypothyroidism and TSH…”
BackgroundInfluential
Thyroid Function and Premature Delivery in TPO Antibody−Negative Women: The Added Value of hCG
Korevaar, T. I. M., Steegers, E. A. P., Chaker, L., Medici, M., Jaddoe, V. W. V., Visser, T. J., de Rijke, Y. B., & Peeters, R. P. (2017) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2017-00846 · Cited by 32 · see citing works
Maternal thyroid hormone trajectories during pregnancy and child behavioral problems
Endendijk, J. J., Wijnen, H. A. A., Pop, V. J. M., & van Baar, A. L. (2017) · Hormones and Behavior · doi:10.1016/j.yhbeh.2017.06.007 · Cited by 32 · see citing works
“This ethnic homogeneity limits the generalizability of our ﬁ ndingstotheDutchmulti-ethnicandmulti-racialpopulation,especial- lysincethereareethnicdifferencesinmaternalthyroidparametersdur-ing pregnancy (Korevaar et al., 2013).”
Thyroid hormone therapy of hypothyroidism in pregnancy
Shan, Z., & Teng, W. (2019) · Endocrine · doi:10.1007/s12020-019-02044-2 · Cited by 28 · see citing works
Gestational TSH and FT4 Reference Intervals in Chinese Women: A Systematic Review and Meta-Analysis
Gao, X., Li, Y., Li, J., Liu, A., Sun, W., Teng, W., & Shan, Z. (2018) · Frontiers in Endocrinology · doi:10.3389/fendo.2018.00432 · Cited by 30 · see citing works
Free thyroxine measurement in clinical practice: how to optimize indications, analytical procedures, and interpretation criteria while waiting for global standardization
D’Aurizio, F., Kratzsch, J., Gruson, D., Ovčariček, P. P., & Giovanella, L. (2022) · Critical Reviews in Clinical Laboratory Sciences · doi:10.1080/10408363.2022.2121960 · Cited by 31 · see citing works
TSH and FT4 reference interval recommendations and prevalence of gestational thyroid dysfunction: quantification of current diagnostic approaches
Osinga, J. A. J., Derakhshan, A., Feldt-Rasmussen, U., Huang, K., Vrijkotte, T. G. M., Männistö, T., Bassols, J., López-Bermejo, A., Aminorroaya, A., Vafeiadi, M., et al. (2024) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgad564 · Cited by 27 · see citing works
“…tend to culminate in misdiagnoses when applied to diverse local populations (13-15), most likely because TSH and FT4 measurements differ due to various methodologies (assay, preanalytical handling (16)) as well as patient characteristics (body mass index, ethnicity, gestational age (8, 17-19)).”
Background
Pregnancy disrupts the accuracy of automated fT4 immunoassays
Jansen, H. I., van Herwaarden, A. E., Huijgen, H. J., Painter, R. C., Hillebrand, J. J., Boelen, A., & Heijboer, A. C. (2022) · European Thyroid Journal · doi:10.1530/etj-22-0145 · Cited by 29 · see citing works
Thyroid stimulating hormone (TSH) ≥2.5mU/l in early pregnancy: Prevalence and subsequent outcomes
Carty, D., Doogan, F., Welsh, P. I., Dominiczak, A. F., & Delles, C. (2017) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2017.01.048 · Cited by 26 · see citing works
The Association of Maternal Iodine Status in Early Pregnancy with Thyroid Function in the Swedish Environmental Longitudinal, Mother and Child, Asthma and Allergy Study
Levie, D., Derakhshan, A., Shu, H., Broeren, M. A. C., de Poortere, R. A., Peeters, R. P., Bornehag, C., DEMENEIX, B. A., & Korevaar, T. I. M. (2019) · Thyroid · doi:10.1089/thy.2019.0164 · Cited by 25 · see citing works
“While it is known that reference ranges differ between populations (24), and that those differences may be partially explained by differences in ethnicity (25–27), there has been insufﬁcient evidence that iodine status may also affect thyroid function within its normal range.”
Toward a science-based testing strategy to identify maternal thyroid hormone imbalance and neurodevelopmental effects in the progeny – part I: which parameters from human studies are most relevant for toxicological assessments?
Sauer, U. G., Asiimwe, A., Botham, P. A., Charlton, A., Hallmark, N., Jacobi, S., Marty, S., Melching‐Kollmuss, S., Palha, J. A., Strauss, V., et al. (2020) · Critical Reviews in Toxicology · doi:10.1080/10408444.2020.1839380 · Cited by 25 · see citing works
Is subclinical hypothyroidism associated with lower live birth rates in women who have experienced unexplained recurrent miscarriage?
van Dijk, M. M., Vissenberg, R., Bisschop, P. H. L. T., Dawood, F., van Wely, M., Goddijn, M., & Farquharson, R. G. (2016) · Reproductive BioMedicine Online · doi:10.1016/j.rbmo.2016.09.002 · Cited by 24 · see citing works
Accurate interpretation of thyroid dysfunction during pregnancy: should we continue to use published guidelines instead of population-based gestation-specific reference intervals for the thyroid-stimulating hormone (TSH)?
Turkal, R., Armağan, T. C., Elbasan, O., Aytan, S., Çakmak, B. D., Gozaydınoğlu, B., Ceyda, T. D., Ünlü, O., Bahramzada, G., Tekin, A. F., et al. (2022) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-022-04608-z · Cited by 23 · see citing works
“also reported misinterpretation of TSH in 18% of pregnant women due to ethnic discrepancy [25].”
Background
Should All Women Be Screened for Thyroid Dysfunction in Pregnancy?
Taylor, P. N., Okosieme, O. E., Premawardhana, L. D. K. E., & Lazarus, J. H. (2015) · Women s Health · doi:10.2217/whe.15.7 · Cited by 23 · see citing works
Current challenges in the pharmacological management of thyroid dysfunction in pregnancy
Khan, I. N., Okosieme, O. E., & Lazarus, J. H. (2016) · Expert Review of Clinical Pharmacology · doi:10.1080/17512433.2017.1253471 · Cited by 23 · see citing works
“function depending on whether population or ethnicity-specific reference ranges are applied [40].”
Background
Association between Low Free Triiodothyronine Levels and Poor Prognosis in Patients with Acute ST-Elevation Myocardial Infarction
Song, Y., Li, J., Bian, S., Qin, Z., Song, Y., Jin, J., Zhao, X., Song, M., Chen, J., & Huang, L. (2018) · BioMed Research International · doi:10.1155/2018/9803851 · Cited by 22 · see citing works
Maternal Thyroid Function in Early Pregnancy and Child Attention-Deficit Hyperactivity Disorder: An Individual-Participant Meta-Analysis
Levie, D., Korevaar, T. I. M., Mulder, T. A., Bath, S. C., Dineva, M., López-Espinosa, M.-J., Basterrechea, M., Santa‐Marina, L., Rebagliato, M., Sunyer, J., et al. (2019) · Thyroid · doi:10.1089/thy.2018.0794 · Cited by 22 · see citing works
“…to adjust for maternal ethnicity/country of birth because it is known that there are ethnic differences in maternal thyroid parameters during pregnancy (48–50), and race/ethnicity is intertwined with social economic status, which has been associated with behavioral problems (51) and ADHD (13,52).”
Variables Contributing to Thyroid (Dys)Function in Pregnant Women: More than Thyroid Antibodies?
Veltri, F., & Poppe, K. G. (2018) · European Thyroid Journal · doi:10.1159/000488279 · Cited by 20 · see citing works
Thyroid Function During Pregnancy in A Multiethnic Population in Norway
Sletner, L., Jenum, A. K., Qvigstad, E., & Hammerstad, S. S. (2021) · Journal of the Endocrine Society · doi:10.1210/jendso/bvab078 · Cited by 20 · see citing works
“The overall prevalence of TPO Ab positivity in our study was similar to other multiethnic population studies [7, 8, 18, 19], but was lower in Middle Eastern women, similar to reports by others, and higher in South Asians [20-22].”
BackgroundResultInfluential
Reference values and the effect of clinical parameters on thyroid hormone levels during early pregnancy
Lin, H., Ye, M., Zhou, Z., Yuan, L., Lash, G. E., Zhang, G., & Li, L. (2020) · Bioscience Reports · doi:10.1042/bsr20202296 · Cited by 21 · see citing works
High Prevalence of Maternal Hypothyroidism Despite Adequate Iodine Status in Indian Pregnant Women in the First Trimester
Jaiswal, N., Melse‐Boonstra, A., Thomas, T. S., Basavaraj, C., Sharma, S. K., Srinivasan, K., & Zimmermann, M. B. (2014) · Thyroid · doi:10.1089/thy.2014.0071 · Cited by 19 · see citing works
“A recent study from the Netherlands suggested that there may be ethnic differences in reference ranges to diagnose thyroid disease (38).”
Screening for Thyroid Dysfunction in Pregnancy With Targeted High-Risk Case Finding: Can It Be Improved?
Sitoris, G., Veltri, F., Kleynen, P., Belhomme, J., Rozenberg, S., & Poppe, K. G. (2019) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2018-02303 · Cited by 19 · see citing works
The Attitude Toward Hypothyroidism During Early Gestation: Time for a Change of Mind?
Pop, V. J. M., Broeren, M. A. C., & Wiersinga, W. M. (2014) · Thyroid · doi:10.1089/thy.2014.0007 · Cited by 17 · see citing works
“Moreover, ethnic differences should also be taken into account (7,8).”
Incidence of Subclinical Hypothyroidism and Hypothyroidism in Early Pregnancy
Hosseini, F., Johansson, B., Möllerström, G., Landgren, B.-M., Stavreus-Evers, A. C., & Skjöldebrand‐Sparre, L. (2017) · Journal of Women s Health · doi:10.1089/jwh.2016.6111 · Cited by 17 · see citing works
“Since the normal range of TSH varies according to geographic region and ethnic background, the incidence of clinical and SCH varies among studies, and the number of patients with undiscovered overt hypothyroidism/SCH remains unknown.(14) Data on the incidence of overt hypothyroidism/SCH in Swedish pregnant women are s…”
Soluble Flt1 and Placental Growth Factor Are Novel Determinants of Newborn Thyroid (Dys)Function: The Generation R Study
Korevaar, T. I. M., Steegers, E. A. P., Schalekamp–Timmermans, S., Ligthart, S., de Rijke, Y. B., Visser, W. E., Visser, W. E., Keizer‐Schrama, S. M. P. F. D. M., Albert Hofman, D., Hooijkaas, H., et al. (2014) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2014-1884 · Cited by 17 · see citing works
Acute painful crises may be causes of sudden deaths in sickle cell diseases
Helvacı, M. R., Camlibel, M., Yuksek, B. C., Sevinç, A., Camcı, C., Abyad, A., & Pocock, L. (2023) · World Family Medicine Journal/Middle East Journal of Family Medicine · doi:10.5742/mewfm.2023.95256109 · Cited by 16 · see citing works
Antithyroid drug therapy in pregnancy: a review of guideline recommendations
Khan, I. N., Okosieme, O. E., & Lazarus, J. H. (2017) · Expert Review of Endocrinology & Metabolism · doi:10.1080/17446651.2017.1338944 · Cited by 16 · see citing works
“ethnicity, geography and iodine nutrition [26,27].”
Thyroid function in pregnancy
Muller, I., Taylor, P. N., & Lazarus, J. H. (2018) · Annals of Thyroid · doi:10.21037/aot.2018.10.05 · Cited by 14 · see citing works
“Several factors influence thyroid status in pregnancy, including iodine status (16), hCG levels (11), ethnicity (27,43), body mass index (44), parity (44) and male foetal sex (44).”
Association between thyroid autoimmunity and gestational diabetes mellitus in euthyroid women
Sitoris, G., Veltri, F., Ichiche, M., Kleynen, P., Praet, J.-P., Rozenberg, S., & Poppe, K. G. (2022) · European Thyroid Journal · doi:10.1530/etj-21-0142 · Cited by 19 · see citing works
Association between thyroid autoimmunity and gestational diabetes mellitus in euthyroid women
Sitoris, G., & Poppe, K. G. (2022) · Dépôt institutionnel de l'Université libre de Bruxelles (Université Libre de Bruxelles) · Cited by 14 · see citing works
A Practical Approach for the Verification and Determination of Site- and Trimester-Specific Reference Intervals for Thyroid Function Tests in Pregnancy
Donovan, L., Metcalfe, A., Chin, A., Yamamoto, J. M., Virtanen, H., Johnson, J.-A., & Krause, R. D. (2018) · Thyroid · doi:10.1089/thy.2018.0439 · Cited by 14 · see citing works
“Since ethnicity has an impact on thyroid test reference intervals in pregnancy (13), this may partially explain why the manufacturer’s reference range for TSH were not conﬁrmed in this study.”
Reference Intervals of Thyroid Function Tests Assessed by Immunoassay and Mass Spectrometry in Healthy Pregnant Women Living in Catalonia
Hernández, J. M., Soldevila, B., Velasco, I., Moreno-Flores, F., Ferrer, L., de, A. P.-M., Santillán, C. D. L. L. R., Muñoz, C., Ballesta, S., Canal, C., et al. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10112444 · Cited by 13 · see citing works
“Due to the known influence of ethnic variations on the thyroid function parameters, we only considered comparisons with studies in the European Caucasian population [19].”
Result
Maternal Thyroid Hormone Programs Cardiovascular Functions in the Offspring
Pedaran, M., Oelkrug, R., Sun, Q., Resch, J., Schomburg, L., & Mittag, J. (2021) · Thyroid · doi:10.1089/thy.2021.0275 · Cited by 13 · see citing works
“These ﬁndings are of clinical relevance, as a large proportion of pregnant women display thyroid disorders (62), but there is a controversial discussion about whether pregnant women should be routinely tested (63).”
Trimester specific reference ranges for serum TSH and Free T4 among United Arab Emirates pregnant women
Khalil, A., Salih, B. T., Chinengo, O., Bardies, M. R. D., Turner, A., & Wareth, L. A. (2018) · Practical Laboratory Medicine · doi:10.1016/j.plabm.2018.e00098 · Cited by 13 · see citing works
Impact of preconceptional serum thyroid stimulating hormone values ranging between 2.5 and 4.5 mIU/L on live birth rates following ovulation induction and intrauterine insemination treatment for unexplained infertility
Karakis, L. S., Kiyak, H. A., Okmen, B., Özdemir, Ç., & Türkgeldi, E. (2021) · BMC Women s Health · doi:10.1186/s12905-021-01299-0 · Cited by 13 · see citing works
“The normal range of thyroid hormones are known to vary with age, geographical location, and ethnicity of the patient population [7].”
Background
Thyroid dysfunction in the era of precision medicine
Galofré, J. C., Díez, J. J., & Cooper, D. S. (2016) · Endocrinología y Nutrición · doi:10.1016/j.endonu.2016.04.009 · Cited by 11 · see citing works
Reference Intervals for Thyroid Hormones During the First Trimester of Gestation: A Report from an Area with a Sufficient Iodine Level
Kianpour, M., Aminorroaya, A., Amini, M., Feizi, A., Janghorbani, M., Shokri, S., Yamini, S. A., Farghadani, M., Hekmatnia, A., & Gharib, H. (2019) · Hormone and Metabolic Research · doi:10.1055/a-0855-7128 · Cited by 10 · see citing works
“Thyroid volume was measured using ultrasound scanning by Philips affinity 70, superficial probe, 4–12 MHz (Made in the Netherlands), for all women by an expert sonographer (S.Sh.).”
ResultInfluential
Gestational age-specific reference intervals for serum thyroid hormone levels in a multi-ethnic population
Ho, C. K. M., Tan, E. T. H., Ng, M. J., Yeo, G. S., Chern, B. S. M., Tee, N. W. S., Kwek, K. Y. C., & Tan, K. H. (2017) · Clinical Chemistry and Laboratory Medicine (CCLM) · doi:10.1515/cclm-2016-0790 · Cited by 10 · see citing works
“Indeed, significant differences in serum TSH levels between ethnic groups have been addressed in the clinical guidelines of the American Thyroid Association [2] and reported in some previous studies [5, 9, 13, 14].”
Background
Establishment of trimester-specific reference range for thyroid hormones during pregnancy
Nazarpour, S., Tehrani, F. R., Simbar, M., Minooee, S., Rahmati, M., Mansournia, M. A., & Azizi, F. (2018) · Clinical Biochemistry · doi:10.1016/j.clinbiochem.2018.01.006 · Cited by 10 · see citing works
Preconceptional thyrotropin level in euthyroid women is inversely associated with the live birth rate in first in vitro fertilization cycle
Grove‐Laugesen, D., Aaskov, C. U., Ebbehøj, E., & Knudsen, U. B. (2019) · Acta Obstetricia Et Gynecologica Scandinavica · doi:10.1111/aogs.13563 · Cited by 10 · see citing works
Thyroid function in neonates of women with subclinical hypothyroidism or hypothyroxinemia
Varner, M. W., Mele, L., Casey, B. M., Peaceman, A. M., Sorokin, Y., Reddy, U. M., Wapner, R. J., Thorp, J. M., Saade, G. R., Tita, A., et al. (2018) · Journal of Perinatology · doi:10.1038/s41372-018-0213-9 · Cited by 9 · see citing works
Iodine Nutritional Status of Pregnant Women After 14 Years of Lipiodol Supplementation: a Cross-Sectional Study in Historically Iodine-Deficient Areas of China
Tayier, R., Wang, C., Ma, P., Yuan, Y., Zhang, Y., Wu, S., & Zhang, L. (2022) · Biological Trace Element Research · doi:10.1007/s12011-022-03123-8 · Cited by 9 · see citing works
Association of Mild Thyroid Dysfunction and Adverse Prognosis Among Chinese Patients With Acute ST Segment Elevation Myocardial Infarction
Li, M., Wei, Z.-T., Li, S., Feng, Q., & Li, J. (2022) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.879443 · Cited by 7 · see citing works
Comparison of the Reference Intervals Used for the Evaluation of Maternal Thyroid Function During Pregnancy Using Sequential and Nonsequential Methods
Fan, J., Yang, S., Qian, W., Shi, F.-T., & Huang, H. (2016) · Chinese Medical Journal · doi:10.4103/0366-6999.178954 · Cited by 7 · see citing works
Pregnancy-related reference intervals for serum thyrotropin based on real-life clinical data
Canovi, S., Vezzani, S., Polese, A., Frasoldati, A., Schiatti, C., Preda, C., Zini, M., Vitiello, A., Foracchia, M., Comitini, G., et al. (2020) · Gynecological Endocrinology · doi:10.1080/09513590.2020.1756251 · Cited by 6 · see citing works
Euthyroid Thyroperoxidase Antibody Positivity during Pregnancy, to Treat or Not to Treat?
Korevaar, T. I. M. (2022) · Endocrinology and Metabolism · doi:10.3803/enm.2022.301 · Cited by 6 · see citing works
“Risk factors for TPOAb positivity are similar to those outside of pregnancy and include a higher age, iodine deficiency or excess and a family or personal history of autoimmune disease, while the link with multiparity remains controversial [4-7].”
Background
Subclinical thyroid diseases and isolated hypothyroxinemia during pregnancy
Locantore, P., Corsello, A., Policola, C., & Pontecorvi, A. (2021) · Minerva Endocrinology · doi:10.23736/s2724-6507.21.03391-5 · Cited by 6 · see citing works
The Effectiveness of Problem-Based Learning in Improving Critical Thinking and Problem-Solving Skills in Medical Students: A Systematic Review of Fifteen Years’ Experience (2005-2019)
Alreshidi, R., & Alreshidi, F. S. (2023) · World Family Medicine Journal/Middle East Journal of Family Medicine · doi:10.5742/mewfm.2023.95256077 · Cited by 7 · see citing works
Medical treatment in pregnant women with subclinical hypothyroidism: systematic review and meta-analysis
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Influential
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“Forty-eight publications were included in the systematic review after removing studies with insufficient data [11, 13, 15, 17, 23–”

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Authors: Korevaar, T. I. M., Medici, M., de Rijke, Y. B., Visser, W., de Muinck Keizer-Schrama, S. M. P. F., Jaddoe, V. W. V., Hofman, A., Ross, H. A., Visser, W. E., Hooijkaas, H., Steegers, E. A. P., Tiemeier, H., Bongers-Schokking, J. J., Visser, T. J., & Peeters, R. P.
Affiliations: Erasmus MC (NL)
Radboud University Nijmegen (NL)
Corresponding author: Peeters, Robin P.
ORCID: Korevaar, Tim I. M.
Medici, Marco
Jaddoe, Vincent W. V.
Steegers, Eric A. P.
Tiemeier, Henning
Peeters, Robin P.
Venue: The Journal of Clinical Endocrinology & Metabolism
Publisher: The Endocrine Society
Published: 2013-09
Volume: 98
Issue: 9
Pages: 3678-3686
ISSN: 0021-972X (ISSN-L)
1945-7197
DOI: 10.1210/jc.2013-2005
OpenAlex: W2133831600
Cited by: 150
References: 51
Citations by year: 2026: 4 · 2025: 3 · 2024: 2 · 2023: 37 · 2022: 17 · 2021: 9 · 2020: 7 · 2019: 13 · 2018: 10 · 2017: 17 · 2016: 9 · 2015: 8 · 2014: 11 · 2013: 2 · 2012: 1
FWCI: 7.84
Type: journal article
Language: en
Open access: closed
Locations: The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
PubMed (publishedVersion)
EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
Radboud Repository (Radboud University) (submittedVersion)
Funders: Erasmus Universiteit Rotterdam
Erasmus Medisch Centrum
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
Health Sciences › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
Keywords: maternal thyroid function, pregnancy, ethnic differences, thyroid-stimulating hormone, free thyroxine, total thyroxine, thyroid peroxidase antibodies, thyroid autoimmunity, thyroid disease diagnosis, Generation R Study
MeSH terms: Adult, Female, Humans, Iodide Peroxidase, Netherlands, Pregnancy, Pregnancy Complications, Reference Values, Thyroid Diseases, Thyroid Function Tests, Thyrotropin, Thyroxine, Triiodothyronine, Prevalence

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Ethnic differences in maternal thyroid parameters during pregnancy: the Generation R study

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