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THERAPY OF ENDOCRINE DISEASE: Antithyroid drug use in early pregnancy and birth defects: time windows of relative safety and high risk?
Open accessAbstract
Background: Antithyroid drugs (ATDs) may have teratogenic effects when used in early pregnancy. Objective: To review the association between the time period of ATD exposure in early pregnancy and the development of birth defects. Methods: We identified publications on birth defects after early pregnancy exposure to the ATDs methimazole (MMI; and its prodrug carbimazole (CMZ)) and propylthiouracil (PTU). Cases of birth defects after ATD treatment had been initiated or terminated within the first 10 weeks of pregnancy were identified and studied in detail. Results: A total of 92 publications were read in detail. Two recent large controlled studies showed ATD-associated birth defects in 2–3% of exposed children, and MMI/CMZ-associated defects were often severe. Out of the total number of publications, 17 included cases of birth defects with early pregnancy stop/start of ATD treatment, and these cases suggested that the high risk was confined to gestational weeks 6–10, which is the major period of organogenesis. Thus, the cases reported suggest that the risk of birth defects could be minimized if pregnant women terminate ATD intake before gestational week 6. Conclusion: Both MMI and PTU use in early pregnancy may lead to birth defects in 2–3% of the exposed children. MMI-associated defects are often severe. Proposals are given on how to minimize the risk of birth defects in fertile women treated for hyperthyroidism with ATDs.
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Metadata
- Authors
- Laurberg, P., & Andersen, S. L.
- Affiliations
- Aalborg University Hospital (DK)
- Corresponding author
- Laurberg, Peter
- Venue
- European Journal of Endocrinology
- Publisher
- Oxford University Press (OUP)
- Published
- 2014-07
- Volume
- 171
- Issue
- 1
- Pages
- R13-R20
- ISSN
- 0804-4643 (ISSN-L)
- 1479-683X
- OpenAlex
- W2078098699
- Cited by
- 115
- References
- 46
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 1 · 2023: 10 · 2022: 9 · 2021: 9 · 2020: 15 · 2019: 10 · 2018: 11 · 2017: 10 · 2016: 14 · 2015: 13 · 2014: 6
- FWCI
- 2.23
- Type
- journal article
- Language
- en
- Open access
- green
- vbn.aau.dk
- Licence
- other-oa
- Locations
- European Journal of Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- VBN Forskningsportal (Aalborg Universitet) (publishedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy and Medication Impact
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pharmacological Effects and Toxicity Studies
- Keywords
- antithyroid drugs, teratogenicity, congenital malformations, early pregnancy, methimazole, carbimazole, propylthiouracil, gestational age, hyperthyroidism in pregnancy, organogenesis, drug safety in pregnancy
- MeSH terms
- Congenital Abnormalities, Carbimazole, Endocrine System Diseases, Female, Humans, Male, Pregnancy, Pregnancy Complications, Propylthiouracil, Antithyroid Agents
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