Testing for and then treating pregnant women with mild or “subclinical” underactive thyroid did not improve pregnancy outcomes, newborn baby outcomes, or the child’s IQ at three to five years.
A clearly underactive thyroid (clinical hypothyroidism) in pregnancy has been linked with various adverse outcomes for the mother and baby, including pre-eclampsia, preterm birth, congenital defects and neurodevelopmental delay. This needs treatment. However, there has been debate around the harms and benefits from treating only mildly abnormal blood test results in women who do not show signs of thyroid problems, subclinical hypothyroidism.
These two linked trials randomised 1,203 women with borderline abnormal levels of thyroid-related hormones (but not “clinical” or “overt” hypothyroidism) to receive thyroid replacement treatment, with levothyroxine, or placebo. Treatment had no benefits for mother or baby, including the main outcome of child IQ by three to five years of age.
This supports current UK practice, which does not routinely screen all pregnant women for subclinical thyroid dysfunction.
NHS England has published Manual for prescribed specialised services 2017/18. This manual is the detailed technical document that describes which elements of specialised services are commissioned by NHS England and which by Clinical Commissioning Groups.
Specialist maternity care for women diagnosed with abnormally invasive placenta includes services provided by Specialist Maternal Care Centres including outreach when delivered as part of a provider network.
Public Health England has published an information poster to support the whooping cough vaccination in pregnancy programme. The poster has been designed to promote the need for maternal pertussis vaccination which is now recommended from week 16 of each pregnancy. It is suitable for GP surgeries, hospitals, maternity units, nurseries, child care centres and libraries.
The Royal College of Obstetricians and Gynaecologists (RCOG) has highlighted the publication of a survey, to understand women’s perceptions of how much they should eat during pregnancy. The survey, commissioned by the National Charity Partnership,, found 69 per cent of women are unaware of how many extra calories they need to consume during pregnancy. The RCOG is working with the National Charity Partnership to bust the ’eating for two’ myth and make it easier for people to understand how to make healthy choices during pregnancy to avoid unhealthy weight gain.
Public Health England has updated its leaflet “There are many ways to help protect you and your baby”. This leaflet explains vaccinations that help protect mums and their baby during and after pregnancy. This update includes more detail about the pertussis (whooping cough) vaccine and eligibility.
The Department of Health has published Physical Activity for pregnant women. This infographic outline the duration, frequency and type of physical activity required to achieve general health benefits for different age ranges. It relates to the start active stay active report published by the UK’s four Chief Medical Officers for the NHS, local authorities and a range of other organisations designing services to promote physical activity
Researchers aimed to predict the impact of advising pregnant women to use calcium supplements (1,000 mg/day) on the number of cases of pre-eclampsia prevented and related health care costs. By use of a decision-analytic model, we assessed the expected impact of advising calcium supplementation to either (1) all pregnant women, (2) women at high risk of developing pre-eclampsia, or (3) women with a low dietary calcium intake compared with current care.
The study concluded that advising pregnant women to use calcium supplements can be expected to cause substantial reductions in the incidence of pre-eclampsia as well as related health care costs. It appears most efficient to advise calcium supplementation to all pregnant women, not subgroups only.
Linda J. E. Meertens, Hubertina C. J. Scheepers, Jessica P. M. M. Willemse et al. Should women be advised to use calcium supplements during pregnancy? A decision analysis. Maternal & Child Nutrition 18 JUN 2017 DOI: 10.1111/mcn.12479