Association of Neonatal Thyroid Stimulating Hormone
Concentration with Intellectual, Psychomotor and Psychosocial
Development of Preschool Children
CAROLINE TRUMPFF Thesis submitted in fulfillment
of the requirements for the degree of Doctor (PhD) in Psychological Sciences
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Table of content
Introduction ... 1
1. Mild iodine deficiency in pregnancy in Europe and its consequences for cognitive and psychomotor development of children ... 3
1.1. Abstract ... 4
1.2. Introduction ... 5
1.3. Thyroid function during pregnancy ... 7
1.4. Maternal TH supply and fetal brain development ... 11
1.5. Maternal hypothyroxinemia and cognitive and psychomotor development during childhood ... 12
1.6. Neonatal hyperthyrotropinaemia and cognitive and psychomotor development during childhood ... 17
1.7. Conclusion ... 23
2. Elevated TSH at birth used as a tool to assess iodine deficiency during pregnancy and/or in a population ... 25
2.1. Abstract ... 26
2.2. Introduction ... 27
2.3. Neonatal screening for congenital hypothyroidism ... 30
2.4. Elevation of TSH at birth as an indicator of iodine deficiency during pregnancy ... 32
2.5. Association of TSH measured at birth with others indicators of iodine status ... 32
2.6. Summary of studies which used TSH as an indicator of iodine status of a population ... 34
2.7. Factors influencing TSH concentration in newborn ... 44
2.8. Discussion ... 51
Methodology... 55
1. Abstract ... 58
2. Introduction ... 60
3. Research objectives ... 64
4. Tools and methods ... 65
XIX
4.2. Subjects ... 65
4.3. Psychological testing ... 67
4.4. Children anthropometric measurements ... 68
4.5. Children urinary iodine concentration ... 68
4.6. Data collection of covariates, effect modifiers and descriptive variables ... 69
5. Discussion ... 72
Results ... 75
6. Factors explaining variation of TSH at birth ... 77
6.1. Abstract ... 78
6.2. Introduction ... 79
6.3. Materials and methods ... 82
6.4. Results ... 84
6.5. Discussion ... 90
7. Elevation of TSH levels at birth and cognitive score in preschool children ... 93
7.1. Abstract ... 94
7.2. Introduction ... 95
7.3. Materials and methods ... 96
7.4. Results ... 100
7.5. Discussion ... 111
8. Elevation of TSH levels at birth and psychomotor score in preschool children ... 117
8.1. Abstract ... 118
8.2. Introduction ... 120
8.3. Methods ... 120
8.4. Results ... 124
8.5. Discussion ... 129
9. Elevation of TSH levels at birth and psychosocial score in preschool children ... 135
9.1. Abstract ... 136
9.2. Introduction ... 137
9.3. Methods ... 138
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9.5. Discussion ... 154
9.6. Conclusion ... 156
General discussion & conclusions ... 161
1. Summary of the objective of the thesis ... 163
2. Summary of the results and discussion ... 164
2.1. Factors influencing TSH concentration at birth ... 164
2.2. Association between neonatal TSH concentration and neurodevelopment of children . 165 2.3. Factors influencing cognitive, psychomotor and psychosocial development ... 175
3. Limitations of the study ... 181
4. Originality of the study and coherence of the results ... 182
5. Recommendation for further research ... 183
5.1. Assessment of the impact of MID in pregnancy on the neurodevelopment of children . 183 5.2. Effect of iodine supplementation on neonatal thyroid function and subsequent neurodevelopment... 183
5.3. Re-evaluation of the use of neonatal TSH as an indicator of iodine status ... 185
6. Conclusion ... 186
