Joanne Rovet

Management of Thyroid Dysfunction during Pregnancy and Postpartum: An Endocrine Society Clinical Practice Guideline

OBJECTIVE The aim was to update the guidelines for the management of thyroid dysfunction during pregnancy and postpartum published previously in 2007. A summary of changes between the 2007 and 2012 version is identified in the Supplemental Data (published on The Endocrine Societys Journals Online web site at http://jcem.endojournals.org). EVIDENCE This evidence-based guideline was developed according to the U.S. Preventive Service Task Force, grading items level A, B, C, D, or I, on the basis of the strength of evidence and magnitude of net benefit (benefits minus harms) as well as the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe both the strength of recommendations and the quality of evidence. CONSENSUS PROCESS The guideline was developed through a series of e-mails, conference calls, and one face-to-face meeting. An initial draft was prepared by the Task Force, with the help of a medical writer, and reviewed and commented on by members of The Endocrine Society, Asia and Oceania Thyroid Association, and the Latin American Thyroid Society. A second draft was reviewed and approved by The Endocrine Society Council. At each stage of review, the Task Force received written comments and incorporated substantive changes. CONCLUSIONS Practice guidelines are presented for diagnosis and treatment of patients with thyroid-related medical issues just before and during pregnancy and in the postpartum interval. These include evidence-based approaches to assessing the cause of the condition, treating it, and managing hypothyroidism, hyperthyroidism, gestational hyperthyroidism, thyroid autoimmunity, thyroid tumors, iodine nutrition, postpartum thyroiditis, and screening for thyroid disease. Indications and side effects of therapeutic agents used in treatment are also presented.

The effect of hypoglycemic seizures on cognitive function in children with diabetes : A 7-year prospective study

Sixteen children with insulin-dependent diabetes mellitus were evaluated at diagnosis and after 1, 3, and 7 years. They showed significant declines in verbal but not visuospatial abilities, particularly if they had any seizures from hypoglycemia. At the 7-year assessment those with hypoglycemic seizures showed deficits on perceptual, motor, memory, and attention tasks.

Intellectual outcome in children with fetal hypothyroidism

Eighty children with congenital hypothyroidism detected by newborn screening were grouped for presence of fetal hypothyroidism using skeletal maturity at the time of diagnosis as the index. Forty-five children with bone age less than 36 weeks were assigned to the delayed group; 35 with bone age 37 weeks to term were assigned to the nondelayed group. Although most children with athyrosis were found in the delayed group, the groups did not differ in birth weight, hormone levels, or family background. Assessments of intellectual and behavioral characteristics at 1, 2, 3, 4, and 5 years of age revealed that, although children in the delayed group performed within the normal range, their scores were significantly lower than those of the nondelayed group from age 2 years on. Perceptual-motor, visuospatial, and language areas were most affected. There were no differences in behavior or temperamental characteristics.

Neurocognitive Correlates of Type 1 Diabetes Mellitus in Childhood

Type 1 Diabetes Mellitus (T1DM) is one of the most prevalent chronic health conditions in children under the age of 18 years. Complications of the disease include hypo- and hyperglycemia, which can have an impact on children’s performance in assessment situations, in the clinic, and in school. Because there is no cure for this disease, there is a need to understand the cognitive deficits associated with some of its complications, as this knowledge will impact on the choice of treatment regimens as well as educational interventions. This paper provides a comprehensive review of the relevant literature on the neurocognitive outcome of T1DM. In particular, disease- and treatment-related variables that are associated with poor performance on cognitive domains will be reviewed. Specifically, age of onset, duration, pubertal effects, and presence of hypoglycemia or hyperglycemia will be examined. These findings are not without controversy, and limitations to conclusions will also be presented. Where relevant, recommendations for future research directions will be provided.

Spatial reasoning in children with congenital adrenal hyperplasia due to 21‐hydroxylase deficiency

It has been proposed that exposure of the central nervous system to high concentrations of androgens during sensitive periods in early development may facilitate the ability to process spatial information. Most tests of this proposal have been derived from nonhuman species. To test this hypothesis in humans, we evaluated spatial reasoning in preadolescent children with congenital adrenal hyperplasia (CAH), a condition characterized by elevated androgens during gestation. The Primary Mental Abilities (PMA) Spatial Relations test was administered to 12 children with CAH (7 girls, 5 boys) and 10 unaffected sibling controls (6 girls, 4 boys), ranging in age from 8 to 12 years. Results showed a significant interaction between sex and clinical status. Girls with CAH achieved significantly higher spatial scores than control girls, whereas boys with CAH showed significantly lower spatial scores than control boys. On the PMA Perceptual Speed test, given for comparison, girls with CAH scored significantly lower tha...

Intellectual Deficits Associated With Early Onset of Insulin-Dependent Diabetes Mellitus in Children

Twenty-seven children with early-onset (< 4 yr) diabetes (EOD), 24 children with late-onset (> 4 yr) diabetes (LOD), and 30 sibling controls were compared in their performance on tests of intellectual functioning and school achievement. The results indicated that children with EOD, particularly girls, scored lower than the other groups of diabetic children and siblings on tests of visuospatial (P < .05) but not verbal ability. Many of the girls with EOD were also having difficulty at school, and several were receiving special education. Children with EOD had more hypoglycemic convulsions than those with LOD. Both convulsions and age of onset were associated with poorer performance on spatial tasks. Girls with EOD had lower spatial test scores regardless of convulsion history, whereas boys with EOD scored lower only if they had had a convulsion.

The Psychoeducational Characteristics of Children with Turner Syndrome

Turner syndrome (TS) is a condition that affects 1 in 2,500 females due to a loss of some X chromosome material. It is characterized by a number of common physical features, including short stature, sexual infantilism, and infertility, as well as by specific learning and behavior problems. This article compares abilities, achievement, behavior, and self-esteem in 67 children with TS and 27 nonaffected controls. Results indicate selective impairments in visuospatial and memory areas and significant underachievement in arithmetic, particularly numerical ability, mental calculation, geometry, and reasoning. Learning problems, a major concern for parents, were not being satisfactorily addressed at school. Poor social competence and increased behavior problems, particularly in the area of hyperactivity, were also noted. Although self-esteem was only marginally lower, issues related to poor peer relations were most problematic.

Effects of prenatal alcohol exposure on hippocampal volume, verbal learning, and verbal and spatial recall in late childhood

Children with prenatal alcohol exposure (PAE) show deficits in verbal learning and spatial memory, as well as abnormal hippocampal development. The relationship between their memory and neuroanatomic impairments, however, has not been directly explored. Given that the hippocampus is integral for the synthesis and retrieval of learned information and is particularly vulnerable to the teratogenic effects of alcohol, we assessed whether reduced learning and recall abilities in children with fetal alcohol spectrum disorders (FASDs) are associated with abnormal hippocampal volumes. Nineteen children with FASDs and 18 typically developing controls aged 9 to 15 years were assessed for verbal learning and verbal and spatial recall and underwent structural magnetic resonance imaging. Images were analyzed for total intracranial volume and for right and left hippocampal volumes. Results revealed smaller left hippocampi and poorer verbal learning and verbal and spatial recall performance in children with FASDs than controls, as well as positive correlations between selective memory indices and hippocampal volumes only in the FASD group. Additionally, hippocampal volumes increased significantly with age in controls only, suggesting that PAE may be associated with long-term abnormalities in hippocampal development that may contribute to impaired verbal learning and verbal and spatial recall.

Attentional Functioning in Children and Adolescents With IDDM

OBJECTIVE To determine whether specific attentional cognitive processes are disrupted in children and adolescents with IDDM. RESEARCH DESIGN AND METHODS We tested 103 children and adolescents with IDDM and 100 healthy control subjects (age range 9.3–18.3 years) for intelligence and attention. Subjects were given multiple clinical tests of attention and a computerized vigilance test, all of which served to provide information about multiple components of attentional processing. Specific components studied were the abilities to focus, select, shift, suppress, inhibit, and sustain attention. A diabetic history was obtained for the IDDM group, and blood glucose levels were determined before and after computerized attention testing. RESULTS Across tests, IDDM subjects differed from control subjects only in the select component of attention, which was accounted for mainly by the poorer performance of children with early-onset diabetes (< 6 years). When subgrouped by history of seizures from hypoglycemia, those having had seizures demonstrated a lower verbal IQ and greater difficulty with select, focus, and inhibit attentional components, whereas sustain, suppress, and shift attentional components were unaffected. Correlation analyses showed that higher concurrent blood glucose levels were associated with less adequate ability to inhibit impulsive responses, whereas multiple regression analyses indicated that inhibit and focus were best predicted by onset age and concurrent blood glucose. CONCLUSIONS In children and adolescents with IDDM, attention is poorer in several but not all aspects of attention; these aspects are affected by a history of seizures from hypoglycemia and higher ambient blood glucose levels at time of testing. These results suggest both organizational and activational effects of diabetes on specific subcomponents of attention in diabetes.

Neurodevelopment of Children Following Prenatal Exposure to Venlafaxine, Selective Serotonin Reuptake Inhibitors, or Untreated Maternal Depression

OBJECTIVE Effects on child neurodevelopment of neurotransmitter reuptake inhibitors used as antidepressants during pregnancy have not been adequately studied. The authors compared the effects of prenatal exposure to venlafaxine (serotonin-norepinephrine reuptake inhibitor), selective serotonin reuptake inhibitors (SSRIs), and maternal depression. METHOD A cohort derived from a prospectively collected database included four groups of children born to 1) depressed women who took venlafaxine during pregnancy (N=62), 2) depressed women who took SSRIs during pregnancy (N=62), 3) depressed women who were untreated during pregnancy (N=54), and 4) nondepressed, healthy women (N=62). The childrens intelligence and behavior outcomes were evaluated with standardized instruments at one time point between the ages of 3 years and 6 years, 11 months. RESULTS The children exposed to venlafaxine, SSRIs, and maternal depression during pregnancy had similar full-scale IQs (105, 105, and 108, respectively). The IQs of the venlafaxine and SSRI groups were significantly lower than that of the children of nondepressed mothers (112). The three groups exposed to maternal depression had consistently, but nonsignificantly, higher rates of most problematic behaviors than the children of nondepressed mothers. Severity of maternal depression in pregnancy and at testing predicted child behavior. Maternal IQ and child sex predicted child IQ. Antidepressant dose and duration during pregnancy did not predict any cognitive or behavioral outcome. CONCLUSIONS Factors other than antidepressant exposure during pregnancy strongly predict childrens intellect and behavior. Depression during pregnancy is a significant risk factor for postpartum depression. Children of depressed mothers may be at risk of future psychopathology.