{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T23:56:51Z","timestamp":1791244611812,"version":"4.1.0"},"reference-count":24,"publisher":"Georg Thieme Verlag KG","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Z Geburtshilfe Neonatol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Thyroid disorders are among the most clinically relevant endocrine conditions\n                        during pregnancy and the puerperal period. Given their clinical importance,\n                        this article aims to contextualize the role of thyroid dysfunction,\n                        particularly subclinical hypothyroidism, during these periods and to analyze\n                        the ongoing debate regarding screening and treatment based on international\n                        guideline recommendations.<\/jats:p>\n                  <jats:p>This narrative literature review was conducted using the SciELO,\n                        PubMed\/MEDLINE, Embase, UpToDate, and Virtual Health Library databases. In\n                        addition, official documents from the Brazilian Ministry of Health, the\n                        Brazilian Society of Endocrinology and Metabolism, the Brazilian Federation\n                        of Gynecology and Obstetrics Associations, the American Thyroid Association,\n                        the European Thyroid Association, the American College of Obstetricians and\n                        Gynecologists, and the Brazilian Association of Medical Education were\n                        reviewed.<\/jats:p>\n                  <jats:p>Thyroid disorders during pregnancy pose a clinical challenge due to\n                        physiological gestational changes, variability in thyroid-stimulating\n                        hormone and thyroxine reference ranges, and the influence of thyroid\n                        autoimmunity. Diagnostic definition is hindered by the lack of uniform\n                        laboratory reference intervals, contributing to overdiagnosis and\n                        unnecessary treatment. Evidence indicates that the benefit of levothyroxine\n                        therapy is mainly observed when the maternal thyroid-stimulating hormone\n                        level exceeds 4.0 mU\/L and treatment is initiated early in pregnancy. In the\n                        postpartum period, the risk of persistent thyroid dysfunction highlights the\n                        importance of hormonal reassessment and individualized, evidence-based\n                        decision-making that accounts for population-specific factors.<\/jats:p>\n                  <jats:p>There is no clear consensus in the literature regarding the diagnosis and\n                        management of thyroid disorders during the pregnancy\u2013puerperal cycle.\n                        Therefore, screening and care strategies should be expanded and adapted to\n                        local contexts in order to optimize maternal and fetal outcomes, while\n                        respecting regional epidemiological and laboratory characteristics.<\/jats:p>","DOI":"10.1055\/a-2956-4381","type":"journal-article","created":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T23:04:38Z","timestamp":1790291078000},"source":"Crossref","is-referenced-by-count":0,"title":["Thyroid Disorders during Pregnancy and Puerperal Periods: A Narrative\n                    Review"],"prefix":"10.1055","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-3864-0569","authenticated-orcid":false,"given":"Gabriela Let\u00edcia","family":"Corr\u00eaa Souza Oliveira","sequence":"additional","affiliation":[{"name":"Albert Einstein Israelite College of Health Sciences (FICSAE), Albert\n                    Einstein Israelite Hospital, -SP, Brazil","place":["S\u00e3o Paulo"],"department":["Discipline of Woman Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4736-3451","authenticated-orcid":false,"given":"Julia","family":"Crocomo Tozzi","sequence":"additional","affiliation":[{"name":"Albert Einstein Israelite College of Health Sciences (FICSAE), Albert\n                    Einstein Israelite Hospital, -SP, Brazil","place":["S\u00e3o Paulo"],"department":["Discipline of Woman Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-1485-2283","authenticated-orcid":false,"given":"Paula","family":"Andregheto","sequence":"additional","affiliation":[{"name":"Albert Einstein Israelite College of Health Sciences (FICSAE), Albert\n                    Einstein Israelite Hospital, -SP, Brazil","place":["S\u00e3o Paulo"],"department":["Discipline of Woman Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6694-6569","authenticated-orcid":false,"given":"Gustavo Yano","family":"Callado","sequence":"additional","affiliation":[{"name":"Albert Einstein Israelite College of Health Sciences (FICSAE), Albert\n                    Einstein Israelite Hospital, -SP, Brazil","place":["S\u00e3o Paulo"],"department":["Discipline of Woman Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6145-2532","authenticated-orcid":false,"given":"Edward","family":"Araujo J\u00fanior","sequence":"additional","affiliation":[{"name":"Paulista School of Medicine \u2013 Federal University of S\u00e3o Paulo\n                    (EPM-UNIFESP), -SP, Brazil","place":["S\u00e3o Paulo"],"department":["Department of Obstetrics"]},{"name":"Municipal University of S\u00e3o Caetano do Sul (USCS), -SP, Brazil","place":["S\u00e3o Caetano do Sul"],"department":["Discipline of Woman Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2942-6182","authenticated-orcid":false,"given":"Antonio","family":"Braga","sequence":"additional","affiliation":[{"name":"School of MedicineFederal University of Rio de Janeiro\n                    (UFRJ), -RJ, Brazil","place":["Rio de Janeiro"],"department":["Department of Gynecology and Obstetrics"]},{"name":"School of Medicine and SurgeryFederal University of the State of Rio de\n                    Janeiro (UNIRIO), -RJ, Brazil","place":["Rio de Janeiro"],"department":["Department of General and Specialized Surgery"]},{"name":"University of Vassouras, -RJ, Brazil","place":["Vassouras"],"department":["Postgraduate Program in Applied Health Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7401-9754","authenticated-orcid":false,"given":"Eduardo","family":"Felix Martins Santana","sequence":"additional","affiliation":[{"name":"Albert Einstein Israelite College of Health Sciences (FICSAE), Albert\n                    Einstein Israelite Hospital, -SP, Brazil","place":["S\u00e3o Paulo"],"department":["Discipline of Woman Health"]},{"name":"Paulista School of Medicine \u2013 Federal University of S\u00e3o Paulo\n                    (EPM-UNIFESP), -SP, Brazil","place":["S\u00e3o Paulo"],"department":["Department of Obstetrics"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,9,24]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3897\/pharmacia.71.e141047","article-title":"Levothyroxine therapy in pregnancy: are we overtreating patients?","volume":"71","author":"V Yanachkova","year":"2024","journal-title":"Pharmacia"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"278","DOI":"10.5005\/jp-journals-10006-2405","article-title":"Levothyroxine therapy: its effect on subclinical hypothyroidism","volume":"16","author":"N P Gupta","year":"2024","journal-title":"J South Asian Feder Obst Gynae"},{"key":"ref3","first-page":"363","article-title":"Subclinical hypothyroidism and thyroid autoimmunity in pregnancy: to treat or\n                    not to treat","volume":"53","author":"S Maraka","year":"2024","journal-title":"Best Pract Res Clin Endocrinol Metab"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1016\/S2213-8587(22)00045-6","article-title":"Levothyroxine in euthyroid thyroid peroxidase antibody\u2013positive women with\n                    recurrent pregnancy loss (T4LIFE trial): a multicentre, randomised,\n                    double-blind, placebo-controlled, phase 3 trial","volume":"10","author":"M M van Dijk","year":"2022","journal-title":"Lancet Diabetes Endocrinol"},{"key":"ref5","doi-asserted-by":"crossref","DOI":"10.1530\/ETJ-24-0051","article-title":"Long-term hypothyroidism in patients started on levothyroxine during\n                    pregnancy","volume":"13","author":"S Demartin","year":"2024","journal-title":"Eur Thyroid J"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1038\/s41574-021-00604-z","article-title":"Assessment and treatment of thyroid disorders in pregnancy and the postpartum\n                    period","volume":"18","author":"S Y Lee","year":"2022","journal-title":"Nat Rev Endocrinol"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1186\/s40842-024-00212-6","article-title":"Impact of maternal thyroid dysfunction on fetal and maternal outcomes in\n                    pregnancy: a prospective cohort study","volume":"10","author":"R Vamja","year":"2024","journal-title":"Clin Diabetes Endocrinol"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/s40748-025-00208-9","article-title":"Overview of thyroid disorders in pregnancy","volume":"11","author":"M A Puthiyachirakal","year":"2025","journal-title":"Matern Health Neonatol Perinatol"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1089\/thy.2015.0418","article-title":"Subclinical hypothyroidism in pregnancy: a systematic review and\n                    meta-analysis","volume":"26","author":"S Maraka","year":"2016","journal-title":"Thyroid"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1089\/thy.2018.0475","article-title":"Differences in diagnostic criteria mask the true prevalence of thyroid disease\n                    in pregnancy: a systematic review and meta-analysis","volume":"29","author":"A C Dong","year":"2019","journal-title":"Thyroid"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"153","DOI":"10.4274\/jcrpe.4931","article-title":"The association between maternal subclinical hypothyroidism and growth,\n                    development, and childhood intelligence: a meta-analysis","volume":"10","author":"Y Liu","year":"2018","journal-title":"J Clin Res Pediatr Endocrinol"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"e19343","DOI":"10.7717\/peerj.19343","article-title":"Subclinical hypothyroidism during pregnancy and the impact of levothyroxine\n                    therapy on pregnancy outcomes in women","volume":"13","author":"Y Zhou","year":"2025","journal-title":"PeerJ"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1089\/thy.2023.0546","article-title":"Effects of levothyroxine treatment on fertility and pregnancy outcomes in\n                    subclinical hypothyroidism: a systematic review and meta-analysis of randomized\n                    controlled trials","volume":"34","author":"A Sankoda","year":"2024","journal-title":"Thyroid"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1111\/cen.14853","article-title":"Maternal hypothyroidism and adverse outcomes of pregnancy","volume":"98","author":"L Kn\u00f8sgaard","year":"2023","journal-title":"Clin Endocrinol (Oxf)"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1210\/clinem\/dgac577","article-title":"Maternal thyroid dysfunction and neuropsychological development in children","volume":"108","author":"Y Chen","year":"2023","journal-title":"J Clin Endocrinol Metab"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"884851","DOI":"10.3389\/fendo.2022.884851","article-title":"Association of maternal mild hypothyroidism with offspring neurodevelopment in\n                    TPOAb-negative women: a prospective cohort study","volume":"13","author":"Q Wang","year":"2022","journal-title":"Front Endocrinol (Lausanne)"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1089\/thy.2016.0457","article-title":"2017 guidelines of the American Thyroid Association for the diagnosis and\n                    management of thyroid disease during pregnancy and the postpartum","volume":"27","author":"E K Alexander","year":"2017","journal-title":"Thyroid"},{"key":"ref19","doi-asserted-by":"crossref","DOI":"10.3389\/fped.2025.1530859","article-title":"Meta-analysis of the effects of levothyroxine therapy for subclinical\n                    hypothyroidism during pregnancy on offspring outcomes","volume":"13","author":"Z You","year":"2025","journal-title":"Front Pediatr"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"2387","DOI":"10.1007\/s00404-024-07512-3","article-title":"Levothyroxine for subclinical hypothyroidism during pregnancy: an updated\n                    systematic review and meta-analysis of randomized controlled trials","volume":"309","author":"H Provinciatto","year":"2024","journal-title":"Arch Gynecol Obstet"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"e261","DOI":"10.1097\/AOG.0000000000003893","article-title":"Thyroid disease in pregnancy: ACOG practice bulletin, number 223","volume":"135","author":"American College of Obstetricians and\n                            Gynecologists","year":"2020","journal-title":"Obstet Gynecol"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1159\/000362597","article-title":"2014 European Thyroid Association guidelines for the management of subclinical\n                    hypothyroidism in pregnancy and in children","volume":"3","author":"J Lazarus","year":"2014","journal-title":"Eur Thyroid J"},{"issue":"05","key":"ref23","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1177\/10507256261445624","article-title":"American Thyroid Association 2026 Guidelines for Thyroid Disease in\n                    Preconception, Pregnancy, and Postpartum","volume":"36","author":"TIM Korevaar","year":"2026","journal-title":"Thyroid"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"3754213","DOI":"10.1155\/2016\/3754213","article-title":"Trimester- and assay-specific thyroid reference intervals for pregnant women in\n                    China","volume":"2016","author":"J Xing","year":"2016","journal-title":"Int J Endocrinol"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"160","DOI":"10.4103\/ijem.IJEM_561_19","article-title":"Trimester-specific reference intervals for thyroid function parameters in Indian\n                    pregnant women during final phase of transition to iodine sufficiency","volume":"24","author":"S Pramanik","year":"2020","journal-title":"Indian J Endocrinol Metab"}],"container-title":["Zeitschrift f\u00fcr Geburtshilfe und Neonatologie"],"original-title":[],"language":"de","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2956-4381.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T23:31:31Z","timestamp":1791243091000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2956-4381"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,24]]},"references-count":24,"URL":"https:\/\/doi.org\/10.1055\/a-2956-4381","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0948-2393","1439-1651"],"issn-type":[{"value":"0948-2393","type":"print"},{"value":"1439-1651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,24]]}}}