Risk Factors for Targeted Thyroid Screening in Pregnancy—Who Gets Missed? [ID 1563]

INTRODUCTION: This study aims to assess the compliance of targeted screening for thyroid disease in pregnancy based on guidelines from the American College of Obstetricians and Gynecologists (ACOG) and the American Thyroid Association (ATA). METHODS: Records for all 1,025 patients presenting for new obstetrical visits in 2020 at a large, hospital-based practice in Illinois were reviewed. Patient risk factors meeting published screening criteria for thyroid disease in pregnancy were analyzed, along with thyroid screening status. RESULTS: A total of 198 patients met ACOG criteria for screening, of whom 86 were screened appropriately. The most often missed risk factor for screening was family history of thyroid disease: 80/97 patients missed (82%). Other missed risk factors included personal history of thyroid disease (28/107 missed [26%]) and type 1 diabetes (1/2 [50%]). A total of 826 patients met ATA criteria for screening, of whom 107 were screened appropriately. The most often missed risk factor for screening was history of preterm delivery: 56/57 patients missed (98%). Other commonly missed risk factors included multiple prior pregnancies (630/708 [89%]), history of pregnancy loss (283/328 [86%]), age over 30 (568/646 [88%]), and morbid obesity (35/42 [83%]). CONCLUSIONS/IMPLICATIONS: A significant number of patients who met criteria for targeted screening either by ACOG or ATA criteria did not receive appropriate screening for thyroid disease in pregnancy as per the current guideline recommendations. By understanding which risk factors are often missed, providers can improve the number of patients who receive appropriate screening. These results also underscore the practical difficulties of adhering to targeted-screening guidelines.