Clinical Epidemiology and Research Unit

Clichy, France

Clinical Epidemiology and Research Unit

Clichy, France
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Roussey M.,Association Francaise Pour le Depistage et la Prevention des Handicaps de lEnfant | Roussey M.,University of Rennes 1 | Lanoe J.L.,INSERMU687 | Larroque B.,Clinical Epidemiology and Research Unit | And 4 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2011

Context: Screening programs resulting in the early treatment of patients with congenital hypothyroidism (CH) have successfully improved neurodevelopmental outcome, but little is known about long-term health. Objectives: The aim of the study was to assess health status, and socioeconomic attainment, for a population-based registry of young adult patients. Design, Setting, and Participants: All 1748 eligible patients diagnosed during the first decade after the introduction of neonatal screening in France were invited to participate in this study at a median age of 23.4 yr. Completed questionnaires were obtained from 1202 of the selected patients. The comparison group included 5817 subjects from the last French Decennial Health Survey. Main Outcome Measures: Health indicators including medical conditions, hearing and visual status, sociodemographic characteristics, and quality of life were measured. Results: Patients with CH were significantly more likely than their peers to report associated chronic diseases (5.7 vs. 2.9%), hearing impairment (9.5 vs. 2.5%), visual problems (55.4 vs. 47.9%), and being overweight with a body mass index of at least 25 kg/m2 (22.8 vs. 15.7%) (P < 0.0001). Furthermore, fewer patients attained the highest socioeconomic category (14.6 vs. 23.1%) and were in full-time employment (39.9 vs. 44.8%) (P < 0.0001). They were more likely to still be living with their parents and had a lower health-related quality of life than their healthy peers, particularly for mental dimensions, with a mean difference for the mental summary component of 0.35 SD score (P < 0.0001). CH severity at diagnosis, treatment adequacy, and the presence of other chronic health conditions were the main determinants of educational achievement and health-related quality of life scores. Conclusion: These findings highlight the need for careful monitoring of neurosensory functioning, weight, and long-term treatment adequacy throughout childhood and adulthood. Copyright © 2011 by The Endocrine Society.


Hassani Y.,French Institute of Health and Medical Research | Larroque B.,Clinical Epidemiology and Research Unit | Larroque B.,French Institute of Health and Medical Research | Larroque B.,University Pierre and Marie Curie | And 4 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2012

Context: Untreated hypothyroidism is known to impair fecundity. Patients treated early for congenital hypothyroidism (CH) have yet to be evaluated in adulthood, because screening programs have been running for only the last 30 years in most industrialized countries. Objective: Our objective was to assess the fecundity of young adults treated early for CH and its determinants. Design, Setting, and Participants: Of the 1748 subjects diagnosed with CH in the first 10 yr after the introduction of neonatal screening in France, 1158 completed a questionnaire on fecundity at ameanage of 25.3 yr. This self-administered questionnaire focused on first attempts to have a child and time to pregnancy. The control group was that used in an analogous study on subjects born between 1971 and 1985. Main Outcome Measures: Fecundability hazard ratios (HR) were estimated with Cox regression models and adjusted for known fecundity confounders (age, smoking, and reproductive history). Results: Fecundability was similar for the CH and control groups: HR = 1.14 (0.89 -1.47) for women, and HR = 0.98 (0.58 -1.66) for men. In women, the most severe initial forms of the disease, athyreosis, absence of bone maturation at the knee epiphyseal ossification centers, and a low serum free T4 concentration at diagnosis (<5 pmol/liter), were associated with lower fecundity: HR = 0.68 (0.50-0.98) (P = 0.02); HR = 0.65 (0.45- 0.94) (p = 0.02) and HR = 0.70 (0.50-0.97) (P = 0.03), respectively. However, fecundability was not associated with age at the start of treatment, initial levothyroxine dose, or the adequacy of hypothyroidism control. Conclusion: There is no evidence that fecundity is generally lower in young adults treated early than in the general population. However, fecundity was lower in women suffering from the most severe form of the disease. Copyright © 2012 by The Endocrine Society.


Leger J.,University Paris Diderot | Leger J.,French Institute of Health and Medical Research | Larroque B.,Clinical Epidemiology and Research Unit | Larroque B.,National Health Research Institute
Journal of Clinical Endocrinology and Metabolism | Year: 2015

Context: Untreated hypothyroidism is associated with a higher risk of adverse obstetric and neonatal outcomes. Pregnancy complications have yet to be evaluated in patients treated early for congenital hypothyroidism (CH). Objective: This study aimed to investigate pregnancy outcomes and their determinants in a population-based registry of young adult women with CH. Setting and Design: In total, 1748 subjects were diagnosed with CH in the first 10 years after the introduction of neonatal screening in France; 1158 of these subjects completed a questionnaire on fecundity at a mean age of 25.3 years.Weanalyzed all declared singleton pregnancies ending after greater than 22 weeks of gestation before the initial survey (n = 207 pregnancies) and in the 3 years following the initial survey (prospective study, n = 174 pregnancies). The reference group comprised 7245 subjects from the French National Perinatal Survey. Main Outcome Measures: Pregnancy outcomes. Serum TSH concentrations and thyroid hormone requirements. Results: In both the overall and prospective analyses, CH was associated with gestational hypertension, emergency cesarean delivery, induced labor for vaginal delivery, and prematurity. For the prospective population with CH, the adjusted odds ratios (aOR) (95% confidence interval [CI]) were 2.19 (1.26-3.81), 1.88 (1.17-3.02), 1.58 (1.12-2.24), and 1.85 (1.06-3.25), respectively. TSH concentrations at least 10 mIU/l during the first 3 or 6 months of pregnancy were associated with a higher risk of preterm delivery (aOR, 5.6; 95% CI, 1.6-20.0) and fetal macrosomia (aOR, 4.5; 95% CI, 1.03-20.1), respectively, whereas no such relationship was observed for TSH concentrations of 5.0-9.9 mIU/l. Conclusion: CH may result in adverse pregnancy outcomes. These nationwide data suggest that better thyroid disease management is required, particularly during the first two trimesters of pregnancy, together with vigilant monitoring. Copyright © 2015 by the Endocrine Society.

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