Study Reveals Major Gaps in Thyroid Screening During Pregnancy

Clinicians miss screening opportunities for a significant number of pregnant women who meet guideline-established criteria for thyroid disease testing, according to new data presented at the 2025 American College of Obstetricians and Gynecologists (ACOG) annual Clinical & Scientific Meeting.¹

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Among the findings, less than half (43%) of the study participants who met ACOG criteria and just 13% of those meeting American Thyroid Association (ATA) criteria received appropriate thyroid screening. One out of 2 women with type 1 diabetes were not appropriately screened, according to the study abstract. The ACOG meeting is being held May 16-18, 2025, in Minneapolis, MN.¹

For the retrospective analysis, presenting author Allan C Dong, MD, of Atrium Health Wake Forest Baptist Center for Fertility and Reproductive Surgery, in Winston-Salem, NC, and colleagues, examined records of 1,025 women who presented for new obstetrical visits in 2020 at a large hospital-based practice in Illinois. The team evaluated compliance with both ACOG and ATA targeted screening guidelines for thyroid disease in pregnancy.¹

Among the 198 participants who met ACOG criteria for screening, only 86 (43%) received appropriate testing. Surprisingly, the most frequently missed risk factor was family history of thyroid disease, with 82% of participants meeting the criterion (80/97) not receiving recommended screening. Additionally, clinicians missed screening opportunities for 26% of pregnant women (28/107) with a personal history of thyroid disease and 50% of those (1/2) with type 1 diabetes.¹

The gap widened substantially when applying ATA guidelines, which recommend screening for a broader range of risk factors. Of 826 patients meeting ATA criteria, only 107 (13%) underwent appropriate screening. The study identified several commonly overlooked risk factors:

- History of preterm delivery: 98% missed (56/57 patients)
- Multiple prior pregnancies: 89% missed (630/708 patients)
- History of pregnancy loss: 86% missed (283/328 patients)
- Age older than 30 years: 88% missed (568/646 patients)
- Morbid obesity: 83% missed (35/42 patients)

Clinical Implications

The findings highlight significant challenges in implementing targeted screening protocols in clinical practice. The researchers suggest that the complexity and breadth of screening criteria may contribute to poor compliance rates.

Thyroid disease is second only to diabetes as the most common endocrinopathy among women during their childbearing years.² Identification of the condition is complicated by the similarity of symptoms with those common during pregnancy. Thyroid disorders during pregnancy can lead to adverse maternal and fetal outcomes, including miscarriage, preterm birth, and impaired neurocognitive development in offspring. While universal screening remains controversial, both ACOG and ATA recommend targeted screening based on risk factors.²

The study findings could help improve clinical discrimination of symptoms by highlighting the risk factors that are most commonly overlooked. "By understanding which risk factors are often missed, [clinicians] can improve the number of patients who receive appropriate screening," Dong et al wrote in the study abstract. "These results also underscore the practical difficulties of adhering to targeted-screening guidelines."¹

Read all the Patient Care coverage of ACOG 2025.

References
1. Dong AC, Lott ML, Stagnaro-Green A. Risk factors for targeted thyroid screening in pregnancy - who gets missed? Abstract presented at: 2025 American College of Obstetricians and Gynecologists Annual Clinical & Scientific Meeting; May 16-18, 2025; Minneapolis, MN.
2. Carney LA, Quinlan JD, West JM. Thyroid disease in pregnancy. Am Fam Physician. 2024;89(4):273-278. https://www.aafp.org/pubs/afp/issues/2014/0215/p273.html