Freddy J K Toloza1,2, Sarah E Theriot3, Naykky M Singh Ospina2,4, Sameen Nooruddin5, Brooke Keathley5, Stacey M Johnson5, Nalin Payakachat6, Elena Ambrogini1,7, Rene Rodriguez-Gutierrez2,8,9, Derek T O'Keeffe10, Juan P Brito2, Victor M Montori2, Nafisa K Dajani5, Spyridoula Maraka1,2,7. 1. Division of Endocrinology and Metabolism, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA. 2. Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA. 3. Department of Obstetrics and Gynecology, The University of Texas Health Science Center at Houston, Houston, Texas, USA. 4. Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Florida, Gainesville, Florida, USA. 5. Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA. 6. Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA. 7. Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, USA. 8. Division of Endocrinology, Department of Internal Medicine, University Hospital "Dr. Jose E. Gonzalez," Autonomous University of Nuevo León, Monterrey, Mexico. 9. Plataforma INVEST Medicina UANL-KER Unit (KER Unit México), Universidad Autónoma de Nuevo León, Monterrey, México. 10. Division of Endocrinology, Department of Medicine, National University of Ireland, Galway, Ireland.
Abstract
Background: The use of prescribed medications during pregnancy is a challenge and an underestimated source of treatment burden. Levothyroxine (LT4) for the treatment of overt and subclinical hypothyroidism is extensively prescribed during pregnancy. To this end, we aimed to explore the patients' perceived benefits and risks, knowledge, beliefs, attitudes, and related burden of LT4 therapy during pregnancy. Methods: In this cross-sectional study, we surveyed pregnant women who were treated with LT4 during pregnancy from January 1, 2019, to December 31, 2019, in a tertiary academic medical center of the United States. The anonymous online survey included questions to gather demographic data and multiple-choice questions regarding the benefits and risks, knowledge, beliefs, attitudes, and burden related to LT4 use during pregnancy. Results: Sixty-four pregnant women (mean age 31.5 years) completed the study survey (response rate: 96%): 62% were diagnosed with hypothyroidism more than 12 months before pregnancy, 16% less than or about 12 months before pregnancy, and 22% during pregnancy. We found that one-third of pregnant women using LT4 had a feeling of uneasiness/anxiety due to their hypothyroidism diagnosis. About half of the respondents (45%) reported that they did not receive an explanation by their clinician regarding the maternal/fetal risks of uncontrolled hypothyroidism or the benefits of adequate control. Finally, two in three patients expressed various concerns of LT4-related treatment burden. Conclusions: Our findings support the need for increased effective communication and tailored counseling to address fears, anxiety, and uncertainties about the benefits and risks of LT4 use in pregnancy. For patients with clear benefits from LT4 treatment in pregnancy, it could help to overcome their concerns, promote adherence, and decrease adverse maternal/fetal outcomes. For patients with no clear benefits established, clinicians need to be aware of LT4-related treatment burden in pregnancy and implement patient-centered approaches in their clinical practices.
Background: The use of prescribed medications during pregnancy is a challenge and an underestimated source of treatment burden. Levothyroxine (LT4) for the treatment of overt and subclinical hypothyroidism is extensively prescribed during pregnancy. To this end, we aimed to explore the patients' perceived benefits and risks, knowledge, beliefs, attitudes, and related burden of LT4 therapy during pregnancy. Methods: In this cross-sectional study, we surveyed pregnant women who were treated with LT4 during pregnancy from January 1, 2019, to December 31, 2019, in a tertiary academic medical center of the United States. The anonymous online survey included questions to gather demographic data and multiple-choice questions regarding the benefits and risks, knowledge, beliefs, attitudes, and burden related to LT4 use during pregnancy. Results: Sixty-four pregnant women (mean age 31.5 years) completed the study survey (response rate: 96%): 62% were diagnosed with hypothyroidism more than 12 months before pregnancy, 16% less than or about 12 months before pregnancy, and 22% during pregnancy. We found that one-third of pregnant women using LT4 had a feeling of uneasiness/anxiety due to their hypothyroidism diagnosis. About half of the respondents (45%) reported that they did not receive an explanation by their clinician regarding the maternal/fetal risks of uncontrolled hypothyroidism or the benefits of adequate control. Finally, two in three patients expressed various concerns of LT4-related treatment burden. Conclusions: Our findings support the need for increased effective communication and tailored counseling to address fears, anxiety, and uncertainties about the benefits and risks of LT4 use in pregnancy. For patients with clear benefits from LT4 treatment in pregnancy, it could help to overcome their concerns, promote adherence, and decrease adverse maternal/fetal outcomes. For patients with no clear benefits established, clinicians need to be aware of LT4-related treatment burden in pregnancy and implement patient-centered approaches in their clinical practices.
Authors: John H Lazarus; Jonathan P Bestwick; Sue Channon; Ruth Paradice; Aldo Maina; Rhian Rees; Elisabetta Chiusano; Rhys John; Varvara Guaraldo; Lynne M George; Marco Perona; Daniela Dall'Amico; Arthur B Parkes; Mohammed Joomun; Nicholas J Wald Journal: N Engl J Med Date: 2012-02-09 Impact factor: 91.245
Authors: Cynthia M Boyd; Jennifer L Wolff; Erin Giovannetti; Lisa Reider; Carlos Weiss; Qian-li Xue; Bruce Leff; Chad Boult; Travonia Hughes; Cynthia Rand Journal: Med Care Date: 2014-03 Impact factor: 2.983
Authors: Leslie De Groot; Marcos Abalovich; Erik K Alexander; Nobuyuki Amino; Linda Barbour; Rhoda H Cobin; Creswell J Eastman; John H Lazarus; Dominique Luton; Susan J Mandel; Jorge Mestman; Joanne Rovet; Scott Sullivan Journal: J Clin Endocrinol Metab Date: 2012-08 Impact factor: 5.958