Dr Umesha Pathmanathan1,2, Dr Annabel Wingate1, Dr Stephanie Teasdale1,2,3
1Mater Hospital, South Brisbane, Australia, 2University of Queensland, Brisbane, Australia, 3Mater Research Institute, Brisbane, Australia
Biography:
Biographies to come
Abstract:
Introduction: Graves’ disease presents unique challenges in pregnancy due to the risk of neonatal morbidity and mortality associated with maternal TSH Receptor antibodies (TRAb). A major maternity hospital in Queensland has devised a policy to identify at-risk neonates, facilitating subsequent follow-up involving cord blood TRAb, thyroid function tests (TFTS), and clinic appointments. This study aims to evaluate the clinical practice of neonatal follow-up in mothers with Graves’ disease, assess missed opportunities for biochemical testing and propose recommendations for future clinical practice in this hospital.
Methods: This retrospective audit covers deliveries between 1st January 2018 to 31st December 2022. Mothers with Graves’ disease were identified via ICD-coding. Demographic data, ultrasound follow up, TRAb titres, TFTs, and treatment details were extracted from maternal charts. Neonatal charts were then reviewed for cord blood TRAb levels, TFTs on days 3-5 and days 10 -14, and phone clinic appointments. Criteria for neonatal testing were either thyroid stimulating immunoglobulin (TSI) positivity or maternal TRAb titres (measuring total TRAb and TSI) >3 times the upper limit of normal. Baseline characteristics and follow-up were summarised by frequency and percentage. The Fisher-Exact test was employed as a comparison of neonatal follow-up before and after 2021 to assess if there was any significant change with policy updates
Results: Data from 70 mothers with active or previously treated Graves’ disease were analysed with 18 pregnancies fulfilling criteria for neonatal testing. The results showed a lack of compliance with only 10% tested for cord blood TRAb and variable adherence to TFT testing. There were no statistically significant improvements post policy update.
Conclusion: This audit highlights the importance of standardised protocols and ongoing education to optimise neonatal follow-up and improve outcomes for neonates born to mothers with Graves’ disease. Recommendations for education, improved documentation and policy updates have been provided.
Keywords
Graves' disease, Neonatal Follow-Up