The second wave of the Controlled Antenatal Thyroid Screening (CATS II) study: the cognitive assessment protocol

Background Children whose mothers had low thyroid hormone levels during pregnancy have been reported to have decreased cognitive function. The reported research is part of the follow-on study of the Controlled Antenatal Thyroid Screening Study (CATS I), a randomised controlled trial which investigated the impact of treated vs. untreated low thyroid hormone level in women during pregnancy with the primary outcome being the child’s IQ at age 3. No significant differences in IQ were found between the treated and untreated groups. These children are now aged between 7 and 10 years and aspects of their cognitive functioning including their IQ are being reassessed as part of CATS II. Methods/Design Cognitive assessments generate an IQ score and further tests administered will investigate long term memory function and motor coordination. The aim is to complete the assessments with 40% of the children born to mothers either in the treated or untreated low thyroid hormone groups (n = 120 per group). Also children born to mothers who had normal thyroid functioning during CATS I are being assessed for the first time (n = 240) to provide a comparison. Assessments are conducted either in the research facility or the participant’s home. Discussion The study is designed to assess the cognitive functioning of children born to mothers with low thyroid hormone levels and normal thyroid functioning during pregnancy. This is the largest study of its type and also is distinguishable in its longitudinal design. The research has the potential to have a significant impact on public health policy in the UK; universal screening of thyroid hormone levels in pregnancy may be the recommendation. Keywords: Hypothyroidism; Pregnancy; Child; Intelligence; IQ; Cognition; Motor coordination; Long term memory; Thyroid functio

Controlled antenatal thyroid screening II: Effect of treating maternal sub-optimal thyroid function on child behaviour

The Controlled Antenatal Thyroid Screening (CATS) study was the first randomised controlled trial to investigate effects of treating suboptimal-gestational-thyroid-function (SGTF) on child cognition. Since observational studies indicated that SGTF may also increase symptoms of autism and attention deficit hyperactivity disorder (ADHD), the CATS cohort was used to investigate whether treatment of mothers affected their children’s behavior

Mitigating the impact of Bats in historic churches: The response of Natterer's Bats Myotis nattereri to artificial roosts and deterrence

© 2016 Zeale et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Bats frequently roost in historic churches, and these colonies are of considerable conservation value. Inside churches, bat droppings and urine can cause damage to the historic fabric of the building and to items of cultural significance. In extreme cases, large quantities of droppings can restrict the use of a church for worship and/or other community functions. In the United Kingdom, bats and their roosts are protected by law, and striking a balance between conserving the natural and cultural heritage can be a significant challenge. We investigated mitigation strategies that could be employed in churches and other historic buildings to alleviate problems caused by bats without adversely affecting their welfare or conservation status. We used a combination of artificial roost provision and deterrence at churches in Norfolk, England, where significant maternity colonies of Natterer's bats Myotis nattereri damage church features. Radio-tracking data and population modelling showed that excluding M. nattereri from churches is likely to have a negative impact on their welfare and conservation status, but that judicious use of deterrents, especially high intensity ultrasound, can mitigate problems caused by bats. We show that deterrence can be used to move bats humanely from specific roosting sites within a church and limit the spread of droppings and urine so that problems to congregations and damage to cultural heritage can be much reduced. In addition, construction of bespoke roost spaces within churches can allow bats to continue to roost within the fabric of the building without flying in the church interior. We highlight that deterrence has the potential to cause serious harm toM. nattereri populations if not used judiciously, and so the effects of deterrents will need careful monitoring, and their use needs strict regulation

CATS II long-term anthropometric and metabolic effects of maternal sub-optimal thyroid function in offspring and mothers

Context and Objectives The Controlled Antenatal Thyroid Screening Study I (CATS-I) was a randomized controlled trial investigating the effects of levothyroxine therapy for suboptimal gestational thyroid function (SGTF), comparing outcomes in children of treated (SGTF-T) with untreated (SGTF-U) women during pregnancy. This follow-up study, CATS-II, reports the long-term effects on anthropometric, bone, and cardiometabolic outcomes in mothers and offspring and includes a group with normal gestational thyroid function (NGTF). Design & Participants 332 mothers (197 NGTF, 56 SGTF-U, 79 SGTF-T) aged 41.2±5.3 years (mean±SD) and 326 paired children assessed 9.3±1.0 years after birth for (i) body mass index (BMI); (ii) lean, fat, and bone mass by dual-energy X-ray absorptiometry; (iii) blood pressure, augmentation index, and aortic pulse-wave-velocity; and (iv) thyroid function, lipids, insulin, and adiponectin. The difference between group means was compared using linear regression. Results Offspring’s measurements were similar between groups. Although maternal BMI was similar between groups at CATS-I, after 9 years (at CATS-II) SGTF-U mothers showed higher BMI (median [interquartile ratio] 28.3 [24.6-32.6] kg/m2) compared with NGTF (25.8 [22.9-30.0] kg/m2; P = 0.029), driven by fat mass increase. At CATS-II SGTF-U mothers also had higher thyroid-stimulating hormone (TSH) values (2.45 [1.43-3.50] mU/L) than NGTF (1.54 [1.12-2.07] mU/L; P = 0.015), since 64% had never received levothyroxine. At CATS-II, SGTF-T mothers had BMI (25.8 [23.1-29.8] kg/m2, P = 0.672) and TSH (1.68 [0.89-2.96] mU/L; P = 0.474) values similar to NGTF mothers. Conclusions Levothyroxine supplementation of women with SGTF did not affect long-term offspring anthropometric, bone, and cardiometabolic measurements. However, absence of treatment was associated with sustained long-term increase in BMI and fat mass in women with SGTF

Cognition and behaviour of children born to mothers with an underactive thyroid; data from the controlled antenatal thyroid screening study

Background and aims Underactive thyroid function during pregnancy and its effects on offspring intelligence, general cognition and behaviour have long been researched and reported on. Some of the differences found for the offspring are so apparent, that is has warranted authors to suggest universal thyroid function screening during pregnancy. The current study was the world’s first randomised controlled trial to investigate the effects of treatment for suboptimal gestational thyroid function (SGTF) on offspring. The aims of this thesis are, 1) to re-analyse the intelligence scores for the offspring at age 3 years, 2) to clarify any SGTF effects by cognitive testing and behavioural questionnaires completed at offspring age 9, and 3) compare and contrast wave one and two findings. Methods and analysis 1) Data was previously collected for this analysis. Treated and untreated SGTF groups were compared by unadjusted and adjusted models. 2) I conducted the intelligence, additional cognitive testing, and collection of the completed behavioural questionnaires. All data were analysed separately (per chapter) by multivariate analysis models. 3) Comparison of intelligence results were explored by correlations and a repeated measures multivariate analysis. Results and conclusions Re-analysis of the age 3 intelligence scores revealed that the untreated SGTF group performed worse compared to the treated SGTF group (p = .008 for scores below 85). No age 9 differences in intelligence or additional cognitive tests were found. The behavioural questionnaires revealed that treatment for SGTF may have had a detrimental effect for the offspring. Intelligence score comparisons revealed no differences between the groups. These results suggest that any intelligence effects from the mother not being treated for SGTF may be present at age 3 but have disappeared by age 9. However, treatment for SGTF appeared to significantly increase behaviour problems for offspring at age 9; though not clinically significant