Pre-eclampsia, Soluble fms-like Tyrosine Kinase 1, and the Risk of Reduced Thyroid Function: Nested Case-Control and Population Based Study

Objective: To determine if pre-eclampsia is associated with reduced thyroid function during and after pregnancy. Design: Nested case-control study during pregnancy and population based follow-up study after pregnancy. Setting: Calcium for Pre-eclampsia Prevention trial of healthy pregnant nulliparous women in the United States during 1992-5, and a Norwegian population based study (Nord-Trondelag Health Study or HUNT-2) during 1995-7 with linkage to the medical birth registry of Norway. Participants: All 141 women (cases) in the Calcium for Pre-eclampsia Prevention trial with serum measurements before 21 weeks’ gestation (baseline) and after onset of pre-eclampsia (before delivery), 141 normotensive controls with serum measurements at similar gestational ages, and 7121 women in the Nord-Trondelag Health Study whose first birth had occurred in 1967 or later and in whom serum levels of thyroid stimulating hormone had been subsequently measured. Main outcome measures: Thyroid function tests and human chorionic gonadotrophin and soluble fms-like tyrosine kinase 1 concentrations in the Calcium for Pre-eclampsia Prevention cohort and odds ratios for levels of thyroid stimulating hormone above the reference range, according to pre-eclampsia status in singleton pregnancies before the Nord-Trondelag Health Study. Results: In predelivery specimens of the Calcium for Pre-eclampsia Prevention cohort after the onset of pre-eclampsia, thyroid stimulating hormone levels increased 2.42 times above baseline compared with a 1.48 times increase in controls. The ratio of the predelivery to baseline ratio of cases to that of the controls was 1.64 (95% confidence interval 1.29 to 2.08). Free triiodothyronine decreased more in the women with pre-eclampsia than in the controls (case ratio to control ratio 0.96, 95% confidence interval 0.92 to 0.99). The predelivery specimens but not baseline samples from women with pre-eclampsia were significantly more likely than those from controls to have concentrations of thyroid stimulating hormone above the reference range (adjusted odds ratio 2.2, 95% confidence interval 1.1 to 4.4). Both in women who developed pre-eclampsia and in normotensive controls the increase in thyroid stimulating hormone concentration between baseline and predelivery specimens was strongly associated with increasing quarters of predelivery soluble fms-like tyrosine kinase 1 (P for trend 0.002 and 3.5 mIU/l). In particular, they were more likely to have high concentrations of thyroid stimulating hormone without thyroid peroxidase antibodies (adjusted odds ratio 2.6, 95% confidence interval 1.3 to 5.0), suggesting hypothyroid function in the absence of an autoimmune process. This association was especially strong (5.8, 1.3 to 25.5) if pre-eclampsia had occurred in both the first and the second pregnancies. Conclusion: Increased serum concentration of soluble fms-like tyrosine kinase 1 during pre-eclampsia is associated with subclinical hypothyroidism during pregnancy. Pre-eclampsia may also predispose to reduced thyroid function in later years

Pre-eclampsia, soluble fms-like tyrosine kinase 1, and the risk of reduced thyroid function: nested case-control and population based study

Objective To determine if pre-eclampsia is associated with reduced thyroid function during and after pregnancy

Success and failure in narrowing the disability employment gap: comparing levels and trends across Europe 2002–2014

Background: International comparisons of the disability employment gap are an important driver of policy change. However, previous comparisons have used the European Union Statistics on Income and Living Conditions (EU-SILC), despite known comparability issues. We present new results from the higher-quality European Social Survey (ESS), compare these to EU-SILC and the EU Labour Force Survey (EU-LFS), and also examine trends in the disability employment gap in Europe over the financial crisis for the first time. Methods: For cross-sectional comparisons of 25 countries, we use micro-data for ESS and EU-SILC for 2012 and compare these to published EU-LFS 2011 estimates. For trend analyses, we use seven biannual waves of ESS (2002–2014) with a total sample size of 182,195, and annual waves of EU-SILC (2004–2014) with a total sample size of 2,412,791. Results: (i) Cross-sectional: countries that have smaller disability employment gaps in one survey tend to have smaller gaps in the other surveys. Nevertheless, there are some countries that perform badly on the lower-quality surveys but better in the higher-quality ESS. (ii) Trends: the disability employment gap appears to have declined in ESS by 4.9%, while no trend is observed in EU-SILC – but this has come alongside a rise in disability in ESS. Conclusions: There is a need for investment in disability measures that are more comparable over time/space. Nevertheless, it is clear to policymakers there are some countries that do consistently well across surveys and measures (Switzerland), and others that do badly (Hungary)