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Global prevalence of congenital hypothyroidism among neonates from 1969 to 2020: a systematic review and meta-analysis

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Abstract

Little is known about the global prevalence of congenital hypothyroidism (CH), though it is known to vary across countries and time periods. This meta-analysis aims to estimate the global and regional prevalence of CH among births between 1969 and 2020. PubMed, Web of Sciences, and Embase databases were searched for relevant studies between January 1, 1975, and March 2, 2020. Pooled prevalence was calculated using a generalized linear mixed model, and expressed as a rate per 10,000 neonates. The meta-analysis involved 116 studies, which analyzed 330,210,785 neonates, among whom 174,543 were diagnosed with CH. The pooled global prevalence of CH from 1969 to 2020 was 4.25 (95% confidence interval (CI) 3.96–4.57). The geographic region with highest prevalence was the Eastern Mediterranean (7.91, 95% CI 6.09–10.26), where the prevalence was 2.48-fold (95% CI 2.04–3.01) that in Europe. The national income level with the highest prevalence was upper-middle (6.76, 95% CI 5.66–8.06), which was 1.91-fold (95% CI 1.65–2.22) that in high-income countries. Global prevalence of CH was 52% (95% CI 4–122%) higher in 2011–2020 than in 1969–1980, after adjusting for geographic region, national income level, and screening strategy.

  Conclusion: The global prevalence of CH increased from 1969 to 2020, which may reflect the implementation of national neonatal screening, neonatal testing for thyroid-stimulating hormone, and a lowering of the diagnostic level of this hormone. Additional factors are likely to be driving the increase, which should be identified in future research.

What is Known:

• Cumulated evidence had suggested that the occurrences of congenital hypothyroidism (CH) among newborns were varied in different countries..

• Up-trends of the birth prevalence of CH were observed in many European and American countries.

What is New:

• This is the first meta-analysis to estimate global and regional prevalence of CH among newborns.

• The global prevalence of CH has increased by 127% since 1969. The Eastern Mediterranean has the highest prevalence and stands out with the most pronounced escalation in the prevalence of CH.

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Availability of data and code

Available upon request from the co-corresponding authors.

Data availability

The data are available from the corresponding author on reasonable request.

Abbreviations

CH:

Congenital hypothyroidism

DHG:

Dyshormonogenesis

HTT:

Hyperthyrotropinemia

NBS:

Newborn screening

PCH:

Permanent congenital hypothyroidism

TCH :

Transient congenital hypothyroidism

TSH :

Thyroid-stimulating hormone

T4 :

Thyroxine

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Author notes

  1. Lei Liu and Wenchong He are joint first authors.

Authors and Affiliations

  1. National Center for Birth Defect Monitoring of China, West China Second University Hospital, Sichuan University, 17 Section 3, Renmin South Road, Chengdu, Sichuan, 610041, People’s Republic of China

    Lei Liu, Jun Zhu, Liangcheng Xiang, Xuelian Yuan, Qi Li & Yongna Yao

  2. West China School of Medicine, Sichuan University, Chengdu, 610041, China

    Wenchong He

  3. National Office for Maternal and Child Health Surveillance, West China Second Hospital, Sichuan University, Chengdu, 610041, China

    Kui Deng

  4. Department of Endocrinology, West China Hospital, Sichuan University, Chengdu, 610041, China

    Huiwen Tan

  5. School of Resource and Environmental Engineering, Mianyang Teachers’ College, Mianyang, 621000, China

    Menglan Huang

  6. Sichuan Birth Defects Clinical Research Center, West China Second University Hospital, Sichuan University, Chengdu, 610041, China

    Yingkun Guo & Xiaohong Li

  7. Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, 20 Section 3, Renmin South Road, Chengdu, Sichuan, 610041, People’s Republic of China

    Xiaohong Li

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Contributions

Xiaohong Li, Yongna Yao, Lei Liu, Wenchong He, Jun Zhu, Kui Deng, Huiwen Tan, Liangcheng Xiang, Xuelian Yuan, and Yingkun Guo designed the project. Jun Zhu, Kui Deng, Xuelian Yuan, Liangcheng Xiang, Huiwen Tan, Yingkun Guo, and Menglan Huang contributed to the systematic search. Lei Liu, Menglan Huang, Liangcheng Xiang, Qi Li, and Liangcheng Xiang contributed to screening. Lei Liu, Yongna Yao, and Xiaohong Li contributed to data collection. Wenchong He, Kui Deng, Liangcheng Xiang, Qi Li, and Yingkun Guo contributed to data extraction. Lei Liu, Yongna Yao, Qi Li, and Xuelian Yuan contributed to data analysis. Xiaohong Li and Wenchong He contributed to data interpretation. Yongna Yao, Lei Liu, Wenchong He, and Xiaohong Li prepared the manuscript. All the authors revised and approved the manuscript.

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Correspondence to Yongna Yao or Xiaohong Li.

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Liu, L., He, W., Zhu, J. et al. Global prevalence of congenital hypothyroidism among neonates from 1969 to 2020: a systematic review and meta-analysis. Eur J Pediatr 182, 2957–2965 (2023). https://doi.org/10.1007/s00431-023-04932-2

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