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Objective: Subclinical hypothyroidism is the most frequent thyroid dysfunction in pregnancy with an incidence of 2-5% which can easily be overlooked due to the absence of clinical symptoms. Studies have shown that thyroid hormones could alter the level of free beta-human chorionic gonadotropin (ß-hCG) and pregnancy-associated plasma protein-A (PAPP-A) released from the placenta during early pregnancy. Since these two serum markers are the two of the parameters used in the first-trimester combined screening, we hypothesized that distorted risk calculation results could be obtained from pregnant women with subclinical hypothyroidism. Methods: We conducted a prospective and cohort study at a tertiary university hospital in northwest Turkey between February 2018 and June 2018, involving 250 pregnant women in their first trimester who were seeking care at the obstetrics outpatient clinic. After evaluation of thyroid functions, first-trimester screening was performed in all 250 singleton pregnancies with fetuses at 11+0 to 13+6 gestational weeks. Thyroid-stimulating hormone (TSH) values above 2,5 mIU/L were considered high. The correlation between the results and parameters of the first-trimester combined screening and thyroid hormone values was examined. Results: Among the participants, after analyzing the fT4 values, all 35 pregnant women with high TSH values were diagnosed with subclinical hypothyroidism. We observed a statistically weak negative correlation between TSH and ß-HCG, which was expected given the similarities in their alpha subunits. There was no statistically significant correlation between TSH and PAPP-A values, combined risk scores, and age risk scores of first-trimester screening. As a matter of course, combined risk scores of first-trimester screening were found to be statistically lower in younger mothers. Conclusion: Pregnant women with normal thyroid functions and subclinical hypothyroidism were investigated for alterations in first-trimester screening parameters and risk scores. As a result, no statistically significant correlation was found between subclinical hypothyroidism and first-trimester screening. [ABSTRACT FROM AUTHOR]

Aim: To demonstrate the effect of the Syrian refugee population on the prevalence of congenital TORCH (Toxoplasmosis, Other [syphilis, varicella‐zoster, parvovirus B19], Rubella, Cytomegalovirus [CMV] and Herpes) infections and to evaluate the cost‐effectiveness of population‐based TORCH screening during pregnancy in Turkey. Methods: Pregnant women (n = 9754) were enrolled. Ultrasonographic findings, immunoglobulin (Ig)M and IgG seropositivity, avidity, amniocentesis and DNA‐polymerase chain reaction (PCR) results were compared. Costs were calculated based on invoice amounts from the Health Applications Communique pricing system. Results: The prevalence of TORCH seropositivity in Turkey was not significantly different between all regions (P > 0.05). Overall, 1333 (13.67%) pregnant Syrian refugees were included in the study. Acute CMV, rubella and Toxoplasma gondii infections (according to low IgG avidity in IgM positive patients) were detected in 17.82%, 21.53% and 14.07% of women, respectively. Twenty‐four women underwent an amniocentesis procedure and nine of them had positive DNA‐PCR and reverse transcription‐PCR results. All women with positive results opted to terminate the pregnancy. There was no statistical difference among groups according to the rate of low IgG avidity in IgM‐positive patients and termination rates for T. gondii, rubella and CMV (P > 0.05). Total cost for screening the entire study population was presented in US dollars (USD). A total of 71 529 and prenatal diagnosis with positive invasive test results were obtained in nine women: toxoplasmosis in four, CMV in three and rubella in two women. Conclusion: Population‐based screening for prenatal TORCH infections is not cost‐effective in Turkey. Syrian refugees have a limited effect on the increasing prevalence of congenital TORCH infections. [ABSTRACT FROM AUTHOR]

Objectives: To examine the costs and outcomes of different screening strategies for Down Syndrome (DS) in singleton pregnancies.Study Design: A decision-analytic model was developed to compare the costs and the outcomes of different prenatal screening strategies. Five strategies were compared for women under 35-year of age: 1A) triple test (TT), 2A); combined test (CT), 3A) Non-invasive Prenatal Screening Test by using cell free fetal DNA (NIPT), 4A) and 5A) NIPT as a second-step screening for high-risk patients detected by either TT, or CT respectively. For women ≥35-year of age, 1B) implementing invasive test (amniocentesis -AC) and 2B) NIPT for all women were compared. Data was analyzed to obtain the outcomes, total costs, the cost per women and the incremental cost-effectiveness ratios (ICERs) for screening strategies.Results: Among the current strategies for women under 35 years old, CT is clearly dominated to TT, as it is more effective and less costly. Although, the current routine practice (2A) is the least-costly strategy, implementing NIPT as a second step screening to high-risk women identified by CT (5A) would be more effective than 2A; leading to a 10.2% increase in the number of detected DS cases and a 96.3% reduction in procedural related losses (PRL). However, its cost to the Social Security Institution that is a public entity would be 17 times higher and increase screening costs by 1.5 times. Strategy 5A would result in an incremental cost effectiveness of 6,873,082 (PPP) US$ when compared to the current one (2A). Strategy 1B-for offering AC to all women ≥35-year of age is dominated over NIPT (2B), as it would detect more DS cases and would be less costly. On the other hand, there would be 206 PRL associated with AC, but NIPT provides clear clinical benefits as there would be no PRL with NIPT.Conclusions: NIPT leads to very high costs despite its high effectiveness in terms of detecting DS cases and avoiding PRL. The cost of NIPT should be decreased, otherwise, only individuals who can afford to pay from out-of-pocket could benefit. We believe that reliable cost-effective prenatal screening policies are essential in countries with low and smiddle income and high birth rates as well. [ABSTRACT FROM AUTHOR]