PPT occurred in 63 women (15

PPT occurred in 63 women (15.3%), and PH in 34/63 (54%). and AINTD, and personal history for AINTD. We measured TSH, FT4, FT3 at 1.5, 3, 6, and 12 months postpartum. PPT occurred in 63 women (15.3%), and PH in 34/63 (54%). Based on positivity/negativity for DMA the three histories, women were classified into 8 categories, FGF22 with PPT rates of 3.8C100%. Seafood consumption allowed further separation of subgroups having different PPT risks. We considered 11 possible strategies, termed [a] through [k]. Strategy [a] consisted in omitting gestational screening, while performing universal postpartum monitoring with TSH and one thyroid hormone; strategy [k] consisted in selective gestational screening with TPOAb and TgAb, based on history and fish consumption, and selective postpartum monitoring in TPOAb and/or TgAb+ve women. The 100% sensitivity, specificity and diagnostic accuracy of strategy [a] were counterbalanced by the highest costs (Euro 32,960 or 523 per each PPT caught). The corresponding numbers for strategy [k] were 78, 95, 93%, and Euro 8,920 or 182/PPT caught. These savings stem from gestational screening being done in 186 women, and postpartum monitoring done in 65/186 women. One gestational screning-free strategy was the cheapest (Euro 2,080 or 83/PPT caught), because based on postpartum monitoring of only 26 women, but had the lowest sensitivity (40%). Identification of pregnant women having different risks for PPT is usually feasible, with the costless evaluation of history and seafood consumption driving gestational screening of thyroid antibody status DMA and postpartum monitoring of thyroid function. = 0.0002, OR = 2.92) was comparable to that conferred by personal history of AINTD (29/63[46.0%] vs. 80/349 [22.9%], = 0.0001, OR = 2.87), and greater than that conferred by family history of thyroid disease (27/63 [42.9%] vs. 100/349 [28.7%], = 0.025, OR = 1.87) (2). Recently, we postulated (4) and then verified (5) that consumption of no fish (that is, meat eating) increases and, among fish eaters, swordfish consumption also increases the risk of PPT, while consumption of small oily fish decreases the risk of PPT. In that study, (5) which was based on universal screening by TPO and TgAb, the prevalence of PPT was 15.3%. This is the second highest frequency of PPT in Italy after the 22.1% found in Liguria, (6) this last prevalence matching the 22.3% of Wales (7). There is no consensus on screening for PPT (1). Both the 2011 (8) and 2017 (9) guidelines of the American Thyroid Association (ATA) limit the postpartum search for PPT in women with postpartum depressive disorder (Recommendation 63 []. = 92) consists of women with selective or predominant consumption of swordfish. Group B (= 85) consists of women with selective or predominant consumption of oily fish. Group C (= 108) consists of women who consume swordfish plus other fish, with swordfish consumption occurring infrequently; if eaten, oily fish also was consumed infrequently. Group D (= 117) consists of women who consume fish other than swordfish and oily fish. Group E (= 10) consists of women who did not consume fish at all (meat eaters). The terms predominant or infrequent indicate at least 50% of the total monthly fish consumprion or 50% of the total monthly fish consumption (4), respectively. The study, in the context of a program for the Health Support Development of Sicily, was conducted in accordance with the ethical standards of our DMA institutional research Committee, the 1964 Declaration of Helsinki, and its later amendments. Informed consent was obtained from all the participants. Costs of Screening We calculated the costs of gestational screening of women at risk for PPT, if performed, and the costs of postpartum screening (that we prefer to call postpartum monitoring) of thyroid function in women considered to be at PPT risk based on gestational screening. We prefer the terminology of postpartum monitoring because thyroid dysfunction occurs anytime.