OBJECTIVES: Pregnancy poses a high risk of thyroid dysfunction (TD) causing adverse outcomes in mother, fetus and neonate. This makes screening pregnant women for TD essential. Universal screening (US) aims to screen all women in contrast to targeted screening (TS) where only women at high-risk get tested for TD during pregnancy. Existing guidelines do not recommend US. Thus we performed meta-analysis to clarify this moot question whether US should be recommended for screening TD in pregnancy.  METHODS: All original research articles comparing the two approaches to detect TD in pregnancy were searched from databases PubMed, EBSCO and Cochrane library. Effect estimate is reported as loss ratio (LR) signifying missed cases. Missed cases are women considered as low risk during TS. Subgroup analysis was done for hyperthyroid and overall thyroid disorder. Further sensitivity and specificity analysis was also done. Data is analyzed using CMA 2.0. RESULTS: Total of 9 studies including 10,888 women was included in present analysis. As significant heterogeneity was found between studies (P ‹ 0.001, I = 0.99), random-effects model was used. 46% hypothyroid cases were missed if TS was performed instead of US (RR 0.46 (95% CI (0.35 to 0.61), P ≤ 0.001). Sensitivity analyses showed (RR 0.40 (95% CI (0.27 to 0 0.55), P≤ 0.001) Specificity test has confirmed it (RR 0.31 (95% CI (0.20 to 0.47), P≤ 0.001). Similar trends were seen in hyperthyroid (RR 0.56 (95% CI (0.51 to 0.65), P≤ 0.001) and over-all TD (RR 0.49 (95% CI (0.43 to 0.60), P≤ 0.001). CONCLUSIONS: Almost half of the cases were missed on TS. The present pooled analysis recommends US to identify overall TD as well as hypothyroid cases in pregnancy. This serves as a strong evidence for inclusion of US into guidelines.