OBJECTIVES: Recent consensus guidelines do not advocate universal thyroid function screening during pregnancy but recommend testing high-risk pregnant women with a personal history of thyroid or other autoimmune disorders or with a family history of thyroid disorders. Maternal subclinical hypothyroidism during pregnancy is associated with various adverse outcomes. The present study aims to assess efficiency of the targeted high-risk case-finding approach in identifying women with thyroid dysfunction during early pregnancy. METHODS: A comprehensive literature search was done in PubMed and EMBASE databases till July 2012 for studies related to screening of thyroid dysfunction. Data was extracted from each relevant article. The primary estimate was pooled odds ratio with 95% CI. Data analysis was done by Comprehensive Meta Analysis software. Heterogeneity was assessed by I2 statistics. Publication bias was assessed using Begg and Egger test. Sensitivity analysis was also performed. RESULTS: A total of 5 studies (published between 2007 and 2011) were found to be pertinent after exclusion of irrelevant studies. Because of significant heterogeneity, a random effects model was chosen. For the effectiveness of universal screening, pooled odds ratio was found to be 2.87 (95% CI, 1.60-4.94, p=0.00). CONCLUSIONS: Targeted thyroid function testing of only the high-risk group would miss about one third of pregnant women with overt/ subclinical hypothyroidism.