摘要
目的动态随访孕妇妊娠期间甲状腺功能变化,探讨低甲状腺素血症(hypothyroxinemia,HT)对妊娠结局和新生儿的影响,明确孕期甲状腺功能筛查的合适时机及随访必要性。方法前瞻性收集2016年1~11月笔者医院产科门诊建卡996例孕妇资料,记录建卡基本资料及首次产科相关检查结果,随访妊娠中期糖尿病筛查结果及甲状腺功能随访和诊疗方案,收集孕妇围生期结局、胎儿最后一次超声及新生儿基本情况。比较不同建卡时期及HT与正常孕妇各指标及妊娠结局的差异。结果996例孕妇中,既往有甲状腺相关疾病史51例;945例孕前甲状腺功能正常孕妇,按照建卡孕周分组,建卡孕周<15周为C组,≥15周为D组。C组亚临床甲状腺功能减退(以下简称亚甲减)、亚临床甲状腺功能亢进(以下简称亚甲亢)及甲亢检出率均明显大于D组(P均<0.05);HT检出率分别为5.70%和17.01%,差异有统计学意义(P<0.01)。C组孕妇TPOAb(+)率HT组明显高于甲状腺功能正常组(P<0.05)。HT组早产和胎盘粘连发生率明显高于甲状腺功能正常组(分别为10.26%vs 4.64%,P<0.05和4.27%vs 0.69%,P<0.01),但胎儿末次超声及新生儿基本比较,差异无统计学意义。妊娠中期,低FT 4水平为巨大儿发生危险因素(OR=1.535,95%CI:0.10~2.34,P=0.047)。结论妊娠早期各种甲状腺功能异常已有较高发生率,且HT者早产和胎盘粘连发生率明显增高,也是发生巨大儿的危险因素,故孕早期就应评估甲状腺功能状态,而甲状腺功能正常者需在孕中期再次评估甲状腺功能。
Objective The dynamic follow-up of thyroid function changes of pregnant women during pregnancy was carried out to investigate the effect of hypothyroxinemia(HT)on the outcomes of pregnancy and neonates,and the appropriate timing and necessity of thyroid function screening during pregnancy were clarified.Methods We collected the data of 996 pregnant women in the obstetrics department of our hospital from January 2016 to November 2016 prospectively.The basic data of card establishment and the results of the first obstetrical examination were recorded.Screening results of gestational diabetes mellitus during the second trimester of pregnancy,thyroid function and treatment program were followed-up.The perinatal outcome,the last ultrasound of the fetus and the basic information of the newborn were collected.The differences of the index and pregnancy outcomes between HT and normal pregnant women in different pregnant period were compared.Results Among the 996 pregnant women,51 had a history of thyroid related diseases and 945 were pregnant women with normal thyroid function before pregnancy.The pregnant women were divided into two groups according to the gestational week during the card establishment.The gestational age below 15 weeks was group C,and the gestational age greater than or equal to 15 weeks was group D.The detection rates of subclinical hypothyroidism,subclinical hyperthyroidism and hyperthyroidism in group C were significantly higher than those in group D(all P<0.05).The HT detection rates were 5.70%and 17.01%,respectively,with statistically significant differences(P<0.01).TPOAb(+)rate of pregnant women in group C was significantly higher in HT group than in normal group(P<0.05).The incidence of preterm birth and placental adhesion in the HT group was significantly higher than that in the normal group(10.26%vs 4.64%,P<0.05 and 4.27%vs 0.69%,P<0.01,respectively),but there were no statistically significant differences in fetal final ultrasound and neonatal basic conditions.In the second trimester,low FT 4 level was a risk factor for macrosomia(OR=1.535,95%CI:0.10-2.34,P=0.047).Conclusion The incidence of various thyroid dysfunction in early pregnancy has been relatively high,and the incidence of premature delivery and placental adhesion in HT patients has been significantly increased.HT is also a risk factor for macrosomia.Therefore,thyroid function should be evaluated in early pregnancy,and should be re-evaluated in the second trimester even in patients with normal thyroid function.
作者
谢俊豪
李文文
金百翰
宋敬云
霍翠兰
刘婷婷
王静
刘玉环
黄勤
Xie Junhao;Li Wenwen;Jin Baihan(Department of Endocrinology,Shanghai Changhai Hospital,Second Military Medical University,Shanghai 200433,China)
出处
《医学研究杂志》
2020年第2期48-53,共6页
Journal of Medical Research
基金
国家自然科学基金资助项目(81471038)
国家卫生和计划生育委员会行业基金资助项目(201502011)。
