Maternal thyroid hypofunction and pregnancy outcome.
Maternal thyroid hypofunction and pregnancy outcome.
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DOI：
10.1097/aog.0b013e3181788dd7
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发表时间：
2008-07
影响因子：
7.2
通讯作者：
D'Alton ME
中科院分区：
文献类型：
--
作者：
Cleary-Goldman J;Malone FD;Lambert-Messerlian G;Sullivan L;Canick J;Porter TF;Luthy D;Gross S;Bianchi DW;D'Alton ME
评估母亲甲状腺功能减退是否与并发症相关。共有 10,990 名患者接受了妊娠早期和中期血清的促甲状腺激素 (TSH)、游离甲状腺素 (freeT4) 以及抗甲状腺球蛋白和抗甲状腺过氧化物酶抗体检测。甲状腺功能减退症定义为 1) 亚临床甲状腺功能减退症：TSH 水平高于第 97.5 个百分位，游离 T4 位于第 2.5 个百分位和 97.5 个百分位之间；或 2) 低甲状腺素血症：TSH 水平位于第 2.5 个百分位和 97.5 个百分位之间，游离 T4 低于 2.5 个百分位。评估了不良后果。将甲状腺功能减退患者与甲状腺功能正常患者进行比较（TSH 和游离 T4 位于第 2.5 个百分位数和第 97.5 个百分位数之间）。比较有和没有抗体的患者。使用针对混杂因素进行调整的多变量逻辑回归分析。据记录，妊娠早期亚临床甲状腺功能减退症的发生率为 2.2%（10,990 人中的 240 人），妊娠中期为 2.2%（10,990 人中的 243 人）。据记录，妊娠早期有 2.1%（10,990 人中的 232 人）患有低甲状腺素血症，而在妊娠中期，则有 2.3%（10,990 人中的 247 人）患有低甲状腺素血症。亚临床甲状腺功能减退症与不良后果无关。在妊娠早期，低甲状腺素血症与早产（调整后优势比 [aOR] 1.62；95% 置信区间 [CI] 1.00–2.62）和巨大儿（aOR 1.97；95% CI 1.37–2.83）相关。在妊娠中期，它与妊娠糖尿病相关（aOR 1.7；95% CI 1.02-2.84）。在妊娠早期，15%（10,990 人中的 1,585 人）和妊娠中期 14%（10,990 人中的 1,491 人）有抗甲状腺抗体。当两种抗体在任一妊娠期均呈阳性时，早产胎膜早破的风险就会增加（分别为 P = .002 和 P<.001）。母亲甲状腺功能减退与不良后果的一致模式无关。
To estimate whether maternal thyroid hypofunction is associated with complications. A total of 10,990 patients had first- and second-trimester serum assayed for thyroid-stimulating hormone (TSH), free thyroxine (freeT4), and antithyroglobulin and antithyroid peroxidase antibodies. Thyroid hypofunction was defined as 1) subclinical hypothyroidism: TSH levels above the 97.5th percentile and free T4 between the 2.5th and 97.5th percentiles or 2) hypothyroxinemia: TSH between the 2.5th and 97.5th percentiles and free T4 below the 2.5th percentile. Adverse outcomes were evaluated. Patients with thyroid hypofunction were compared with euthyroid patients (TSH and free T4 between the 2.5th and 97.5th percentiles). Patients with and without antibodies were compared. Multivariable logistic regression analysis adjusted for confounders was used. Subclinical hypothyroidism was documented in 2.2% (240 of 10,990) in the first and 2.2% (243 of 10,990) in the second trimester. Hypothyroxinemia was documented in 2.1% (232 of 10,990) in the first and 2.3% (247 of 10,990) in the second trimester. Subclinical hypothyroidism was not associated with adverse outcomes. In the first trimester, hypothyroxinemia was associated with preterm labor (adjusted odds ratio [aOR] 1.62; 95% confidence interval [CI] 1.00–2.62) and macrosomia (aOR 1.97; 95% CI 1.37–2.83). In the second trimester, it was associated with gestational diabetes (aOR 1.7; 95% CI 1.02–2.84). Fifteen percent (1,585 of 10,990) in the first and 14% (1,491 of 10,990) in the second trimester had antithyroid antibodies. When both antibodies were positive in either trimester, there was an increased risk for preterm premature rupture of membranes (P = .002 and P<.001, respectively). Maternal thyroid hypofunction is not associated with a consistent pattern of adverse outcomes.