Treatment of Hyperthyroidism in Pregnancy and Birth Defects
Treatment of Hyperthyroidism in Pregnancy and Birth Defects
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DOI：
10.1210/jc.2010-0652
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发表时间：
2010-11-01
影响因子：
5.8
通讯作者：
Mastroiacovo, Pierpaolo
中科院分区：
文献类型：
--
作者：
Clementi, Maurizio;Di Gianantonio, Elena;Mastroiacovo, Pierpaolo
背景：临床甲状腺功能亢进症在妊娠期并不少见，据报道患病率为0.1%至0.4%。可用的抗甲状腺药物是丙基硫氧嘧啶和甲巯咪唑/carbimazole.Objectives：在这份报告中，我们研究了这两种药物与先天性畸形的关联使用的数据从国际出生缺陷监测和研究交换所。设计：该研究采用了受病例影响的对照分析，包括18,131例畸形和报告的第一孕期暴露于药物。共有127名受试者出生的母亲与已知的头三个月的抗甲状腺药物exposure.Results：在52组的畸形进行了分析，反位+/-贲门，孤立的单侧肾/发育不全，心脏流出道缺陷与产前暴露于丙基硫氧嘧啶的基础上，三个，两个和五个案件，分别。出生前暴露于甲巯咪唑/卡比咪唑与后鼻孔闭锁、脐膨出和全反位+/-贲门反位显著相关（P < 0.01）。结论：由于出生缺陷的发生率低，缺乏生物相容性，以及漏诊的可能性，需要进一步的研究来全面评估丙基硫氧嘧啶与出生缺陷的关系。甲巯咪唑/卡比咪唑暴露与脐膨出和后鼻孔闭锁之间的关联与先前的报告一致，明确表明这些畸形可能是特定的胚胎病的一部分，即使罕见。（临床内分泌代谢杂志95：E337-E341，2010）
Context: Clinical hyperthyroidism is not uncommon in pregnancy, with a reported prevalence of 0.1 to 0.4%. The available antithyroid drugs are propylthiouracil and methimazole/carbimazole.Objectives: In this report we examined the association of both drugs with congenital malformations using data from the International Clearinghouse for Birth Defects Surveillance and Research.Design: The study used a case-affected control analysis and included 18,131 cases with malformations and reported first-trimester exposure to medication. A total of 127 subjects were born to mothers with known first-trimester antithyroid drug exposure.Results: Among the 52 groups of malformations that were analyzed, situs inversus +/- dextrocardia, isolated unilateral kidney a/dysgenesis, and cardiac outflow tract defects were associated with prenatal exposure to propylthiouracil based on three, two, and five cases, respectively. Prenatal exposure to methimazole/carbimazole was significantly associated with choanal atresia, omphalocele, and total situs inversus +/- dextrocardia (P < 0.01).Conclusions: Further studies are required to exhaustively evaluate the associations between propylthiouracil and birth defects because of the low number, the lack of biological plausibility, and the possibility of underdiagnosis. Association between methimazole/carbimazole exposure and omphalocele and choanal atresia is consistent with previous reports and definitely suggests that these malformations could be part of a specific, even if rare, embryopathy. (J Clin Endocrinol Metab 95: E337-E341, 2010)