Subclinical hypothyroidism and pregnancy outcomes
Subclinical hypothyroidism and pregnancy outcomes
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DOI：
10.1097/01.aog.0000152345.99421.22
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发表时间：
2005-02-01
影响因子：
7.2
通讯作者：
Cunningham, FG
中科院分区：
文献类型：
--
作者：
Casey, BM;Dashe, JS;Cunningham, FG
背景：临床上甲状腺功能异常与妊娠并发症如高血压、早产有关。出生、低出生体重、胎盘脱垂和胎儿死亡。亚临床甲状腺功能减退症的关系。怀孕的结果还没有得到很好的研究。我们进行了这项前瞻性的甲状腺筛查研究，以评估妊娠结局的妇女与升高的促甲状腺激素（促甲状腺激素，TSH）和正常的游离甲状腺素level.METHODS：所有妇女谁提出的帕克兰医院产前护理2000年11月1日至2003年4月14日，甲状腺筛查使用荧光促甲状腺激素测定。筛查时TSH值等于或高于孕龄第97.5百分位数且游离甲状腺素大于0.680 ng/dL的女性被回顾性确定为亚临床甲状腺功能减退症。妊娠结局与第5次和第95次妊娠期间TSH值正常的孕妇进行了比较。结果：共有25,756名妇女接受了甲状腺筛查，并产下了一个单胎婴儿。有17，298名（67%）妇女在妊娠20周或更短时间内接受产前护理，其中404名（2.3%）被认为患有亚临床甲状腺功能减退症。亚临床甲状腺功能减退症妇女妊娠并发胎盘早剥的可能性是其3倍（相对危险度3.0，95%可信区间1.1-8.2）。早产，定义为在妊娠34周或之前分娩，在亚临床甲状腺功能减退症的妇女中几乎高出2倍。（相对危险度，1.8，95%可信区间1.1-2.9）。结论：我们推测，以前报道的亚临床甲状腺功能减退症妇女的后代智商降低可能与早产的影响有关。
BACKGROUND: Clinical thyroid dysfunction has been associated with pregnancy complications such as hypertension, preterm. birth, low birth weight, placental abruption, and fetal death. The relationship between subclinical hypothyroidism. and pregnancy outcomes has not been well studied. We undertook this prospective thyroid screening study to evaluate pregnancy outcomes in women with elevated thyrotropin (thyroid-stimulating hormone, TSH) and normal free thyroxine levels.METHODS: All women who presented to Parkland Hospital for prenatal care between November 1, 2000, and April 14, 2003, had thyroid screening using a chemiluminescent TSH assay. Women with TSH values at or above the 97.5th percentile for gestational age at screening and with free thyroxine more than 0.680 ng/dL were retrospectively identified with subclinical hypothyroidism. Pregnancy outcomes were compared with those in pregnant women with normal TSH values between the 5th and 95th percentiles.RESULTS: A total of 25,756 women underwent thyroid screening and were delivered of a singleton infant. There were 17,298 (67%) women enrolled for prenatal care at 20 weeks of gestation or less, and 404 (2.3%) of these were considered to have subclinical hypothyroidism. Pregnancies in women with subclinical hypothyroidism were 3 times more likely to be complicated by placental abruption (relative risk 3.0, 95% confidence interval 1.1-8.2). Preterm birth, defined as delivery at or before 34 weeks of gestation, was almost 2-fold higher in women with subclinical hypothyroidism. (relative risk, 1.8, 95% confidence interval 1.1-2.9).CONCLUSION: We speculate that the previously reported reduction in intelligence quotient of offspring of women with subclinical hypothyroidism may be related to the effects of prematurity.