Subclinical Hypothyroidism and Thyroid Autoimmunity Are Not Associated With Fecundity, Pregnancy Loss, or Live Birth
Subclinical Hypothyroidism and Thyroid Autoimmunity Are Not Associated With Fecundity, Pregnancy Loss, or Live Birth
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DOI：
10.1210/jc.2016-1049
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发表时间：
2016-06-01
影响因子：
5.8
通讯作者：
Mumford, Sunni L.
中科院分区：
文献类型：
--
作者：
Plowden, Torie C.;Schisterman, Enrique F.;Mumford, Sunni L.
背景：先前研究亚临床甲状腺功能减退症和抗甲状腺抗体与早期妊娠丢失和活产之间的关系表明，在该患者群体中没有研究混合结果和妊娠时间（TTP）。目的：本研究旨在探讨在有生育能力和有流产史的妇女中，孕前TSH浓度和甲状腺自身免疫与TTP、流产和活产的关系。设计和环境：这是一项前瞻性队列研究，来自美国四个医疗中心的大型随机对照试验。患者或其他参与者：健康女性，年龄18-40岁，积极尝试怀孕，之前有过一次或两次妊娠失败，没有不孕史，符合研究条件。干预：没有干预。主要结局指标：TTP、妊娠损失和活产。结果：与TSH = 2.5 mIU/L的妇女相比，TSH >= 2.5 mIU/L的妇女没有增加的流产风险（风险比，1.07；95%可信区间[CI]， 0.81-1.41）或活产率（风险比，0.97;95% CI, 0.88-1.07）或TTP（生育能力优势比，1.09;95% CI, 0.90-1.31）的降低，抗甲状腺抗体的存在与生育能力、流产或活产无关。因此，患有亚临床甲状腺功能减退症或甲状腺自身免疫的妇女可以放心，她们怀孕和活产的机会可能不会受到边缘性甲状腺功能障碍的影响。
Context: Prior studies examining associations between subclinical hypothyroidism and antithyroid antibodies with early pregnancy loss and live birth suggest mixed results and time to pregnancy (TTP) has not been studied in this patient population.Objective: This study sought to examine associations of prepregnancy TSH concentrations and thyroid autoimmunity with TTP, pregnancy loss, and live birth among women with proven fecundity and a history of pregnancy loss.Design and Setting: This was a prospective cohort study from a large, randomized controlled trial that took place at four medical centers in the United States.Patients or Other Participants: Healthy women, ages 18-40 y, who were actively attempting to conceive and had one or two prior pregnancy losses and no history of infertility were eligible for the study.Intervention: There were no interventions.Main Outcome Measure: TTP, pregnancy loss, and live birth.Results: Women with TSH >= 2.5 mIU/L did not have an increased risk of pregnancy loss (risk ratio, 1.07; 95% confidence interval [CI], 0.81-1.41) or a decrease in live birth rate (risk ratio, 0.97; 95% CI, 0.88-1.07) or TTP (fecundability odds ratio, 1.09; 95% CI, 0.90-1.31) compared with women with TSH = 2.5 mIU/L or the presence of antithyroid antibodies were not associated with fecundity, pregnancy loss, or live birth. Thus, women with subclinical hypothyroidism or thyroid autoimmunity can be reassured that their chances of conceiving and achieving a live birth are likely unaffected by marginal thyroid dysfunction.