Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child.
Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child.
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DOI：
10.1097/00006254-200001000-00002
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发表时间：
1999-12
期刊：
影响因子：
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通讯作者：
J. Haddow;G. Palomaki;Walter C. Allan;Josephine Williams;G. Knight;June Gagnon;Cheryl E. O’heir;M. Mitchell;R. Hermos;S. Waisbren;J. Faix;R. Klein
中科院分区：
文献类型：
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作者：
J. Haddow;G. Palomaki;Walter C. Allan;Josephine Williams;G. Knight;June Gagnon;Cheryl E. O’heir;M. Mitchell;R. Hermos;S. Waisbren;J. Faix;R. Klein
背景：当孕妇和胎儿同时发生甲状腺缺乏时，儿童的神经心理发育会受到不利影响。如果只有母亲在怀孕期间患有甲状腺功能减退症，是否会发生发育问题尚不清楚。方法：在1996年和1997年，我们对1987年1月至1990年3月期间收集的25216名孕妇的血清样本进行了促甲状腺激素检测。然后，我们找到了47名血清促甲状腺素浓度在所有孕妇值的99.7百分位数或以上的妇女，15名血清促甲状腺素浓度在98和99.6百分位数之间（包括98和99.6百分位数）并伴有低甲状腺素水平的妇女，124名符合正常值的妇女。他们的7到9岁的孩子在出生时都没有甲状腺功能减退症，他们接受了15项有关智力、注意力、语言、阅读能力、学业表现和视觉运动表现的测试。结果62例血清促甲状腺素浓度高的妇女的孩子在所有15项测试中的表现稍差。在韦氏儿童智力量表（第三版）中，她们的全面智商得分平均比124名匹配的对照组妇女的孩子低4分（P= 0.06）；15%的孩子得分在85分或85分以下，而对照组中只有5%的孩子得分在85分以下。在62名患有甲状腺缺陷的女性中，48名在怀孕期间没有接受治疗。他们的孩子的全面智商得分比124名匹配的对照组平均低7分（P=0.005）；19%的人得分在85分或85分以下。在怀孕11年后，64%的未接受治疗的女性和4%的对照组女性确诊患有甲状腺功能减退症。结论：未确诊的孕妇甲状腺功能减退可能对胎儿产生不良影响；因此，在怀孕期间进行甲状腺缺乏筛查是有必要的。
BACKGROUND When thyroid deficiency occurs simultaneously in a pregnant woman and her fetus, the child's neuropsychological development is adversely affected. Whether developmental problems occur when only the mother has hypothyroidism during pregnancy is not known. METHODS In 1996 and 1997, we measured thyrotropin in stored serum samples collected from 25,216 pregnant women between January 1987 and March 1990. We then located 47 women with serum thyrotropin concentrations at or above the 99.7th percentile of the values for all the pregnant women, 15 women with values between the 98th and 99.6th percentiles, inclusive, in combination with low thyroxine levels, and 124 matched women with normal values. Their seven-to-nine-year-old children, none of whom had hypothyroidism as newborns, underwent 15 tests relating to intelligence, attention, language, reading ability, school performance, and visual-motor performance. RESULTS The children of the 62 women with high serum thyrotropin concentrations performed slightly less well on all 15 tests. Their full-scale IQ scores on the Wechsler Intelligence Scale for Children, third edition, averaged 4 points lower than those of the children of the 124 matched control women (P= 0.06); 15 percent had scores of 85 or less, as compared with 5 percent of the matched control children. Of the 62 women with thyroid deficiency, 48 were not treated for the condition during the pregnancy under study. The full-scale IQ scores of their children averaged 7 points lower than those of the 124 matched control children (P=0.005); 19 percent had scores of 85 or less. Eleven years after the pregnancy under study, 64 percent of the untreated women and 4 percent of the matched control women had confirmed hypothyroidism. CONCLUSIONS Undiagnosed hypothyroidism in pregnant women may adversely affect their fetuses; therefore, screening for thyroid deficiency during pregnancy may be warranted.