The impact of isolated maternal hypothyroxinemia during the first and second trimester of gestation on pregnancy outcomes: an intervention and prospective cohort study in China.
The impact of isolated maternal hypothyroxinemia during the first and second trimester of gestation on pregnancy outcomes: an intervention and prospective cohort study in China.
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孕早期和孕中期孤立性母亲低甲状腺素血症对妊娠结局的影响：中国的一项干预和前瞻性队列研究
DOI：
10.1007/s40618-018-0960-7
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发表时间：
2019-05
影响因子：
5.4
通讯作者：
Teng W
中科院分区：
文献类型：
--
作者：
Gong X;Liu A;Li Y;Sun H;Li Y;Li C;Yu X;Fan C;Shan Z;Teng W
目的探讨妊娠早、中期孤立的母体低甲状腺素血症(IMH)对妊娠结局的影响。目的：探讨左旋甲状腺素(L-T4)治疗早期妊娠合并特发性子宫出血是否能改善妊娠结局。碘充足地区(n = 3398)的早期妊娠妇女被招募到这项前瞻性队列研究(CHICCTR-TRC3398)。检测血清促甲状腺激素(TSH)、游离甲状腺素(FT4)和甲状腺过氧化物酶抗体(TPOAb)。12周前患有IMH的女性选择接受L-T4治疗，或者继续不治疗。调整L-T4的剂量，以达到正常的FT4和TSH水平。在随访期间评估妊娠结局。与对照组相比，妊娠早期的IMH与不良妊娠结局的风险增加无关。巨大儿(p = 0.022)和妊娠期高血压(p = 0.018)的发生率在妊娠中期明显高于对照组。妊娠中期发现的IMH是巨大儿[调整优势比(AOR)1.942，95%CI 1.076~3.503，p = 0.027]和妊娠期高血压(AOR 4.203，95%CI 1.611~10.968，p <； )的危险因素，当妊娠早期体重指数为 <； 25时。无论妇女是否接受L-T4治疗，妊娠早期的IMH都不会增加不良结局的风险。然而，在妊娠中期发现的IMH与不良妊娠结局的风险增加有关。结果表明，即使在妊娠早期甲状腺功能正常，中期的甲状腺功能随访也是必要的。本文的在线版本(10.1007/s4061801809607)包含补充材料，可供授权用户使用。
To explore the effect of isolated maternal hypothyroxinemia (IMH) during the first and second trimester of gestation on pregnancy outcomes. To explore whether levothyroxine (L-T4) treatment of women who had IMH identified in the first trimester improves pregnancy outcomes. Women in the early pregnancy in the iodine-sufficient area (n = 3398) were recruited to this prospective cohort study (ChiCTR-TRC-12002326). Serum thyroid-stimulating hormone (TSH), free thyroxine (FT4), and thyroid peroxidase antibody (TPOAb) were detected. Women with IMH before 12 weeks chose to receive L-T4 or remain untreated. The L-T4 dose was adjusted to attain a normal FT4 and TSH level. Pregnancy outcomes were evaluated during follow-up. IMH in the first trimester was not associated with increased risk of adverse pregnancy outcome compared with controls. The incidence of macrosomia (p = 0.022) and gestational hypertension (p = 0.018) was significantly higher in IMH identified in the second trimester of gestation compared with controls. IMH identified in the second trimester of gestation was a risk factor for macrosomia [adjusted odds ratio (aOR) 1.942, 95% CI 1.076–3.503, p = 0.027] and gestational hypertension (aOR 4.203, 95% CI 1.611–10.968, p < 0.01), when body mass index in the early pregnancy was < 25 kg/m2. IMH in the first trimester did not increase the risk of adverse outcomes irrespective of whether women received L-T4 treatment. However, IMH identified in the second trimester was associated with increased risk of adverse pregnancy outcome. The results suggest that thyroid function follow-up during the second trimester is necessary, even if thyroid function is normal during the first trimester. The online version of this article (10.1007/s40618-018-0960-7) contains supplementary material, which is available to authorized users.
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DOI：
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