Thyroid diseases in pregnancy
Thyroid diseases in pregnancy
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DOI：
10.1097/gco.0b013e328332a836
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发表时间：
2009-12-01
影响因子：
2.1
通讯作者：
Gaertner, Roland
中科院分区：
文献类型：
--
作者：
Gaertner, Roland
综述目的甲状腺疾病在妊娠期很常见，影响母体和胎儿的结局。最近的研究结果最近重新评估了妊娠早期和中期正常甲状腺功能的参考值。低甲状腺素血症影响儿童的神经心理发育。母亲甲状腺功能障碍或仅存在甲状腺特异性抗体与早期流产、早产和新生儿发病风险增加相关。接受左旋甲状腺素治疗的孕妇常常治疗不足或过度。建议对孕妇进行甲状腺功能障碍筛查，并且具有成本效益。总结最近，妊娠期碘摄入的推荐剂量从200微克/天增加到250微克/天，因为最近的研究表明，即使是轻到中度的碘摄入也可能影响孩子的神经心理发育。大约 5-18% 的孕妇表现出甲状腺特异性抗体升高，但只有 0.3% 的孕妇出现明显的甲状腺功能减退症，0.1-0.4% 的孕妇出现明显的甲状腺功能亢进。然而，那些患有自身免疫性甲状腺炎且甲状腺功能正常的孕妇可能会出现甲状腺储备受限，继而出现低甲状腺素血症和/或妊娠期间促甲状腺激素增加。流产、早产和小胎儿的发生率可能会增加，并且可能会延迟神经心理发育。强调所有孕妇至少尽早进行常规甲状腺功能检测。
Purpose of reviewThyroid disorders are common in pregnancy and affect maternal and fetal outcome.Recent findingsThe reference values for normal thyroid function during first and second trimester had been re-evaluated recently. Hypothyroxinemia affects the neuropsychological development of the child. Maternal thyroid dysfunction or only the presence of thyroid-specific antibodies is associated with increased risk for early abortion, preterm delivery and neonatal morbidity. Pregnant women under levothyroxine treatment are often undertreated or overtreated. Screening for thyroid dysfunction of pregnant women is recommended and cost-effective.SummaryRecently, the recommended dose for iodine intake during pregnancy had been increased from 200 to 250 mu g/day, because recent studies revealed that even mild-to-moderate iodine intake might affect the neuropsychological development of the child. About 5-18% of all pregnant women exhibit elevated thyroid-specific antibodies, but only 0.3% develop overt hypothyroidism and 0.1-0.4% overt hyperthyroidism. However, those pregnant women with autoimmune thyroiditis and normal thyroid function may have a restricted thyroid reserve, followed by hypothyroxinemia and/or thyroid-stimulating hormone increase during pregnancy. The incidence of miscarriage, preterm delivery and small for date offspring might be increased and probably a delayed neuropsychological development. Routine thyroid function testing at least as early as possible in all pregnant women is emphasized.