Maternal hypothyroxinaemia during early pregnancy and subsequent child development: a 3-year follow-up study
Maternal hypothyroxinaemia during early pregnancy and subsequent child development: a 3-year follow-up study
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DOI：
10.1046/j.1365-2265.2003.01822.x
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发表时间：
2003-09-01
影响因子：
3.2
通讯作者：
de Vijlder, JJ
中科院分区：
文献类型：
--
作者：
Pop, VJ;Brouwers, EP;de Vijlder, JJ
目的评价妊娠早期产妇甲状腺功能减退症（fT4低于最低10%，TSH在参考范围：0.15-2.0 mIU/I）对婴儿发育的影响，以及妊娠期间fT4的任何后续变化。设计：对孕妇及其2岁以下儿童进行为期3年的前瞻性随访研究。测量方法：在妊娠12周（病例）和妊娠12周（对照）甲状腺功能减退症（fT4低于妊娠第10百分位数）妇女的儿童（fT4低于妊娠第50百分位数至第90百分位数）的儿童中，通过Bayley婴儿发育量表评估儿童发育。在妊娠12周、24周和32周时评估母体甲状腺功能（fT4和TSH）。比较1岁时63例和62例对照，2岁时57例和58例对照的精神和运动功能。结果孩子的女性与hypothyroxinaemia 12周的妊娠期推迟了精神和运动机能而控制:10指数点心理量表(95%置信区间CI: 45-15点,P = 0003)和8岁电机规模1年(95%置信区间:2.3—-12.8分,P = 0.02),以及八个指数点精神(95%置信区间CI: 4 - 12点,P = 0.02),和10个电机规模(95%置信区间CI: -点,P = 0.005)岁2年。在妊娠24周和32周fT4浓度升高的甲状腺功能减退妇女的儿童得分与对照组相似，而在对照组中，发育得分不受母亲在妊娠24周和32周fT4进一步下降的影响。结论：妊娠早期母亲甲状腺功能低下是婴儿神经发育延迟的独立决定因素。然而，在妊娠早期甲状腺机能减退的妇女中，当fT4浓度升高时，婴儿发育似乎不会受到不利影响。
OBJECTIVE To evaluate the impact of maternal hypothyroxinaemia during early gestation (fT4 below the lowest tenth percentile and TSH within the reference range: 0.15-2.0 mIU/I) on infant development, together with any subsequent changes in fT4 during gestation. DESIGN A prospective 3-year follow-up study of pregnant women and their children up to the age of 2 years.MEASUREMENTS Child development was assessed by means of the Bayley Scales of Infant Development in children of women with hypothyroxinaemia (fT4 below the tenth percentile at 12 weeks' gestation) at 12 weeks' gestation (cases), and in children of women with fT4 between the 50th and 90th percentiles at 12 weeks' gestation, matched for parity and gravidity (controls). Maternal thyroid function (fT4 and TSH) was assessed at 12,24 and 32 weeks' gestation. The mental and motor function of 63 cases and 62 controls was compared at the age of 1 year, and of 57 cases and 58 controls at the age of 2 years.RESULTS Children of women with hypothyroxinaemia at 12 weeks' gestation had delayed mental and motor function compared to controls: 10 index points on the mental scale (95% CI: 45-15 points, P= 0003) and eight on the motor scale at the age of 1 year (95% CI: 2.3-12.8 points, P= 0.02), as well as eight index points on the mental (95% CI: 4-12 points, P= 0.02), and 10 on the motor scale (95% CI: 6-16 points, P= 0.005) at the age of 2 years. Children of hypothyroxinaemic women in whom the fT4 concentration was increased at 24 and 32 weeks' gestation had similar scores to controls, while in the controls, the developmental scores were not influenced by further declines in maternal fT4 at 24 and 32 weeks' gestation.CONCLUSIONS Maternal hypothyroxinaemia during early gestation is an independent determinant of a delay in infant neurodevelopment. However, when fT4 concentrations increase during pregnancy in women who are hypothyroxinaemic during early gestation, infant development appears not to be adversely affected.