Thyroid-stimulating hormone, anti-thyroid antibodies, and pregnancy outcomes.
Thyroid-stimulating hormone, anti-thyroid antibodies, and pregnancy outcomes.
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DOI：
10.1016/j.ajog.2017.09.001
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发表时间：
2017-12
影响因子：
9.8
通讯作者：
Mumford SL
中科院分区：
文献类型：
--
作者：
Plowden TC;Schisterman EF;Sjaarda LA;Perkins NJ;Silver R;Radin R;Kim K;Galai N;DeCherney AH;Mumford SL
显性甲状腺功能障碍与不良产科结局相关。然而，对亚临床甲状腺功能减退症或甲状腺自身免疫及其与妊娠并发症的关系知之甚少。研究孕前抗甲状腺抗体与亚临床甲状腺功能减退症、早产（PTD）、妊娠期糖尿病（GDM）和先兆子痫之间的关系。对参加低剂量阿司匹林多中心随机、安慰剂对照试验的18-40岁既往流产1-2次的女性（n=1193）的前瞻性队列进行次要分析。检测孕前促甲状腺激素（TSH）、游离甲状腺素、甲状腺球蛋白抗体（抗TG）和甲状腺过氧化物酶抗体（抗TPO）水平。使用校正年龄和体重指数（BMI）的广义线性模型估计相对风险（RR）和95%置信区间（CI）。在估计胎龄>20周的持续妊娠妇女中，（>2.5 vs ≤2.5 mIU/L）和PTD（aRR 0.77; 95% CI 0.40，1.47）、GDM（aRR 1.28; 95% CI 0.54，3.04）或先兆子痫（aRR 1.20; 95% CI 0.71，2.04）。同样，与无甲状腺抗体的女性相比，在有甲状腺抗体的女性中，PTD（RR 1.26; 95% CI 0.65，2.45）、GDM（RR 1.33; 95% CI 0.51，3.49）或先兆子痫（RR 1.02; 95% CI 0.54，1.92）的可能性没有增加。在有1-2次流产史的妇女中，亚临床甲状腺功能减退症和甲状腺自身免疫与PTD、GDM或先兆子痫的风险增加无关。这些数据支持目前的建议，即低风险无症状的妇女不应定期筛查甲状腺功能障碍或自身免疫。
Overt thyroid dysfunction has been associated with adverse obstetrical outcomes. However, less is known regarding subclinical hypothyroidism or thyroid autoimmunity and their relationship to pregnancy complications. To examine the association between pre-pregnancy anti-thyroid antibodies and subclinical hypothyroidism and preterm delivery (PTD), gestational diabetes (GDM), and preeclampsia. Secondary analysis of a prospective cohort of 18–40 year old women with 1–2 prior pregnancy losses (n=1193) participating in a multi-center randomized, placebo-controlled trial of low-dose aspirin. Pre-pregnancy levels of thyroid stimulating hormone (TSH), free thyroxine, thyroglobulin antibody (anti-TG) and thyroid peroxidase antibody (anti-TPO) were measured. Relative risks (RR) and 95% confidence intervals (CIs) were estimated using generalized linear models adjusting for age and body mass index (BMI). Among women with an ongoing pregnancy of >20 weeks estimated gestational age, there was no association between pre-pregnancy TSH level (>2.5 versus ≤2.5 mIU/L) and PTD (aRR 0.77; 95% CI 0.40, 1.47), GDM (aRR 1.28; 95% CI 0.54, 3.04) or preeclampsia (aRR 1.20; 95% CI 0.71, 2.04). Similarly, among women with thyroid antibodies, there was no increase in the likelihood of PTD (RR 1.26; 95% CI 0.65, 2.45), GDM (RR 1.33; 95% CI 0.51, 3.49) or preeclampsia (RR 1.02; 95% CI 0.54, 1.92), compared to women without these antibodies. Among women with 1–2 prior pregnancy losses, subclinical hypothyroidism and thyroid autoimmunity were not associated with an increased risk of PTD, GDM, or preeclampsia. These data support current recommendations that low-risk asymptomatic women should not be routinely screened for thyroid dysfunction or autoimmunity.
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影响因子：
168.9
作者：
Schisterman, Enrique F.;Silver, Robert M.;Galai, Noya
通讯作者：
Galai, Noya
影响因子：
7.2
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影响因子：
5.8
作者：
Plowden, Torie C.;Schisterman, Enrique F.;Mumford, Sunni L.
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Mumford, Sunni L.
影响因子：
5.4
作者：
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通讯作者：
Robins, JM
影响因子：
1.1
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Inversetti A;Serafini A;Manzoni MF;Dolcetta Capuzzo A;Valsecchi L;Candiani M
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