Study of the Factors Leading to Fetal and Neonatal Dysthyroidism in Children of Patients With Graves Disease.
Study of the Factors Leading to Fetal and Neonatal Dysthyroidism in Children of Patients With Graves Disease.
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DOI：
10.1210/js.2017-00189
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发表时间：
2017-06
影响因子：
4.1
通讯作者：
Luton D
中科院分区：
文献类型：
--
作者：
Banigé M;Estellat C;Biran V;Desfrere L;Champion V;Benachi A;Ville Y;Dommergues M;Jarreau PH;Mokhtari M;Boithias C;Brioude F;Mandelbrot L;Ceccaldi PF;Mitanchez D;Polak M;Luton D
新生儿甲状腺功能亢进症于1912年首次被描述，并于1964年被证明与母体抗体的经胎盘通过有关。很少有多中心研究描述围产期因素导致胎儿和新生儿甲状腺功能障碍。显示胎儿甲状腺功能障碍（FD）和新生儿甲状腺功能障碍（ND）可以预测围产期变量，特别是，抗促甲状腺激素受体抗体（TRAb）在母亲和孩子的循环水平。这是一项回顾性多中心研究，数据来自2007年至2014年监测妊娠的所有患者的病历。在28万例新生儿中，筛选出2288例甲状腺功能不全妇女的病历，纳入417例妊娠期TRAb阳性的Graves病妇女。使用母体TRAb水平，2.5 IU/L的临界值是FD的最佳预测值，灵敏度为100%，特异性为64%。使用新生儿TRAb水平，6.8 IU/L的临界值是ND的最佳预测值，敏感性为100%，特异性为94%。在我们的研究中，65%有Graves病史的妇女在怀孕期间没有接受抗甲状腺药物，但仍然有ND的风险。对于TRAb水平≥ 2.5 IU/L的孕妇，胎儿超声监测至关重要，直至分娩。所有TRAb水平≥ 6.8 IU/L的新生儿应接受儿科医生检查，特别注意甲状腺功能障碍，必要时进行治疗。我们确定了TRAb与所有妇女以及妊娠期间接受或未接受ATD治疗的妇女的产前和产后甲状腺功能障碍相关的精确临界值。
Neonatal hyperthyroidism was first described in 1912 and in 1964 was shown to be linked to transplacental passage of maternal antibodies. Few multicenter studies have described the perinatal factors leading to fetal and neonatal dysthyroidism. To show how fetal dysthyroidism (FD) and neonatal dysthyroidism (ND) can be predicted from perinatal variables, in particular, the levels of anti-thyrotropin receptor antibodies (TRAbs) circulating in the mother and child. This was a retrospective multicenter study of data from the medical records of all patients monitored for pregnancy from 2007 to 2014. Among 280,000 births, the medical records of 2288 women with thyroid dysfunction were selected and screened, and 417 women with Graves disease and positive for TRAbs during pregnancy were included. Using the maternal TRAb levels, the cutoff value of 2.5 IU/L best predicted for FD, with a sensitivity of 100% and specificity of 64%. Using the newborn TRAb levels, the cutoff value of 6.8 IU/L best predicted for ND, with a sensitivity of 100% and a specificity of 94%. In our study, 65% of women with a history of Graves disease did not receive antithyroid drugs during pregnancy but still had infants at risk of ND. In pregnant women with TRAb levels ≥2.5 IU/L, fetal ultrasound monitoring is essential until delivery. All newborns with TRAb levels ≥6.8 IU/L should be examined by a pediatrician with special attention for thyroid dysfunction and treated, if necessary. We determined the precise cutoff values for TRAbs in relation to antenatal and postnatal dysthyroidism in the population of all women and for women with or without ATD treatment during pregnancy.