Effects of subclinical hypothyroidism on maternal and perinatal outcomes during pregnancy: a single-center cohort study of a Chinese population.
Effects of subclinical hypothyroidism on maternal and perinatal outcomes during pregnancy: a single-center cohort study of a Chinese population.
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亚临床甲状腺功能减退症对孕期孕产妇和围产儿结局的影响：针对中国人群的单中心队列研究
DOI：
10.1371/journal.pone.0109364
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Lu XM
中科院分区：
文献类型：
--
作者：
Chen LM;Du WJ;Dai J;Zhang Q;Si GX;Yang H;Ye EL;Chen QS;Yu LC;Zhang C;Lu XM
目的不良的产妇结局和围产期并发症与明显的产妇甲状腺功能减退密切相关，但这些并发症是否发生在亚临床甲状腺功能减退（SCH）妇女妊娠期仍存在争议。本研究的目的是评估SCH对妊娠期间孕产妇和围产期结局的影响。方法对8012例孕妇进行前瞻性研究，其中371例甲状腺功能不全，7641例甲状腺功能正常。在不同的妊娠阶段采集母体血清样本，检测甲状腺激素浓度。SCH被定义为促甲状腺激素浓度超过妊娠特异性参考值，而游离甲状腺素浓度正常。产妇结局的发生，包括妊娠期高血压（GH）、妊娠期糖尿病、前置胎盘、胎盘早剥、产前胎膜破裂（PROM）和早产；围产期结局，包括宫内生长受限（IUGR）、胎儿窘迫、低出生体重（LBW；活产体重≤2500 g）、死产和畸形。结果与甲状腺功能正常患者相比，甲状腺功能紊乱患者的GH发生率较高(1.819% vs. 3.504%, P = 0.020; χ 2 = 7.345；优势比（OR） 2.243；95%置信区间（CI）， 1.251-4.024), PROM (4.973% vs. 8.625%, P = 0.002; χ 2 = 72.102；校正OR， 6.014; 95% CI, 3.975-9.099), IUGR (1.008% vs. 2.965%, <0.001; χ 2 = 13.272；校正OR， 3.336; 95% CI, 1.745-6.377), LBW （1.885% vs. 4.582%， P<0.001; χ 2 = 13.558；校正OR， 2.919; 95% CI, 1.650-5.163）。结论SCH孕妇发生GH和早破的风险增加，其胎儿和婴儿发生IUGR和LBW的风险增加。因此，常规的产妇甲状腺功能检测是必要的，以改善产妇和围产期结局。
Objective Adverse maternal outcomes and perinatal complications are closely associated with overt maternal hypothyroidism, but whether these complications occur in women with subclinical hypothyroidism (SCH) during pregnancy remains controversial. The aim of this study was to evaluate the effects of SCH on maternal and perinatal outcomes during pregnancy. Methods A prospective study of data from 8012 pregnant women (371 women with SCH, 7641 euthyroid women) was performed. Maternal serum samples were collected in different trimesters to examine thyroid hormone concentrations. SCH was defined as a thyroid stimulating hormone concentration exceeding the trimester-specific reference value with a normal free thyroxine concentration. The occurrence of maternal outcomes, including gestational hypertension (GH), gestational diabetes mellitus, placenta previa, placental abruption, prelabor rupture of membranes (PROM), and premature delivery; and perinatal outcomes, including intrauterine growth restriction (IUGR), fetal distress, low birth weight (LBW; live birth weight ≤2500 g), stillbirth, and malformation, was recorded. Logistic regression with adjustment for confounding demographic and medical factors was used to determine the risks of adverse outcomes in patients with SCH. Results Compared with euthyroid status, SCH was associated with higher rates of GH (1.819% vs. 3.504%, P = 0.020; χ 2 = 7.345; odds ratio (OR), 2.243; 95% confidence interval (CI), 1.251–4.024), PROM (4.973% vs. 8.625%, P = 0.002; χ 2 = 72.102; adjusted OR, 6.014; 95% CI, 3.975–9.099), IUGR (1.008% vs. 2.965%, <0.001; χ 2 = 13.272; adjusted OR, 3.336; 95% CI, 1.745–6.377), and LBW (1.885% vs. 4.582%, P<0.001; χ 2 = 13.558; adjusted OR, 2.919; 95% CI, 1.650–5.163). Conclusions The results of this study indicate that pregnant women with SCH had increased risks of GH and PROM, and their fetuses and infants had increased risks of IUGR and LBW. Thus, routine maternal thyroid function testing is necessary to improve maternal and perinatal outcomes.
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