文章摘要

妊娠期甲状腺功能减退对母婴妊娠结局的影响

作者: 1赵一芳, 1顾颖
1 无锡市妇幼保健院产科,江苏 无锡 214001
通讯:
DOI: 10.3978/j.issn.2095-6959.2021.03.012
基金: 江苏省妇幼健康科研项目(F201735);无锡市科技发展资金项目(CSE31N1718)。

摘要

目的:探讨妊娠期甲状腺功能减退(以下简称甲减)对母婴妊娠结局的影响。方法:选取2016年1月至2019年6月在无锡市妇幼保健院产科门诊检查并住院分娩的甲减孕妇771例,其中临床甲减病例81例作为甲减组、临床亚甲减病例690例作为亚甲减组,随机选取同期420例正常孕妇为对照组,对其甲状腺功能(TSH和FT4水平)、妊娠并发症及结局(妊娠期糖尿病、妊娠期高血压疾病、胎膜早破、羊水异常、产后出血)、围产儿不良结局(胎儿宫内窘迫、流产或死胎、早产、新生儿窒息等)进行比较分析。结果:30 698例孕妇中甲减发生率为2.51% (771/30 698)。3组间年龄、孕前BMI、产次和孕周的比较,差异无统计学意义(P<0.05)。甲减组、亚甲减组在孕中期、孕晚期的TSH水平均高于对照组(P<0.05),FT4水平均低于对照组(P<0.05);甲减组在孕中期、孕晚期的TSH水平高于亚甲减组(P<0.05),FT4水平低于亚甲减组(P<0.05)。甲减组的妊娠糖尿病、妊娠期高血压疾病、胎膜早破、羊水异常等的发生率均高于对照组(P<0.05),亚甲减组的妊娠糖尿病、妊娠期高血压疾病、胎膜早破等发生率高于对照组(P<0.05),而甲减组的妊娠糖尿病、胎膜早破等发生率水平高于亚甲减组(P<0.05)。甲减组、亚甲减组的胎儿宫内窘迫、早产及新生儿窒息发生率均高于对照组(P<0.05),而甲减组的新生儿窒息发生率高于对照组(P<0.05)。结论:孕妇有较高的甲减发生率,并与母婴不良结局增加有关;应早期筛查和治疗妊娠期甲减,控制孕妇甲状腺激素水平,改善母婴妊娠结局。
关键词: 甲状腺功能减退;妊娠期;妊娠结局;妊娠并发症

Effect of hypothyroidism during pregnancy on maternal and infant pregnancy outcomes

Authors: 1ZHAO Yifang, 1GU Ying
1 Department of Obstetrics, Wuxi Maternal and Child Health-Care Hospital, Wuxi Jiangsu 214001, China

Foundation: This work was supported by Jiangsu Provincial Maternal and Child Health Research Project (F201735) and Wuxi Science and Technology Development Fund Project (CSE31N1718), China.

Abstract

Objective: To explore the effect of hypothyroidism during pregnancy on maternal and infant pregnancy outcomes. Methods: A total of 771 cases of hypothyroid pregnant women who were examined in the obstetric outpatient department and hospitalized for delivery in Wuxi Maternity and Child Health Hospital from January 2016 to June 2019 were selected as subjects. Among them, 81 cases of clinical hypothyroidism were regarded as hypothyroidism group, and 690 cases of clinical hypothyroidism cases were regarded as hypomethylene group, and randomly sampling 420 cases of normal pregnant women as control group. Then comparative analysis on thyroid function (TSH and FT4 levels), pregnancy complications and outcomes (gestational diabetes, gestational hypertension, premature rupture of membranes, abnormal amniotic fluid, postpartum hemorrhage), adverse perinatal outcomes (fetal distress, miscarriage or stillbirth, premature birth, neonatal asphyxia, etc.) were adopted. Results: The incidence rate of hypothyroidism in the 30 698 cases of pregnant women was 2.51% (771/30 698). There was no significant difference in age, BMI before pregnancy, parity and gestational week among the three groups (P<0.05). TSH levels in the second and third trimesters of hypothyroidism and hypomethylene were higher than those of the control group (P<0.05), and FT4 levels were lower than those of the control group (P<0.05); the level of TSH in the second and third trimesters of the hypothyroidism group was higher than that of the hypothylene group (P<0.05), and the level of FT4 was lower than that of the hypothylene group (P<0.05). The incidences of gestational diabetes, gestational hypertension, premature rupture of membranes, and abnormal amniotic fluid in the hypothyroid group were higher than those in the control group (P<0.05). In the hypothylene group, the incidence of gestational diabetes, gestational hypertension, and premature rupture of membranes was higher than that of the control group (P<0.05), while the incidence of gestational diabetes and premature rupture of membranes in the hypothylene group was higher than that of the hypothyroid group (P<0.05). The incidences of fetal distress, premature delivery and neonatal asphyxia in the hypothyroid group and hypothylene group were higher than those in the control group (P<0.05), while the incidence of neonatal asphyxia in the hypothyroidism group was higher than that in the control group (P<0.05). Conclusion: Pregnant women have a relatively high incidence rate of hypothyroidism during pregnancy. We should early screen and treat hypothyroidism during pregnancy, adjust thyroid hormone level in pregnant women, to improve pregnancy outcomes of maternal and infant.
Keywords: hypothyroidism; pregnancy; pregnancy outcome; pregnancy complication