甲状腺功能减退妇女早孕期促甲状腺素达标与否与妊娠期糖尿病发生的关系

Relationship between thyroid stimulating hormone treat-to-target during early pregnancy and incidence of gestational diabetes mellitus in women with hypothyroidism

目的探讨已诊断甲状腺功能减退(简称甲减)妇女早孕期促甲状腺素(TSH)达标与否与妊娠期糖尿病(GDM)发生的关系。方法回顾性分析2015年1月至2018年12月在中山大学附属第三医院规律产检、自然受孕且首次产检孕周≤13+6周的单胎孕妇6978例,其中甲减组186例,甲状腺功能正常组6792例;甲减组中,按首次检查TSH是否达标(TSH<2.5 mU/L为达标)再分为TSH达标组(124例)与TSH未达标组(62例)。收集首次产检的基本信息,同时空腹采血检测甲状腺功能[TSH、游离甲状腺素(FT4)、甲状腺过氧化物酶抗体(TPOAb)]和空腹血糖(FPG);在孕24~28周行75 g口服葡萄糖耐量试验(OGTT)。甲减组与正常组、TSH达标组和未达标组GDM发生率的比较采用χ^(²)检验,同时利用logistic回归分析法分析GDM发生的危险因素。结果甲减组GDM的发病率明显高于正常组,差异具有统计学意义[分别为21.5%(40/186)和13.7%(929/6792),P=0.002]。TSH未达标组[24.2%(15/62)]与达标组[20.2%(25/124)]GDM的发病率均明显高于正常组,差异具有统计学意义(均P<0.05)。logistic回归分析结果显示,年龄、孕前体重指数、甲减病史、FPG、TPOAb阳性及甘油三酯为GDM发病的独立危险因素(OR值为1.071~2.979,均P<0.05),TSH是否达标未能进入方程。结论与甲状腺功能正常的妇女比较,甲减妇女无论早孕期TSH是否达标,其孕期GDM的发生风险仍明显增加。

Objective To explore whether thyroid stimulating hormone(TSH)treat-to-target during early pregnancy had an impact on the incidence of gestational diabetes mellitus(GDM)in women with hypothyroidism.Methods A retrospective analysis was performed on naturally conceived singleton pregnant women who had accepted routinely prenatal services at the Third Affiliated Hospital of Sun Yat-sen University from January 2015 to December 2018.The gestational weeks of the first obstetric examination were before 13 weeks and 6 days of gestation.Data of 6978 subjects were analyzed,including 186 cases in the hypothyroidism group and 6792 cases in the normal group.In the hypothyroidism group,according to whether TSH levels were<2.5 mU/L in the first prenatal examination,124 cases were in the under control group and 62 cases in the non-control group.Basic information was collected at first visit,and laboratory tests were performed with fasting samples,including thyroid function[TSH,free thyroxine(FT4),thyroid peroxidase antibody(TPOAb)]and fasting plasma glucose(FPG).The 75-gram oral glucose tolerance test(OGTT)was performed at 24 to 28 weeks.The incidence of GDM and the impact of TSH levels on it between the hypothyroidism group and the normal group were explored by using χ^(2) test.The risk factors of GDM were analyzed by logistic regression.Results The incidence of GDM in the hypothyroidism group was higher than that in the under-control group[21.5%(40/186)vs.13.7%(929/6792),P=0.002].The incidences of GDM in the under-control group[20.2%(25/124)]and the non-control group[24.2%(15/62)]were higher than that of the control group(all P<0.05).Multivariate logistic regression analysis for risk factors of incidence of GDM was performed,and finally age,pregestational body mass index,history of hypothyroidism,FPG,positive TPOAb,and triglyceride were considered to be independent risk factors for incidence of GDM(P<0.05).Whether TSH met the standard was ruled out from the equation.Conclusion Compared with women with normal thyroid function,women with hypothyroidism still are at higher risk of developing GDM,whether TSH levels are under control or not.