妊娠早期甲状腺功能减退与妊娠期糖尿病及糖代谢指标的关系

Relationship between hypothyroidism and gestational diabetes mellitus,glucose metabolism indexes in early pregnancy

目的探究妊娠早期甲状腺功能减退与妊娠期糖尿病(GDM)及糖代谢指标的关系。方法抽取妊娠9~13+6周常规产检正常(正常组)、甲状腺功能减退(甲减组)妊娠早期孕妇各80例,于妊娠中期行口服75 g葡萄糖耐量试验(OGTT)及糖代谢指标检测,记录GDM发生情况及妊娠结局。结果甲减组GDM发生率明显高于正常组(P<0.05),甲减组GDM孕妇剖宫产率、并发症发生率均显著高于无GDM孕妇(P<0.05)。与正常组相比,甲减组娠中期OGTT各时相血糖、空腹血糖(FPG)、餐后2 h血糖(2 h PG)及糖化血红蛋白(HbA1c)均显著高(P<0.05)。妊娠早期血清促甲状腺激素(TSH)、游离甲状腺激素(FT4)与妊娠中期OGTT各时相血糖、FBG、2 h PG及HbAlc明显相关(P<0.05)。孕前体质量指数(BMI)>27.2 kg/m2、TSH上升2.2μIU/ml、FT4下降1.8 pmol/L是GDM的危险因素(P<0.05)。结论妊娠早期甲状腺功能减退可增加GDM发生风险,且与妊娠中期糖代谢指标变化相关。

Objective To investigate the relationship of hypothyroidism and gestational diabetes mellitus(GDM).Methods 80 pregnant women with hypothyroidism at 9~13+6 gestational weeks were selected as hypothyroidism group,and 80 normal pregnant women as normal group.Oral 75 g glucose tolerance test(OGTT)and glycometabolism were performed in the second trimester of pregnancy.The occurrence of GDM and pregnancy outcomes were recorded and analyzed statistically.Results The incidence of GDM in hypothyroidism group was significantly higher than that in normal group(P<0.05).The incidence of cesarean section and complications in hypothyroidism group was significantly higher(P<0.05).The OGTT blood glucose,fasting blood glucose(FPG),2-hour postprandial blood glucose(2hPG)and glycosylated hemoglobin(HbA1c)were significantly higher in the hypothyroidism group during the second trimester(P<0.05).Serum thyroid stimulating hormone(TSH)and free thyroid hormone(FT4)were significantly correlated with blood glucose,FBG,2hPG and HbAlc of OGTT in the second trimester of pregnancy(P<0.05).Pre-pregnancy body mass index(BMI)>27.2 kg/m2,TSH increased by 2.2μgIU/ml and FT4 decreased by 1.8 pmol/L were risk factors for GDM(P<0.05).Conclusions Hypothyroidism in early pregnancy is related to the changes of glucose metabolism in the second trimester of pregnancy and may increase the risk of GDM.It is necessary to actively monitor the changes of thyroid hormone levels.