妊娠合并亚临床甲状腺功能减退症

Subclinical Hypothyroidism in Pregnancy

亚临床甲状腺功能减退症（SCH）是指血促甲状腺激素（TSH）升高而甲状腺激素水平正常的一种病理状态，其在孕妇中的患病率为2％-5％。SCH能降低妇女的受孕概率，并与多种产科并发症密切相关，如流产、贫血、妊娠高血压综合征、胎盘早剥、产后出血和产后甲状腺炎。妊娠期SCH还与一系列围生期不良预后如早产、低体质量儿和新生儿呼吸窘迫有关，能使子女的神经心理发育、智商和学习能力严重受损。因此，应在怀孕前或发现怀孕时对高危人群进行SCH筛查，并使用孕周校正后的TSH参考值作为诊断标准，对发现SCH者进行甲状腺激素替代治疗。本文对妊娠合并SCH的流行特征、危害性、筛查方法、治疗及疗效等予以综述。

Subclinical hypothyroidism （SCH）, defined as elevated serum thyroid-stimulating hormone （TSH） with normal serum free thyroxin （ FT4 ）, has a prevalence of 2% -5 % among pregnant women. This dis- ease is associated with decreased fertility and increased risk for peripartum complications such as abortion, a- nemia, gestational hypertension, placenta abruption, postpartum hemorrhage and postpartum thyroiditis （PPT）. Untreated maternal SCH is related to adverse neonatal outcomes including preterm birth,low birth weight and neonatal respiratory distress. Since thyroid hormone is an important factor contributing to normal fetal brain development, there is a significantly increased risk of impairment in neurnpsychological developmental indices, intelligence quotient（IQ） scores and school learning abilities in the offspring of SCH mothers. Appropriate thyroxin treatment has been shown to improve pregnancy outcomes for both the mother and off- spring. Therefore,screening of women at high risk for thyroid dysfunction for SCH before or during pregnancy is strongly recommended, and gestational week specific reference ranges for serum TSH should be used as diagnostic criteria. Women diagnosed as SCH should be treated with thyroxin instantly. Here,we reviewed the epidemic characteristics, perniciousness, screening,treatment methods and effects of SCH in pregnancy.