妊娠合并甲状腺功能减退症或亚临床甲状腺功能减退症77例临床分析

Clinical analysis of hypothyroidism or subclinical hypothyroidism during pregnancy

目的探讨甲状腺功能减退症（简称甲减）及亚临床甲减对孕产妇妊娠结局及围产儿的影响。方法回顾性分析2005年1月至2008年3月在北京协和医院妊娠合并甲减（57例）或亚临床甲减（20例）分娩孕妇77例，随机选取同期分娩的正常孕妇79例作为对照，分析三组孕妇的一般临床资料、产时产后并发症及围产儿结局。结果3年间我院妊娠合并甲减的患病率为0．74％，合并亚临床甲减的患病率为0．26％，且呈逐年升高趋势。妊娠合并甲减组新生儿平均出生体重低于对照组[（3191．8±659．4）g和（3301．9±423．1）g，P〈0．051，妊娠期糖代谢异常发生率（24．6％）及小于胎龄儿的发生率（12．3％）均高于对照组（分别为11．4％和2．5％）（P〈0．05）。妊娠合并亚临床甲减组各项妊娠期并发症的发生率与对照组比较，均无统计学意义。结论妊娠合并甲减及亚临床甲减的患病率逐年上升，即使经过治疗，甲减或亚临床甲减孕妇小于胎龄儿等并发症的发生几率仍增加。对高危人群早期筛查、充分治疗是改善妊娠结局的最好方法。

Objective To investigate the maternal and fetal outcomes of pregnant women with hypothyroidism or subclinical hypothyroidism. Methods From Jan. 2005 to Mar. 2008, clinical records of 77 women with hypothyroidism （n = 57） or subclinical hypothyroidism （n = 20） during pregnancy who delivered at Peking Union Medical College Hospital were reviewed. The basic information, maternal complications and neonatal outcomes of the patients were compared with 79 healthy women who delivered during the same period. Results The prevalence of maternal hypothyroidism during the study period was 0.74 %, and that of maternal subclinical hypothyroidism was 0.26%. The mean neonatal birth weight of women with hypothyroidism was lower than that of the control[（3191.8±659.47 g） vs （3301.9±423.1 g）, P〈0.05], the incidence of abnormal glucose metabolism was higher （24.6% vs 11.4% ,P〈0.05）, and small for gestational age infants were more common than in the control group （12.3% vs 2.5%, P〈0.05）. The maternal and fetal outcomes of women with subclinical hypothyroidism during pregnancy showed no difference compared with the control. Conclusions Early screening for the high risk women and appropriate management are important to improve the neonatal and fetal outcomes of women with hypothyroidism and subclinical hypothyroidism during pregnancy.