妊娠母体甲状腺功能减退与母婴妊娠结局的相关性分析

Correlation of maternal hypothyroidism and maternal and neonatal outcomes

目的探究与分析妊娠母体甲状腺功能减退与妊娠结局的相关性。方法选取自2012年9月至2015年9月来临朐县人民医院行早孕检查并具有完整随访资料的789例孕产妇作为研究对象,对孕产妇妊娠12周至38周之间的甲状腺功能指标给予观察记录,并最终调查妊娠结局。结果孕中期与孕晚期TSH、FT3、FT4值所占比例比较均无明显差异(χ2值分别为0.23、0.54、1.23,均P>0.05)。甲状腺激素指标正常组和异常组尿碘分级有显著性差异,甲状腺激素指标正常组尿碘<150μg/L患者所占比例显著高于异常组(χ2=4.12,P<0.05)。孕中期不同尿碘分级下妊娠结局为正常、流产、早产、低出生体重、胎儿窘迫及其他发生率均无明显差异(χ2值分别为1.09、1.22、0.98、1.27、0.90、1.18,均P>0.05)。孕晚期尿碘分级<150μg/L者较>300μg/L者相比,妊娠正常率明显降低,流产、早产、低出生体重、胎儿窘迫及其他发生率明显升高(χ2值分别为5.24、4.56、5.23、5.89、4.77、5.23,均P<0.05)。孕晚期尿碘分级<150μg/L者较150~300μg/L分别相比,妊娠正常率明显降低,流产、早产、低出生体重、胎儿窘迫及其他发生率明显升高(χ2值分别为4.21、5.21、5.63、5.13、6.12、6.23,均P<0.05),且其所产新生儿,其尿碘分级<150μg/L发生率明显高于尿碘分级>150μg/L者(χ2值分别为6.14、4.37,均P<0.05)。结论孕晚期甲状腺功能减退可能对妊娠结局及新生儿的甲状腺功能带来影响,要求妇产科医生能够积极开展尿碘的检测,以达到改善并预防不良妊娠结局的目的。

Objective To explore and analyze the correlation of maternal hypothyroidism and pregnancy outcomes. Methods From September 2012 to September 2015 789 pregnant women taking check in People Hospital of Linxun Country with complete follow-up data were selected as research objects, and the maternal thyroid function indexes during 12 to 38 weeks of gestation were observed. Final pregnancy outcomes were investigated. Results At mid and late pregnancy TSH, FI3 and FF4 values were not obviously different （X2 value was 0.23, 0.54 and 1.23, respectively, all P 〉 0.05 ）. Compared with the group with abnormal thyroid hormone index, the proportion of patients with urine iodine 〈 150ug/L was significandy higher in the group with normal thyroid hormone index （X2 = 4.12, P 〈0. 05 ）. At mid-pregnancy under different urinary iodine grading, outcomes of normal pregnancy, miscarriage, premature birth, low birth weight, fetal distress and other incidences were not obviously different （X2 value was 1.09, 1.22, O. 98, 1.27, 0.90 and 1.18, respectively, all P 〉 0.05 ）. In late pregnancy compared to the cases with urine iodine classification 〉 300txg/L, cases with urine iodine classification 〈 150p^g/ L had significantly lower normal pregnancy rate but higher incidence of abortion, premature birth, low birth weight, fetal distress and other complications （X2 value was 5.24, 4.56, 5.23, 5.89, 4.77 and 5.23, respectively, all P 〈 0.05 ）. In late pregnancy compared to the cases with urine iodine classification of 150-300ug/L, cases with urine iodine classification 〈 150ug/L had significantly lower normal pregnancy rate but higher incidence of abortion, premature birth, low birth weight, fetal distress and other complications （X2 value was 4.21, 5.21,5.63, 5.13, 6.12 and 6.23, respectively, all P 〈0.05）. Compared to the cases with urine iodine classification 〉 150ug/L in late pregnancy, the incidence of urine iodine classification 〈 150ug/L in neonates was higher in cases with urine iodine classification 〈 150ug/L （X2 value was 6.14 and 4.37, respectively, both P 〈 0.05 ）. Conclusion Hypothyroidism in late pregnancy may affect pregnancy outcomes and neonatal thyroid function. Therefore, obstetrics and gynecology doctors are required to actively carry out urinary iodine testing in order to achieve the purpose of improving and preventing adverse pregnancy outcomes.