妊娠期甲状腺功能异常与不良妊娠结局的临床分析

Correlation between maternal thyroid dysfunction during pregnancy and adverse pregnancy outcomes

目的分析妊娠期甲状腺功能异常与出生缺陷及不良妊娠结局间的关系。方法选取2008年11月至2014年3月在三亚市妇幼保健院进行常规产前检查1 017例单胎孕妇,留取空腹静脉血,检测血清促甲状腺激素(TSH)、游离甲状腺素(FT4)及总甲状腺素(TT4)水平,并对孕妇进行随访。根据测定结果建立不同孕周甲状腺功能的正常值参考范围并分组,应用Logistic回归分析妊娠期各甲状腺功能异常组与不良妊娠结局关系。结果妊娠期临床甲状腺功能减退症是死胎、治疗性引产与胎儿流失的危险因素(调整后OR值分别为44.24、44.24、13.45),亦是胎儿发生循环系统先天性畸形及分娩低出生体重儿的危险因素(调整后OR值分别为10.44和9.05)。亚临床甲状腺功能减退症孕妇所分娩的新生儿头围和身长均低于甲状腺功能正常孕妇所分娩的新生儿(t值分别为6.834、7.223,均P<0.05),其也是早产、胎儿窘迫、婴儿视力及神经精神发育不良的危险因素(调整后OR值分别为3.32、3.65、5.34、10.49)。妊娠期单纯高T4血症孕妇更容易发生自然流产(调整后OR值为6.02);而单纯低T4血症其胎儿更容易发生骨骼肌肉先天性畸形(调整后OR值为9.12)。结论妊娠期甲状腺功能异常与不良妊娠结局及出生缺陷有一定的关系,应注意识别并加强治疗,同时监测胎儿生长情况,以改善预后。

Objective To explore the correlation between maternal thyroid dysfunction during pregnancy and birth defects as well as adverse pregnancy outcomes. Methods A total of 1 017 women with singleton pregnancy were selected from November 2008 to March 2014 in Maternal and Child Health Hospital of Sanya,and fasting venous blood of them were collected for detecting thyroid stimulating hormone（ TSH）,free thyroxine（ FT4） and total thyroxine（ TT4） levels. Then these pregnant women were followed up. According to the results,the normal ranges of thyroid function in different gestational weeks were established,and the pregnant women were divided into different groups. Logistic regression analysis was used to analyze the relationship between thyroid dysfunction during pregnancy and adverse pregnancy outcomes. Results Clinical hypothyroidism in pregnancy was the risk factor of fetal death,therapeutic odinopoeia and fetal loss（ adjusted OR value was 44. 24,44. 24 and 13. 45,respectively）,and also the risk factor of fetal congenital abnormality in circulatory system and low birth weight（ adjusted OR value was 10. 44 and 9. 05,respectively）. Neonatal head circumference and body length of pregnant women with subclinical hypothyroidism were significantly lower than those of pregnant women with normal thyroid function（ t value was 6. 834 and 7. 223,respectively,both P〈 0. 05）,and subclinical hypothyroidism was also the risk factor of premature,fetal distress,infant visual acuity dysplasia and neuropsychiatric dysplasia（ adjusted OR value was 3. 32,3. 65,5. 34 and 10. 49,respectively）.Pregnant women with high T4 level were more prone to develop spontaneous abortion（ adjusted OR = 6. 02）,while fetuses of those with low T4 level were more likely to have congenital malformations in skeletal muscle（ adjusted OR = 9. 12）. Conclusion Maternal thyroid dysfunction during pregnancy is associated with birth defects and adverse pregnancy outcomes. Therefore it is necessary to identify maternal thyroid dysfunction,strengthen the treatment,and monitor fetal growth for improvement in prognosis.