妊娠并发亚临床甲状腺功能减退症的影响因素及对妊娠结局的影响

Influencing factors of subclinical hypothyroidism during pregnancy and its effect on pregnancy outcome

目的探讨妊娠期并发亚临床甲状腺功能减退症(SCH)的影响因素及对妊娠结局的影响,为妊娠期并发SCH的防治提供依据。方法选择2013年5月-2016年12月在天津市宁河区医院产检的孕妇1 036例为研究对象,其中妊娠期并发SCH 104例(73例接受左甲状腺素钠片正规治疗并达到治疗目标者作为治疗组,31例未接受治疗及治疗未达标者作为未治疗组),906例甲状腺功能正常孕妇作为对照组,观察各组孕妇并发症发生情况及妊娠结局。并应用单因素和多因素Logistic回归分析对年龄、孕前体质指数(BMI)、文化程度等因素进行分析,分析妊娠期并发SCH危险因素。结果未治疗组孕妇妊娠期糖尿病、贫血、胎膜早破发生率显著高于治疗组和对照组(P<0.05),治疗组妊娠期糖尿病、妊娠期高血压、贫血、前置胎盘、胎盘早剥、胎膜早破、产后出血发生率与对照组比较,差异无统计学意义(P>0.05)。未治疗组流产、剖宫产、死胎、早产、新生儿窒息不良结局发生率显著高于治疗组和对照组(P<0.05),而治疗组与对照组差异无统计学意义(P>0.05)。单因素相关分析显示年龄、孕前BMI、孕产史、吸烟与妊娠并发SCH有关(P<0.05)。多因素Logistic回归分析显示年龄≥30岁且初产、孕前BMI<18 kg/m^2、吸烟是妊娠并发SCH的危险因素,年龄20~35岁是妊娠并发SCH的保护因素(P<0.05)。结论妊娠期并发SCH可以增加孕妇妊娠期糖尿病、贫血、胎膜早破发生率和流产、剖宫产、死胎、早产、新生儿窒息不良结局发生率,年龄≥30岁且初产、孕前BMI<18 kg/m^2、吸烟是妊娠并发SCH的危险因素,应针对危险因素进行干预,降低妊娠并发SCH发生率。

Objective To explore the influencing factors of subclinical hypothyroidism（ SCH） during pregnancy and its effect on pregnancy outcome,and provide a basis for prevention and treatment of SCH during pregnancy. Methods A total of 1 036 pregnant women receiving prenatal examination in the hospital from May 2013 to December 2016 were selected and divided into treatment group（ 73 pregnant women with SCH,treated by levothyroxine sodium pills regularly,reaching treatment goal）,untreatment group（ 31 pregnant women with SCH,not treated by levothyroxine sodium pills regularly,not reaching treatment goal）,and control group（ 906 pregnant women with normal thyroid function）. The incidence rates of complications and pregnancy outcomes in the three groups were observed. Univariate logistic regression analysis and multivariate logistic regression analysis were used to analyze age,pre-pregnancy body mass index（ BMI）,and educational level; the risk factors of pregnancy complicated with SCH were analyzed. Results The incidence rates of gestational diabetes mellitus,anemia,and premature rupture of fetal membranes in untreatment group were statistically significantly higher than those in treatment group and control group（ P 0. 05）; there was no statistically significant difference in the incidence rates of gestational diabetes mellitus,hypertensive disorder complicating pregnancy,anemia,placenta previa,placental abruption,premature rupture of fetal membranes,and postpartum hemorrhage between treatment group and control group（ P〉0. 05）. The incidence rates of abortion,cesarean section,stillbirth,premature birth,and neonatal asphyxia in untreatment group were statistically significantly higher than those in treatment group and control group（ P〈0. 05）; there was no statistically significant difference between treatment group and control group（ P〉0. 05）. Univariate logistic regression analysis showed that age,pre-pregnancy BMI,history of gestation,and smoking were correlated with pregnancy complicated with SCH（ P〈0. 05）. Multivariate logistic regression analysis showed that aged 30 years old or more than 30 years old and primipara,pre-pregnancy BMI18 kg/m^2,and smoking were risk factors of pregnancy complicated with SCH,while aged 20-35 years old was protective factor of pregnancy complicated with SCH（ P〈0. 05）. Conclusion Pregnancy complicated with SCH can increase the incidence rates of gestational diabetes mellitus,anemia,premature rupture of fetal membranes,abortion,cesarean section,stillbirth,premature birth,and neonatal asphyxia. Aged 30 years old or more than 30 years old and primipara,pre-pregnancy BMI18 kg/m^2,and smoking are risk factors of pregnancy complicated with SCH. Interventions should be carried out according to the risk factors to reduce the incidence rate of pregnancy complicated with SCH.