妊娠期甲状腺功能减退对妊娠结局和母儿的影响

Effect of hypothyroidism during pregnancy on pregnancy outcomes and maternal and fetal outcomes

目的分析妊娠期甲状腺功能减退对妊娠结局和母儿的影响。方法选择2013年6月至2017年6月948例于浙江省医疗健康集团杭州医院住院分娩产妇的临床资料进行分析,其中伴有妊娠期甲减为A组(35例),亚临床甲减为B组(38例),随机选取50例甲状腺功能正常且未伴有其他妊娠期合并症的健康孕产妇为C组。统计妊娠期甲减发生率并比较各组产妇妊娠结局及母婴状况。结果 948例中,诊断临床甲减35例(3.69%),亚临床甲减38例(4.01%)。三组产妇胎盘早剥、胎膜早破发生率比较均无统计学意义(χ2值分别为0.09、0.19,均P>0.05);结果发现A组产妇妊娠期高血压疾病、妊娠期糖尿病及产后出血的发生率较B组均显著升高(χ2=4.46~5.66,均P<0.05);A组产妇早产、贫血、妊娠期高血压疾病、妊娠期糖尿病及产后出血的发生率较C组均显著升高(χ2=4.40~7.39,均P<0.05),而B与C组不良妊娠结局的比较,均无明显差异(χ2=0.09~0.84,均P>0.05)。三组胎儿畸形、胎儿窘迫及巨大儿发生率的比较均无统计学意义(χ2=0.27~0.65,均P>0.05),但A组分娩低出生体重儿的发生率较其他两组显著升高(χ2值分别为4.46、8.99,均P<0.05)。结论妊娠期甲减容易引起不良妊娠结局,对母婴安全造成极大的影响,因此临床中对此类孕产妇应加强筛查与规范治疗以改善母婴状况,获得良好的妊娠结局。

Objective To analyze the effect of hypothyroidism during pregnancy on pregnancy outcomes and maternal and fetal outcomes.Methods The clinical data of 948 pregnant women hospitalized in Hangzhou Hospital of Zhejiang Medical and Health Group from June 2013 to June 2017 were analyzed,including 35 cases of gestational hypothyroidism in group A and 38 cases of subclinical hypothyroidism in group B.Fifty cases of healthy pregnant women with normal thyroid function and without other pregnancy complications were randomly selected in group C.The incidence rate of hypothyroidism in pregnancy was calculated and pregnancy outcomes and maternal and fetal status in each group were compared.Results Of 948 cases,35 cases（3.69%）were diagnosed with clinical hypothyroidism and 38 cases（4.01%）with subclinical hypothyroidism.The incidence rate of placental abruption and premature rupture of membranes among three groups was not statistically significant（χ2 value was 0.09 and 0.19,respectively,both P〉0.05）.The incidence of hypertensive disorder,gestational diabetes and postpartum hemorrhage in group A was significantly higher than that in group B（χ2 value ranged 4.46-5.66,both P〈0.05）,and the incidence of preterm birth,anemia,pregnancy induced hypertension,gestational diabetes and postpartum hemorrhage in group A was significantly higher than that in group C（χ2 value ranged 4.40-7.39,respectively,all P 0.05）.But there was no significant difference in adverse pregnancy outcomes between group B and group C（χ2 value ranged 0.09-0.84,all P〉0.05）.There was no significant difference in the incidence rate of fetal malformation and fetal distress among three groups（χ2 value ranged 0.27-0.65,all P〉0.05）,but the incidence rate of low birth weight infants in group A was significantly higher than that in the other two groups（χ2 value was4.46 and 8.99,respectively,both P〈0.05）.Conclusion Hypothyroidism during pregnancy is easy to cause adverse pregnancy outcomes,which has great impact on the safety of mothers and infants.Therefore,screening and standardized treatment should be strengthened in order to improve the situation of mothers and fetus and get better pregnancy outcomes.