妊娠期亚临床甲状腺功能减退症及过氧化物酶抗体阳性对妊娠结局和胎儿的影响

Influences of subclinical hypothyroidism and positive peroxidase antibody in pregnancy on pregnancy outcome and fetus

目的分析妊娠期亚临床甲状腺功能减退症及过氧化物酶抗体(TPOAb)阳性对妊娠结局及胎儿结局的影响。方法随机选择2018年1~12月至我院分娩的60例妊娠期亚临床甲状腺功能减退症及TPOAb阳性孕妇作为观察组,随机选择同期至我院分娩的60例健康孕妇作为对照组,观察两组产妇产前的促甲状腺激素(TSH)、血清游离甲状腺素(FT4)、血清游离三碘甲腺原氨酸(FT3)等甲状腺功能相关指标,比较两组孕妇的分娩方式及分娩并发症发生率,记录两组新生儿的结局、体重以及1 min Apgar评分情况。结果观察组孕妇的TSH、TPOAb水平明显高于对照组,差异有统计学意义(P<0.05);两组孕妇的FT3、FT4水平比较,差异无统计学意义(P>0.05)。观察组的剖宫率为36.67%,明显高于对照组的20.00%,差异有统计学意义(P<0.05),两组孕妇的自然分娩率和产钳助产率比较,差异无统计学意义(P>0.05)。观察组孕妇的先兆流产发生率为13.33%,明显高于对照组的3.33%,差异有统计学意义(P<0.05)。观察组孕妇的早产发生率为16.37%,明显高于对照组的5.00%,差异有统计学意义(P<0.05)。两组孕妇的胎儿窘迫、胎膜早破、胎盘早剥、产后出血发生率比较,差异无统计学意义(P>0.05)。观察组的低出生体重儿占16.67%,明显高于对照组的5.00%,差异有统计学意义(P<0.05)。两组新生儿的巨大儿、窒息、围生儿死亡发生率比较,差异无统计学意义(P>0.05)。观察组的新生儿体重和1 min Apgar评分均低于对照组,差异有统计学意义(P<0.05)。结论妊娠期亚临床甲状腺功能减退症及TPOAb阳性会增加孕妇剖宫产、早产和先兆流产、低体重新生儿的发生率,并降低新生儿出生评分,对于妊娠结局和胎儿结局均有不良影响。

Objective To analyze the influence of subclinical hypothyroidism and TPOAb positive during pregnancy on pregnancy outcome and fetal outcome.Methods A total of 60 pregnant women with subclinical hypothyroidism and TPOAb positive during pregnancy from January to December 2018 were randomly selected as the observation group,and 60 healthy pregnant women from the same period to our hospital were randomly selected as the control group.The relevant indicators of thyroid function such as prenatal thyroid stimulating hormone(TSH),serum free thyroxine(FT4),serum free triiodothyronine(FT3)were observed in the two groups.The mode of delivery and the incidence of complications were compared between the two groups.The outcome,weight and 1 min Apgar score of the two groups were recorded.Results The levels of TSH and TPOAb in the observation group were significantly higher than those in the control group,the difference was statistically significant(P<0.05).There was no significant difference in the level of FT3 and FT4 between the two groups(P>0.05).The cesarean section rate in the observation group was 36.67%,which was significantly higher than that in the control group(20.00%),the difference was statistically significant(P<0.05).There was no significant difference in natural delivery rate and forceps delivery rate between the two groups(P>0.05).The incidence of threatened abortion in the observation group was 13.33%,which was significantly higher than that in the control group(3.33%),the difference was statistically significant(P<0.05).The incidence of premature delivery in the observation group was 16.37%,which was significantly higher than that in the control group(5.00%),the difference was statistically significant(P<0.05).There was no significant difference in the incidence of fetal distress,premature rupture of membranes,placental abruption and postpartum hemorrhage between the two groups(P>0.05).The low birth weight infants in the observation group accounted for 16.67%,which was significantly higher than 5.00%in the control group,the difference was statistically significant(P<0.05).There was no significant difference in the mortality rates of macrosomia,asphyxia and perinatal infants between the two groups(P>0.05).The neonatal weight and 1 min Apgar score in the observation group were lower than those in the control group,the difference was statistically significant(P<0.05).Conclusion Subclinical hypothyroidism and TPOAb positive in pregnancy can increase the incidence of cesarean section,premature delivery,threatened abortion and low birth weight neonates,and reduce the birth score of neonates,which has adverse influence on pregnancy outcomes and fetal outcomes.