妊娠合并亚临床甲状腺功能减退症的不同治疗时机对妊娠结局及子代的影响

Effect of different treatment time on pregnancy outcomes and offspring of pregnancy with subclinical hypothyroidism

目的比较不同孕周开始对妊娠合并亚临床甲状腺功能减退症(SCH)的孕妇进行左甲状腺素(L-T4)替代治疗的妊娠结局及子代发育情况,探讨SCH孕妇进行L-T4替代治疗的最佳时机.方法选取2017年1月至2018年7月在江苏省无锡市妇幼保健院合并SCH的单胎妊娠孕妇100例,根据治疗时间分为早治疗组(于孕8周前开始进行口服L-T4替代治疗)和晚治疗组(于孕8周后开始进行口服L-T4替代治疗),各50例.另选取同期分娩的甲状腺功能正常的健康孕妇50例为对照组.比较3组孕妇的不良妊娠结局、妊娠期并发症、子代发育情况.结果早治疗组各妊娠不良结局和妊娠期并发症发生率低于晚治疗组,差异均有统计学意义(均P<0.05);高于对照组,差异均无统计学意义(均P>0.05).早治疗组子代第16、28周发育商高于晚治疗组[(93.3±3.3)分比(88.1±2.3)分,(94.6±2.8)分比(90.0±1.9)分],差异均有统计学意义(均P<0.05);低于对照组,差异均无统计学意义(均P>0.05).结论妊娠合并SCH对妊娠结局有不良影响,早期治疗可以有效降低产科并发症及不良妊娠结局的发生率,改善SCH对子代发育的影响.

Objective To observe the perinatal outcomes and offspring development in pregnant women with subclinical hypothyroidism(SCH)treated with levothyroxine(L-T4)at different gestational weeks,and to explore the optimal timing of L-T4 replacement therapy for pregnancy with SCH.Methods From January 2017 to July 2018,100 singleton pregnant women with SCH were enrolled at Wuxi Maternal and Child Health Care Hospital,Jiangsu Province,and they were assigned to take L-T4 before or after 8 gestational weeks(early treatment group and late treatment group,with 50 cases in each group).Fifty healthy pregnant women were enrolled as control group.Pregnancy outcomes,complications and offspring development were analyzed.Results In the early treatment group there were less poor pregnancy outcomes and complications,higher offspring developmental quotients at 16 and 28 weeks[(93.3±3.3)vs(88.1±2.3),(94.6±2.8)vs(90.0±1.9)]as compared with the late treatment group(all P<0.05);the incidence rates of poor pregnancy outcomes and complications were higher and the offspring developmental quotients were lower than those in those in the compared group,but the differences were not viewed as statistically significant(P>0.05).Conclusions Pregnancy complicated with SCH has adverse effect on pregnancy outcomes.Early treatment can effectively reduce obstetric complications and adverse pregnancy outcomes,and improve the development of offspring.