妊娠期孕妇亚临床甲状腺功能减退症与早产的Meta分析

Meta-analysis of the association between maternal subclinical hypothyroidism during pregnancy and preterm birth

目的系统评价妊娠期孕妇亚临床甲状腺功能减退症(subclinical hypothyroidism,SCH)与早产的相关性。方法计算机检索PubMed、Embase、Web of Science、Cochrane图书馆、维普、中国知网、万方数据库和中国生物医学文献数据库自建库至2019年11月30日发表的关于评价或探讨妊娠期孕妇SCH与早产风险的文献,提取纳入研究的SCH定义、孕妇孕周、出生胎龄、研究类型等信息,应用Stata 12.0软件进行Meta分析。结果最终纳入9篇队列研究和12篇病例对照研究,其中英文文献11篇,中文文献10篇,涵盖7个国家和地区,共100016例孕妇,其中SCH孕妇7562例。Meta分析结果显示,妊娠期孕妇SCH是发生早产的危险因素(OR=1.46,95%CI 1.25~1.71,P<0.001)。按照出生胎龄进行亚组分析显示,孕妇妊娠期SCH增加了胎龄<37周(OR=1.43,95%CI 1.16~1.76,P=0.001)、<34周(OR=1.84,95%CI 1.41~2.39,P<0.001)及<32周早产(OR=1.65,95%CI 1.08~2.52,P=0.020)的发病风险。进一步按照研究类型和SCH定义进行亚组分析,结果均显示妊娠期孕妇SCH会增加早产风险。结论SCH是发生早产的危险因素,但仍有必要进一步开展质量更高、样本量更大的研究进行验证。

Objective To study the association between maternal subclinical hypothyroidism(SCH)during pregnancy and preterm birth to provide a theoretical basis for the prevention of premature birth.Method From the establishment of the database to 30 November 2019,literature on the risk of SCH during pregnancy and premature delivery were researched in databases including PubMed,Embase,Web of Science,Cochrane library,VIP,CNKI,Wanfang and China biomedical literature database.Inclusion and exclusion criteria were established.Data including SCH definition,gestational week of pregnant women,preterm week at birth and study type were extracted and analyzed using Stata 12.0 software.Result A total of 9 cohort studies and 12 case-control studies were included,11 in English and 10 in Chinese,covering 7 countries and regions.A total of 100016 pregnant women were included,including 7562 pregnant women with SCH.Meta-analysis showed that SCH in pregnant women was a risk factor for preterm delivery(OR=1.46,95%CI 1.25~1.71,P<0.001).Subgroup analysis according to gestational age showed that SCH during pregnancy increased the risk of preterm delivery at<37 weeks(OR=1.43,95%CI 1.16~1.76,P=0.001),<34 weeks(OR=1.84,95%CI 1.41~2.39,P<0.001)and<32 weeks(OR=1.65,95%CI 1.08~2.52,P=0.020).Further subgroup analysis according to study type and definition of SCH also showed that maternal SCH during pregnancy might increase the risk of preterm delivery.Conclusion SCH may be a risk factor for preterm delivery,but further studies with higher quality and larger sample size are needed.