妊娠期亚临床甲状腺功能减退及左甲状腺素替代治疗对母婴结局的影响

Effect of subclinical hypothyroidism in pregnancy and levothyroxine replacement therapy on maternal and infant outcomes

目的探讨妊娠期亚临床甲状腺功能减退(亚临床甲减)及左甲状腺素(L-T 4)替代治疗对妊娠结局及围产儿的影响。方法回顾性分析100名妊娠期亚临床甲减孕妇(亚临床甲减组)的临床资料,另选取同期分娩的100例正常孕妇作为对照组。根据L-T 4代替治疗情况将亚临床甲减组中76例孕妇作为治疗组,其余24例作为未治疗组。分析亚临床甲减组与对照组、治疗组与未治疗组孕妇的妊娠结局(胎膜早破、早产、产后出血、胎头下降停滞、妊娠高血压、妊娠糖尿病)及围产儿情况[出生时Apgar评分以及胎儿窘迫、宫内发育迟缓、出生低体重、先天性甲状腺功能减低症(甲减)、新生儿畸形的发生情况]。结果亚临床甲减组与对照组的胎膜早破、产后出血、胎头下降停滞、妊娠期高血压发生率以及围产儿情况(除宫内发育迟缓外)差异无统计学意义(均P>0.05),但亚临床甲减组孕妇的妊娠糖尿病发生率及早产发生率均高于对照组(均P<0.05)。亚临床甲减治疗组与未治疗组孕妇的胎膜早破、早产、产后出血、胎头下降停滞及妊娠高血压发生率以及围产儿情况差异无统计学意义(均P>0.05),而亚临床甲减治疗组孕妇的妊娠糖尿病发生率低于未治疗组(P<0.05)。结论妊娠期亚临床甲减或可增加妊娠糖尿病及早产发生风险,而L-T 4替代治疗或可降低妊娠期糖尿病风险,但两者对围产儿结局均无明显影响。

Objective To investigate the effect of subclinical hypothyroidism in pregnancy and levothyroxine replacement therapy on pregnancy outcome and perinatal infants.Methods The clinical data of 100 pregnant women with subclinical hypothyroidism in pregnancy(subclinical hypothyroidism group)were retrospectively analyzed,and another 100 healthy pregnant women with simultaneous delivery were selected as control group.According to the condition of levothyroxine therapy,76 pregnant women in the subclinical hypothyroidism group were enrolled as treatment group,and the remaining 24 cases as non-treatment group.An analysis was performed in the subclinical hypothyroidism group and the control group,or in the treatment group and the non-treatment group,on pregnancy outcome of pregnant women(premature rupture of membrance,premature delivery,postpartum hemorrhage,protracted descent,gestational hypertension,and gestational diabetes mellitus)as well as conditions of perinatal infants(Apgar score at birth,and incidence of fetal distress,intrauterine growth retardation,low birth weight,congenital hypothyroidism and birth defects).Results There was no statistically significant difference in incidence rate of premature rupture of membranes,postpartum hemorrhage,protracted descent or gestational hypertension,or conditions of perinatal infants excluding intrauterine growth retardation between the subclinical hypothyroidism group and the control group(all P>0.05).However,the subclinical hypothyroidism group had higher incidence rates of gestational diabetes mellitus and premature delivery than the control group(all P<0.05).No statistically significant difference was found between the subclinical hypothyroidism group and the non-treatment group in incidence rate of premature rupture of membrance,premature delivery,postpartum hemorrhage,protracted descent or gestational hypertension,or conditions of perinatal infants(all P>0.05),whereas the subclinical hypothyroidism group experienced lower incidence rate of gestational diabetes mellitus than the non-treatment group(P<0.05).Conclusion Subclinical hypothyroidism in pregnancy may increase the risk of developing gestational diabetes mellitus and premature delivery,moreover,levothyroxine replacement therapy may reduce the risk of gestational diabetes mellitus,but neither has evident effect on prenatal outcome.