高龄孕妇对亚临床甲减的认知及其妊娠疾病和母婴结局探讨

Study on the cognition of subclinical hypothyroidism, pregnant diseases and maternal and infant outcome in elderly pregnant women

目的探讨高龄孕妇对亚临床甲减(subclinical hypothyroidism, SCH)的认知及其妊娠疾病和母婴结局。方法选择2017年8月至2019年7月在中山市博爱医院进行产检和分娩的676例高龄孕妇为研究对象,根据是否存在SCH分为SCH组(39例)和非SCH组(637例)。收集孕妇的基本信息,采用改良的《妊娠SCH知晓情况调查问卷》调查研究对象对SCH的知晓情况和态度,查阅产检记录和分娩记录获得其妊娠疾病和母婴结局情况,并比较SCH组和非SCH组的基本情况、SCH知识的知晓情况、妊娠疾病和母婴结局。结果 SCH组和非SCH组的年龄≥40岁(53.85%vs 35.48%)、不按时产检(23.08%vs 10.99%)、不经常学习妊娠知识(58.97%vs 25.75%)、无饮食管理(66.67%vs 37.83%)比较,SCH组均高于非SCH组(P<0.05)。SCH组和非SCH组SCH知识知晓总得分[(44.43±7.09)分vs(48.35±7.64)分]、妊娠期学习SCH的态度[(8.68±1.89)分vs(9.28±2.07)分]、妊娠SCH危害知晓情况[(24.79±3.73)分vs(26.16±3.92)分]、妊娠SCH的防治态度得分[(10.96±1.98)分vs(12.91±2.12)分]比较,SCH组均低于非SCH组(P<0.05)。SCH组和非SCH组的促甲状腺激素(thyroid stimulating hormone, TSH)值[(6.06±0.86)μU/mL vs(1.83±0.43)μU/mL]比较,SCH组高于非SCH组(P<0.05)。SCH组和非SCH组的妊娠高血压(7.69%vs 0.63%)、子痫前期或子痫(2.56%vs 0.16%)、新生儿低出生体重(17.95%vs 9.58%)、胎儿窘迫(10.26%vs 2.83%)、新生儿低Apgar评分(5.13%vs 0.47%)比较,SCH组均高于非SCH组(P<0.05)。结论高龄孕妇SCH的患病率较高,SCH危害的知晓率较低。加强SCH知识的宣传与教育,提高高龄孕妇自我保健意识和保健行为的采取率,有助于预防SCH的危害。

Objective To explore the cognition of subclinical hypothyroidism(SCH),pregnancy diseases and maternal and infant outcomes in elderly pregnant women.Methods The 676 elderly pregnant women who underwent obstetrics examination and childbirth in Zhongshan Boai Hospital from August 2017 to July 2019 were selected as the research objects.According to the existence of SCH,they were divided into SCH group(39 cases) and non-SCH group(637 cases).Collected the basic information of pregnant women, used the modified "Pregnancy SCH Awareness Questionnaire" to investigate the subjects’ awareness and attitude towards SCH,checked the obstetric examination records and delivery records to obtain their pregnancy disease and maternal and infant outcomes, and compared the basic information, knowledge of SCH,pregnancy diseases and maternal and infant outcomes of SCH group and non-SCH group.Results The ratio of age≥40 years(53.85% vs 35.48%),didn’t process antenatal checkup in time(23.08% vs 10.99%),infrequent learning about pregnancy(58.97% vs 25.75%),no diet management(66.67% vs 37.83%) of the SCH group were higher than those of non-SCH group(P<0.05).The scores of awareness of subclinical hypothyroidism total scores[(44.43±7.09) vs(48.35±7.64)],study attitude scores[(8.68±1.89)vs(9.28±2.07)],awareness of SCH hazards[(24.79±3.73)vs(26.16±3.92)],attitude of prevention and treatment[(10.96±1.98)vs(12.91±2.12)]of the SCH group were lower than those of non-SCH group(P<0.05).The level of thyroid stimulating hormone(TSH)of the SCH group[(6.06±0.86)μU/mL vs(1.83±0.43)μU/mL] was higher than non-SCH group(P<0.05).The ratio of pregnancy-hypertension(7.69% vs 0.63%),preeclampsia or eclampsia(2.56% vs 0.16%),lower birth weight(17.95% vs 9.58%),fetal distress(10.26% vs 2.83%),lower apgar scores(5.13% vs 0.47%) of the SCH group were higher than non-SCH group(P<0.05).Conclusion The prevalence of SCH in elderly pregnant women is higher, and the awareness rate of SCH harm is lower.Strengthening the publicity and education of SCH knowledge, improving the self-care awareness and the adoption rate of health care behaviors of elderly pregnant women will help prevent the harm of SCH.