亚临床甲状腺功能减退症孕妇不同治疗时机对新生儿的影响

Effect of different treatment time of subclinical hypothyroidism in pregnant women on neonates

目的探讨亚临床甲状腺功能减退症(SCH)孕妇3个不同治疗时机对孕妇围生期、新生儿生后并发症及甲状腺功能的影响。方法选取2016年1-12月云南省第一人民医院新生儿科收治的在门诊确诊为SCH并规范治疗和定期随访孕妇及所产新生儿85例作为研究对象,按不同治疗时间分为孕前治疗组(29例)、孕早期治疗组(22例)和孕中晚期治疗组(34例);另选取同期在云南省第一人民医院行产检的甲状腺功能正常的健康孕妇及所产新生儿40例为对照组。比较4组孕妇围生期情况、新生儿一般情况、出生后并发症发生情况等,进行促甲状腺激素(TSH)初筛。结果4组孕妇妊娠期糖尿病、妊高征、妊娠期贫血、胎膜早破发生率比较,差异均无统计学意义(P>0.05);孕早期治疗组、孕中晚期治疗组新生儿复苏抢救率均明显高于孕前治疗组和对照组,且孕中晚期治疗组新生儿复苏抢救率明显高于孕早期治疗组,差异均有统计学意义(P<0.05);4组新生儿生后并发症发生率比较,差异均无统计学意义(P>0.05);孕中晚期治疗组孕妇治疗时间与新生儿支气管肺发育不良呈正相关(r=-0.233,P<0.05);孕中晚期治疗组新生儿初筛TSH值明显高于对照组和孕早期治疗组,差异均有统计学意义(P<0.05)。结论SCH孕妇经规范治疗后妊娠期并发症发生率无明显差异,其所产新生儿一般情况及新生儿初筛TSH值与甲状腺功能正常孕妇所产新生儿无明显差异;SCH孕妇治疗越晚其所产新生儿支气管肺发育不良发生概率越大,新生儿新筛TSH值越高。

Objective To investigate the effect of three different treatment times of pregnant woman with Subclinical hypothyroidism(SCH)on the general conditions,postnatal complications and thyroid disease screening of neonates.Methods A total of 85 pregnant women and their newborns who were diagnosed with SCH in outpatient department of Neonatology of Yunnan First People's Hospital from January to December 2016 were selected as the research subjects.According to different treatment time,they were divided into prepregnancy treatment group(29 cases),early pregnancy treatment group(22 cases)and middle and late pregnancy treatment group(34 cases).In addition,40 healthy pregnant women with normal thyroid function and newborns who underwent labor examination in yunnan First People's Hospital during the same period were selected as the control group.The perinatal condition,neonatal general condition and postnatal complications of pregnant women in 4 groups were compared,and thyroid stimulating hormone(TSH)screening was performed.Results The incidence of pregnant women with diabetes,pregnancy hypertension,anemia showed no significant difference in the four groups(P>0.05).The early pregnant treatment group and middle and late pregnant treatment group had higher rate of neonatal resuscitation than the other two groups(P<0.05),and the neonatal resuscitation rate of middle and late pregnant treatment group is higher than the early pregnant treatment group(P<0.05).There was no significant difference between the four groups in the incidence of complications after birth.There was a positive correlation between the treatment time of middle and late pregnant treatment group and neonatal bronchopulmonary dysplasia(r=-0.233 P<0.05);In the middle and late pregnant treatment group,the newborn screening TSH value was significantly higher than that of the group(P<0.05)and the early pregnant treatment group(P<0.05).Conclusion SCH pregnant women with L-T4 treatment had no significant difference in the incidence of complications of pregnancy and neonatal general situation to euthyroid pregnant women.The later SCH pregnant women were treated,the higher the incidence of bronchopulmonary dysplasia and the higher the TSH value of newborn.