经LT_(4)治疗的妊娠期亚临床甲状腺功能减退症对子代0~36月龄生长发育及神经心理影响的队列研究

Effects of subclinical hypothyroidism during pregnancy treated with LT_(4) on the growth and neuropsychology of offspring aged 0-36 months:A cohort study

目的评价经LT_(4)治疗的妊娠期亚临床甲状腺功能减退症(甲减)对子代0~36月龄生长发育及神经心理的影响。方法招募孕前无甲状腺病史的20~45岁单胎妊娠健康妇女建立母婴队列,对妊娠期发生亚临床甲减的妇女给予LT_(4)治疗。纵向收集子代0~36月龄的体重、身长、头围等生长发育检查结果。通过问卷调查母婴营养、家庭经济水平和婴儿照护等情况。应用《0~6岁儿童神经心理发育量表》评价子代6月龄和12月龄的神经心理发育水平。结果最终将186对母子纳入研究队列,依据孕期甲状腺功能将研究对象分为甲状腺功能正常组(136例)和亚临床甲减组(50例)。亚临床甲减组子代出生时的体重、身长、体重/身长Z评分,1月龄体重/身长Z评分,6月龄头围Z评分,8月龄身长Z评分,24月龄体重/身长Z评分,以及12月龄的语言评分均低于甲状腺功能正常组(P<0.05)。经LT_(4)治疗的妊娠期亚临床甲减对早产、低出生体重、发育商<85分均未呈现显著影响,但可降低巨大儿的发生风险(AOR 0.206,95%CI 0.046~0.929,P=0.040)。结论妊娠期亚临床甲减经LT4治疗后仍可能对子代0~36月龄的生长发育和神经心理产生不利影响。

Objective To evaluate the effects of subclinical hypothyroidism during pregnancy treated with LT_(4) on the growth and neuropsychology of offspring aged 0-36 months.Methods A maternal-infant cohort was established in healthy singleton pregnant women aged 20-45 years without history of thyroid disease.Women developing subclinical hypothyroidism during pregnancy were treated with LT_(4).The weight,length,and head circumference of the offspring were recorded between 0 to 36 months after birth.Meanwhile,infant nutrition and family support were investigated.The Neuropsychological Development Questionnaire of 0-6 year old children was used to evaluate the neurodevelopment of offspring.Results A total of 186 mother-infant pairs were included.All subjects were divided into the euthyroidism(ETH)group(n=136)and subclinical hypothyroidism(SHT)group(n=50)according to maternal thyroid function during pregnancy.The Z-scores(adjusted by months of age and gender)of weight,length,weight/length at birth,weight/length at 1 month,head circumference at 6 months,length at 8 months,weight/length at 24 months of SHT group were lower than those of the ETH group(P<0.05).Furthermore,the language competence of the SHT offspring at 12 months of age was also lower than that of the ETH group(P<0.05).Maternal subclinical hypothyroidism treated with LT4 did not significantly affect preterm delivery,low birth weight,and developmental quotient<85,but reduced the risk of macrosomia(AOR 0.206,95%CI 0.046-0.929,P=0.040).Conclusion Although women with subclinical hypothyroidism received LT_(4) treatment during pregnancy,the offspring still may suffer adverse effects on their growth and neural development.