妊娠期亚临床甲状腺功能减低与不良母婴结局meta分析

Meta-analysis of subclinical hypothyroidism and adverse maternal or neonatal outcomes during pregnancy

目的:评价妊娠期亚临床甲状腺功能减低与不良母婴结局的关系。方法:系统检索PubMed、万方和中国知网等数据库关于妊娠期亚临床甲状腺功能减低与母婴结局的队列研究,进行文献筛选、资料提取和质量评价,采用Stata 12.0软件进行Meta分析。结果:共纳入15个队列研究,共计44072个样本。Meta分析结果显示妊娠期亚临床甲减会增加母体流产(RR=2.15,95%CI:1.48~3.13,P<0.001)、胎膜早破(RR=1.35,95%CI:1.11~1.64,P=0.002)以及早产(RR=1.19,95%CI:1.05~1.34,P=0.005)不良妊娠结局发病风险,与新生儿不良结局低出生体质量、低Apgar评分、胎儿窘迫以及先天畸形的发病风险均无关(P均>0.05)。结论:妊娠期母体亚临床甲状腺机能减退症(SCH)与不良妊娠结局有关,临床应给予一定的干预措施。

Objective:To evaluate the relationship between subclinical hypothyroidism and adverse maternal or neonatal outcomes during pregnancy.Methods:A systematic review of the database of PubMed,Wan Fang and China Knowledge Network database on subclinical hypothyroidism and adverse maternal or neonatal outcomes during pregnancy was conducted.Literature screening,data extraction and quality evaluation were performed.Meta-analysis was performed using Stata12.0 software.Results:A total of 44,072 samples were included in 15 cohort studies.Meta-analysis showed that subclinical hypothyroidism during pregnancy increased maternal abortion(RR=2.15,95%CI:1.48~3.13,P<0.001),premature rupture of membranes(RR=1.35,95%CI:1.11~1.64,P=0.002)and preterm birth(RR=1.19,95%CI:1.05~1.34,P=0.005)risk of adverse pregnancy outcomes.There was no association with neonatal adverse outcomes of low birth weight,low Apgar score,fetal distress and the risk of congenital malformation(P>0.05)was observed.Conclusion:The maternal with subclinical hypothyroidism(SCH)during pregnancy is associated with adverse pregnancy outcomes,clinical interventions should be given.