孕早期双胎妊娠甲状腺功能减退对妊娠结局的影响

The impact of hypothyroidism of twin pregnancy in first trimester on pregnancy outcomes

目的 探讨双胎妊娠孕早期甲状腺功能减退对妊娠结局的影响。方法 纳入双胎孕妇1 203例,按早孕期TSH水平根据双胎TSH的参考范围分为TSH正常组(0.01≤TSH≤3.35 mIU/L)、TSH>3.35组(3.35<TSH≤4.0 mIU/L)及TSH>4组(TSH>4.0 mIU/L),对其妊娠结局进行回顾性分析。结果 多因素分析提示,在调整年龄、孕前BMI、ART受孕、甲状腺功能减退病史、甲状腺自身抗体阳性及孕期使用左旋甲状腺素类药物治疗等因素后,孕早期TSH>4 mIU/L是双胎发生妊娠期糖尿病(GDM)的独立危险因素(OR3.48,95%CI 1.27~9.55)。结论 双胎妊娠孕早期甲状腺功能减退与妊娠期糖尿病的发生可能存在关系,TSH> 4 mIU/L是其独立的危险因素。

Objective To investigate the impact of hypothyroidism of twin pregnancy in first trimester on pregnancy outcomes. Methods A total of 1 203 cases of twin pregnant women were enrolled in this retrospective study and divided into three groups based on maternal TSH concentration in first trimester. Normal TSH group contained twin pregnant women with TSH levels between 0.01 to 3.35 mIU/L in first trimester, TSH > 3.35 group contained twin pregnant women whose TSH concentrations between 3.35 to 4 mIU/L, TSH > 4 group included those with TSH levels beyond 4 mIU/L. The pregnancy outcomes were analyzed between three groups. Results Logistics analysis between maternal TSH levels and pregnancy outcomes of twin pregnancy showed TSH beyond 4 mIU/L in first trimester was corelated with the incidence of gestational diabetes mellitus(GDM), and its OR was 3.48, 95% CI was 1.27 ~ 9.55. Conclusion The risk of GDM in twin pregnant women with hypothyroidism in first trimester may increase and TSH > 4 mIU/L was one of independent risk factors of GDM.