妊娠合并甲状腺功能减退患者孕早期血清TSH水平对妊娠不良结局的影响

Effect of serum TSH level on adverse pregnancy outcomes in patients with hypothyroidism during early pregnancy

目的:探讨妊娠合并甲状腺功能减退(甲减)患者孕早期血清促甲状腺素(TSH)水平对妊娠不良结局的影响。方法:回顾性分析获得妊娠结局的236例甲减孕产妇临床资料,按首次产检时TSH是否达标将患者分为TSH达标组(n=155,<2.5 mU/L)与TSH未达标组(n=81,≥2.5 mU/L)。比较两组临床资料和妊娠不良结局发生情况,应用Logistic回归模型分析相关影响因素。结果:相比TSH达标组,TSH未达标组妊娠糖尿病(GDM)发生率和低出生体重儿发生率均增高(P<0.05);两组妊娠期高血压、巨大儿、早产等不良妊娠结局发生率比较,差异无统计学意义(P>0.05)。Logistic回归分析得出年龄、孕前体质量指数(BMI)及TPOAb阳性是GDM的独立危险因素(P<0.05);且孕前BMI、TSH未达标与低出生体重儿独立相关(P<0.05)。结论:妊娠合并甲减患者孕早期TSH水平未达标患者有较高的低出生体重儿风险;患者均存在较高的GDM风险,尤其需对TPOAb阳性甲减患者加强孕期监护。

Objective:To investigate the effect of serum thyroid stimulating hormone(TSH) level on adverse pregnancy outcomes in patients with hypothyroidism during early pregnancy.MMethods:The clinical data of 236 pregnant women with hypothyroidism diagnosed and obtained pregnancy outcomes were retrospectively analyzed.According to whether TSH reached the standard at the first prenatal examination, the patients were divided into TSH standard group(n=155,< 2.5 mU/L) and TSH non-standard group(n= 81,≥2.5 mU/L).The clinical data and adverse pregnancy outcomes were compared between the two groups.Logistic regression model was used to analyze the related influencing factors.Results:Compared with the TSH standard group, the incidence of GDM and the incidence of low birth weight infants in the TSH non-standard group were increased(P<0.05).There was no significant difference in the incidence of adverse pregnancy outcomes such as gestational hypertension, macrosomia and premature delivery between the two groups(P>0.05).Logistic regression analysis showed that age, pre-pregnancy BMI and TPOAb positive were independent risk factors for GDM(P<0.05).And pre-pregnancy BMI and TSH did not reach the standard were independently associated with low birth weight infants(P<0.05).Conclusion:The level of TSH in early pregnancy is related to the occurrence of low birth weight infants.Patients with TSH not reaching the standard have higher risk of low birth weight infants.In addition, even if the TSH level in the early pregnancy reaches the standard, the GDM risk should still be paid attention to, especially for TPOAb positive hypothyroidism patients.