孕期甲状腺激素敏感性与出生结局关系的队列研究

Maternal sensitivity to thyroid hormones and birth outcomes:a cohort study

目的前瞻性探究孕中期膳食平衡指数(diet balance index for pregnancy,DBI)与婴幼儿体重发育的纵向关联。方法基于出生队列,通过食物频率问卷收集孕中期妇女过去1个月内的摄入膳食情况,并采用经修订的孕妇膳食平衡指数(diet balance index for pregnancy,DBI-P)评价孕妇膳食质量,评分分值越高代表偏离推荐值程度越高。随访其子代至24月龄,分别在1、6、12、18、24月龄测量体重,并计算年龄别体重Z分值和0~24月龄年龄别体重Z分值变化值。分别采用混合线性模型和多重logistic回归分析模型进行关联性分析。结果共纳入543对母子对,13.45%的孕妇存在低度以上摄入过量,84.53%的孕妇存在低度以上的摄入不足,88.77%的孕妇存在低度以上膳食不均。孕期水果类摄入评分与婴幼儿0~24月龄年龄别体重呈正相关(β=0.065,P=0.002);孕期添加糖评分和DBI-P正端分(high bound score,HBS)与0~24月龄年龄别体重变化值呈正相关(β=0.091,P=0.032);孕期饮酒评分与0~24月龄年龄别体重变化值呈负相关(β=-0.282,P=0.032)。结论广州市孕中期妇女膳食摄入不均衡,应强调适宜摄入水果,减少孕期过量摄入水果及添加糖,避免酒类摄入。

Objective The objective of this study was to explore the association between sensitivity to thyroid hormones during pregnancy and birth outcomes.Methods A total of 5411 pairs of mother-newborn from large birth cohorts in Wuhan were included based on the inclusion criteria.The thyroid hormones sensitivity indicators,including thyroid stimulating hormone index(TSHI),thyrotroph thyroxine resistance index(TT4RI),and thyroid feedback quantile-based index(TFQI)were calculated based on values of thyroid function indicators free triiodothyronine(FT3),free thyroxine(FT4),thyroid stimulating hormone(TSH)which were detected during routinely prenatal care.The outcomes included birth weight,gestational duration,birth weight Z-score,low birth weight,preterm birth,and small for gestational age(SGA).Multiple linear regression and logistic regression were used to assess associations of exposures with continuous and categorical outcomes,respectively,adjusting for potential confounders.Results FT4,TSHI,TFQI were significantly negatively associated with birth weight and birth weight Z-score(all P≤0.01).Higher TSHI,TT4RI,TFQI were associated with higher risk of SGA(TTSHI:OR=1.52,95%CI:1.12-2.06,P<0.01;TT4RI:OR=1.15,95%CI:1.03-1.29,P=0.02;TFQI:OR=1.41,95%CI:1.10-1.81,P<0.01).No thyroid indicators were significantly related to low birth weight or preterm birth.The associations were almost unchanged when pregnant women with hypothyroidism were excluded.Conclusions Impaired sensitivity to thyroid hormones during pregnancy is an independent risk factor of SGA.