合并亚临床甲状腺功能减退症对妊娠结局的影响及其危险因素分析

The impact of subclinical hypothyroidism on pregnancy outcomes and its risk factors analysis

目的探讨妊娠期合并亚临床甲状腺功能减退症(subclinical hypothyroidism,SCH)对产后出血等不良妊娠结局的影响及其危险因素。方法选择2021年7月至2022年12月于张家口市第五医院妇产科进行产检及住院分娩且经临床诊断为妊娠期合并SCH的产妇150例,分为治疗组(75例)接受左甲状腺素钠片正规治疗并达到治疗目标者,未治疗组(75例)未接受治疗者。另选取同期150例甲状腺功能正常产妇为对照组,观察各组产妇妊娠期糖尿病、妊娠期高血压、产后出血等妊娠结局发生情况,并应用单因素和多因素Logistic回归分析影响妊娠期合并SCH的危险因素。结果治疗组、对照组妊娠期糖尿病、妊娠期高血压疾病、贫血及产后出血发生率较未治疗组低(P<0.05);治疗组妊娠期糖尿病、妊娠期高血压疾病、前置胎盘、贫血、胎盘早剥、产后出血发生率与对照组比较差异无统计学意义(P>0.05);经多因素Logistic回归分析结果显示,年龄>30岁、初产妇、孕前BMI<18.5 kg/m^(2)、患有甲状腺疾病史或家族史、甲状腺过氧化物酶抗体(TPOAb)均是影响妊娠合并SCH的危险因素(OR=2.192、1.765、1.960、1.887、1.571、2.079,95%CI=1.108-4.337、1.088-2.864、1.189-3.231、0.996-3.575、0.895-2.758、1.115-3.878,P<0.05)。结论妊娠期合并SCH经过正规治疗后可降低孕妇妊娠期糖尿病、妊娠期高血压疾病、贫血及产后出血发生率,且年龄>30岁、初产妇、孕前BMI<18.5 kg/m^(2)、患有甲状腺疾病史或家族史、TPOAb均是影响妊娠合并SCH的危险因素。

Objective To explore the impact of subclinical hypothyroidism(SCH)during pregnancy on adverse pergnancy Department of outcomes such as postpartum hemorrhage and its risk factors.Methods 150 pregnant women who underwent prenatal examination and hospital delivery in the Department of Obstetrics and Gynecology of the Fifth Hospital of Zhangjiakou from July 2021 to December 2022 were clinically diagnosed with pregnancy complicated with SCH,and divided into a treatment group(75 cases)of those who received regular treatment with levothyroxine sodium tablets and achieved treatment goals,while an untreated group(75 cases)of those who did not receive treatment.Another 150 pregnant women with normal thyroid function during the same period were selected as the control group.The incidence of pregnancy outcomes such as pregnancy diabetes,pregnancy hypertension,postpartum hemorrhage and so on were observed in each group,and the risk factors of pregnancy complicated with SCH were analyzed by single factor and multiple factor Logistic regression.Results The incidence of diabetes in pregnancy,hypertension in pregnancy,anemia and postpartum hemorrhage in the treatment group and the control group was lower than that in the untreated group(P<0.05).There was no statistical diference between the treatment group and the control group in the incidence of pregnancy diabetes,pregnancy induced hypertension,placenta previa,anemia,placental abruption,and postpartum hemorhage(P>0.05).Multifactor Logistic regresion analysis showed that age>30,primipara,pre-pregnancy BMI<18.5 kg/m^(2),history of thyroid disease or family history,thyroid peroxidase antibody(TPOAb)were all risk factors for pregnancy with SCH(OR=2.192,1.765,1.960,1.887,1.571,2.079,95%CI=1.108-4.337,1.088-2.864,1.189-3.231,0.996-3.575,0.895-2.758,1.115-3.878,P<0.05).Conclusion After formal treatment,pregnancy with SCH can reduce the incidence of pregnancy with diabetes,pregnancy with hypertension,anemia and postpartum hemorrhage.Another,age>30,primipara,pre-pregnancy BMI<18.5 kg/m^(2),history of thyroid disease or family history,TPOAb are all risk factors affecting pregnancy with SCH.