GDM并发甲状腺功能减退症影响因素及对母婴结局的影响

Influence factors of the gestational diabetes mellitus complicated with hypothyroidism of pregnant women and their maternal and infant outcomes

目的:探讨妊娠期糖尿病(GDM)并发甲状腺功能减退症的影响因素及对母婴结局的影响.方法:收集2020年1月-2023年1月于本院建档产前检查并在县内分娩的GDM并发甲状腺功能减退症产妇108例(并发组)、单纯GDM产妇134例(单纯组)临床资料,分析GDM并发甲状腺功能减退症影响因素及其母婴不良结局.结果:并发组孕次≥3次、产次≥3次、有甲状腺疾病史、有妊娠期高血压病史及有甲状腺疾病家族史的占比均高于单纯组(P<0.05),空腹血糖、肌酸肌酶、餐后2h血糖、肌酸肌酶同工酶、总胆固醇、尿酸、凝血酶时间、糖化血红蛋白及纤维蛋白原均高于单纯组,凝血酶原时间低于单纯组(均P<0.05);多孕次、多产次、有甲状腺疾病史、有妊娠期高血压病史、有甲状腺疾病家族史、低凝血酶原时间及高凝血酶时间是GDM并发甲状腺功能减退症的危险因素(P<0.05);并发组不良母婴结局总发生率(41.7%)高于单纯组(14.9%)(P<0.05).结论:多孕次、多产次、有甲状腺疾病史、有妊娠期高血压病史、有甲状腺疾病家族史、低凝血酶原时间及高凝血酶时间是GDM并发甲状腺功能减退症的危险因素,且可能对母婴结局造成不良影响,提示临床需密切监测该类患者的甲状腺功能,以及时采取预防和治疗措施,改善母婴结局.

Objective:To explore the influencing factors of the gestational diabetes mellitus(GDM)complicated with hypothyroidism of pregnant women,and to study their influence on the maternal and infant outcomes.Methods:The clinical data of 108 pregnant women with GDM complicated with hypothyroidism from January 2020 to January 2023 were collected in observation group,and the clinical data of 134 pregnant women with GDM only during the same period were collected in control group.The influencing factors of GDM complicated with hypothyroidism of the women and their influence on the maternal and infant outcomes were analyzed.Results:The proportions of the gravidity≥3 times,the parity≥3 times,the history of thyroid disease,the history of gestational hypertension and the family history of thyroid disease of the women in the observation group were significantly higher than those of the women in the control group(P<0.05).The levels of fasting blood glucose,creatine kinase,2h postprandial blood glucose,creatine kinase isoenzyme,total cholesterol,uric acid,glycosylated hemoglobin and fibrinogen,and the thrombin time value of the women in the observation group were significantly higher than those of the women in the control group,but the prothrombin time of the women in the observation group was significantly lower(all P<0.05).The multiple gravidity and parity,the history of thyroid disease,the history of gestational hypertension,the history of family thyroid disease,the low value of prothrombin time and the high value of thrombin time of the pregnant women were the risk factors of their GDM complicated with hypothyroidism(P<0.05).The total incidence of the adverse maternal and infant outcomes(41.7%)of the women in the observation group was significantly higher than that(14.9%)of the women in the control group(P<0.05).Conclusion:The multiple gravidity and parity,the history of thyroid disease,the history of gestational hypertension and the history of family thyroid disease,and the low value of prothrombin time and the high value of thrombin time of the pregnant women are the risk factors of their GDM complicated with hypothyroidism,which may have influence on the adverse maternal and infant outcomes.It is suggested that the thyroid function of these pregnant women should be closely monitored,and the preventive and treatment measures should be taken for these women timely,so as to improve the maternal and infant outcomes.