INTRODUCTION: Overt hypothyroidism in pregnancy is associated with adverse outcomes, but the effects of subclinical hypothyroidism and isolated hypothyroxinemia on pregnancy outcomes are still controversial. Subclinic...INTRODUCTION: Overt hypothyroidism in pregnancy is associated with adverse outcomes, but the effects of subclinical hypothyroidism and isolated hypothyroxinemia on pregnancy outcomes are still controversial. Subclinical hypothyroidism might be associated with preterm delivery, low Apgar score, fetal death and miscarriages and isolated hypothyroxinemia with preterm labor, high birth weight and neurocognitive deficits in children. Other studies show no association with any complications at all. In the present study we tried to estimate whether maternal subclinical hypothyroidism and isolated hypothyroxinemia are associated with complications during pregnancy in our population which represents the pregnant population of Western Greece. METHODS: In a total of 469 pregnant women, third trimester serum was assayed for thyroid-stimulating hormone (TSH) and free thyroxine (free T4). Thyroid hypofunction was defined as 1) subclinical hypothyroidism with TSH levels above 3 mIU/L for the 3rd trimester and normal free T4 and 2) isolated hypothyroxinemia with TSH levels below 3 mIU/L for the 3rd trimester and free T4 below the 5th percentile. The results were associated with birth weight, week of labor, history of miscarriages and demographic characteristics. Patients with thyroid hypofunction were compared with euthyroid patients (TSH and free T4 between normal limits). The results were analyzed with one-way ANOVA and χ2 test. RESULTS: Subclinical hypothyroidism was documented in 10.9% and isolated hypothyroxinemia in 21.7% of pregnant women. Subclinical hypothyroidism was not associated with birth weight, week of labor, or history of miscarriages. On the contrary, hypothyroxinemia was associated with high birth weight (P < 0.05). CONCLUSION: In our study, we did not find a link between subclinical hypothyroidism and adverse pregnancy outcomes. Similarly, hypothyroxinemia was not associated with pregnancy complications. However, it was associated with higher birth weight. Our studies contribute to our understanding, whether or not subclinical hypothyroidism and isolated hypothyroxinemia are associated with pregnancy adverse outcomes and whether treatment and test for hypothyroidism should become routine during pregnancy.展开更多
目的探讨妊娠期低甲状腺素血症对妊娠结局及胎儿的影响,明确激素治疗的可行性。方法回顾性分析2014年11月-2015年10月第二军医大学附属长海医院收治的1141例孕妇资料,包括妊娠期间及分娩时各项检查、末次超声、新生儿足跟血促甲状腺激素...目的探讨妊娠期低甲状腺素血症对妊娠结局及胎儿的影响,明确激素治疗的可行性。方法回顾性分析2014年11月-2015年10月第二军医大学附属长海医院收治的1141例孕妇资料,包括妊娠期间及分娩时各项检查、末次超声、新生儿足跟血促甲状腺激素(TSH)值等资料,并比较不同程度低甲状腺素血症孕妇相关指标间的差异。结果1141例孕妇中,既往有甲状腺疾病史者200例,血游离甲状腺素(FT4)低于正常值189例[依据血FT4水平低于正常值0~5%、5%~10%及10%以上,分为A(n=60)、B(n=40)、C(n=89)三组],正常对照组752例。与正常对照组比较,C组早产、妊娠期糖尿病、剖宫产率明显增高(P<0.05),B组孕前高血压和血脂异常率也明显升高(P<0.05)。其中,B、C组剖宫产率明显高于A组,且C组明显高于正常对照组(P<0.05)。分娩时C组孕妇体重、体重指数、舒张压及末次超声胎儿头围均大于正常对照组孕妇(P<0.01),但新生儿孕周(38.55±1.86周)小于正常对照组孕妇(39.14±1.57周,P<0.01)。189例低甲状腺素血症孕妇依据甲状腺过氧化物酶抗体(TPOAb)浓度分组后发现抗体阳性组胎儿末次超声头围明显大于阴性组(45.99±62.36 vs 33.23±2.08cm,P<0.01)。结论不同程度的低FT4血症均会对妊娠结局及胎儿造成影响,尤其是血FT4值低于正常值10%以上或TPOAb阳性时。建议孕妇在孕早期行甲状腺功能检测。展开更多
目的:探讨早产儿暂时性低甲状腺素血症(transient hypothyroxinemia of prematurity,THP)发病情况,并对其早期生活质量进行量化观察。方法:将125例早产儿按是否合并其他疾病分成早产儿单纯生活能力低下为生观察组(A组,n=56)和合并其他...目的:探讨早产儿暂时性低甲状腺素血症(transient hypothyroxinemia of prematurity,THP)发病情况,并对其早期生活质量进行量化观察。方法:将125例早产儿按是否合并其他疾病分成早产儿单纯生活能力低下为生观察组(A组,n=56)和合并其他疾病组(B组,n=69);同期出生的62名正常足月儿作为对照组(C组)。应用电化学发光法检测3组新生儿生后第1、7天静脉血促甲状腺激素(TSH)、总甲状腺素(TT4)、总三碘甲状腺原氨酸(TT3),并对THP组和非THP组早产儿的早期生活质量进行量化观察。结果:早产儿THP发病率为62.4%。3组新生儿TSH、TT4、TT3第7天水平均低于第1天,A、B组均相应低于对照组(P<0.01);B组第1天与A组差异均无统计学意义(P<0.01),第7天TT4低于A组(P<0.01)。3组新生儿TT4/TSH第1天差异无统计学意义(P>0.05),第7天对照组、A组、B组依次降低(P<0.01)。THP组早产儿需氧、规则自行排便、高胆红素血症持续、热量达418.4 kJ.kg-1.d-1、恢复出生体重日龄及住院时间均较非THP组显著延迟(P<0.01)。结论:早产儿下丘脑-垂体-甲状腺轴发育不成熟,生后甲状腺功能可降低,危重早产儿甲状腺功能下降更明显,且降低了早产儿早期生活质量。展开更多
文摘INTRODUCTION: Overt hypothyroidism in pregnancy is associated with adverse outcomes, but the effects of subclinical hypothyroidism and isolated hypothyroxinemia on pregnancy outcomes are still controversial. Subclinical hypothyroidism might be associated with preterm delivery, low Apgar score, fetal death and miscarriages and isolated hypothyroxinemia with preterm labor, high birth weight and neurocognitive deficits in children. Other studies show no association with any complications at all. In the present study we tried to estimate whether maternal subclinical hypothyroidism and isolated hypothyroxinemia are associated with complications during pregnancy in our population which represents the pregnant population of Western Greece. METHODS: In a total of 469 pregnant women, third trimester serum was assayed for thyroid-stimulating hormone (TSH) and free thyroxine (free T4). Thyroid hypofunction was defined as 1) subclinical hypothyroidism with TSH levels above 3 mIU/L for the 3rd trimester and normal free T4 and 2) isolated hypothyroxinemia with TSH levels below 3 mIU/L for the 3rd trimester and free T4 below the 5th percentile. The results were associated with birth weight, week of labor, history of miscarriages and demographic characteristics. Patients with thyroid hypofunction were compared with euthyroid patients (TSH and free T4 between normal limits). The results were analyzed with one-way ANOVA and χ2 test. RESULTS: Subclinical hypothyroidism was documented in 10.9% and isolated hypothyroxinemia in 21.7% of pregnant women. Subclinical hypothyroidism was not associated with birth weight, week of labor, or history of miscarriages. On the contrary, hypothyroxinemia was associated with high birth weight (P < 0.05). CONCLUSION: In our study, we did not find a link between subclinical hypothyroidism and adverse pregnancy outcomes. Similarly, hypothyroxinemia was not associated with pregnancy complications. However, it was associated with higher birth weight. Our studies contribute to our understanding, whether or not subclinical hypothyroidism and isolated hypothyroxinemia are associated with pregnancy adverse outcomes and whether treatment and test for hypothyroidism should become routine during pregnancy.
文摘目的探讨妊娠期低甲状腺素血症对妊娠结局及胎儿的影响,明确激素治疗的可行性。方法回顾性分析2014年11月-2015年10月第二军医大学附属长海医院收治的1141例孕妇资料,包括妊娠期间及分娩时各项检查、末次超声、新生儿足跟血促甲状腺激素(TSH)值等资料,并比较不同程度低甲状腺素血症孕妇相关指标间的差异。结果1141例孕妇中,既往有甲状腺疾病史者200例,血游离甲状腺素(FT4)低于正常值189例[依据血FT4水平低于正常值0~5%、5%~10%及10%以上,分为A(n=60)、B(n=40)、C(n=89)三组],正常对照组752例。与正常对照组比较,C组早产、妊娠期糖尿病、剖宫产率明显增高(P<0.05),B组孕前高血压和血脂异常率也明显升高(P<0.05)。其中,B、C组剖宫产率明显高于A组,且C组明显高于正常对照组(P<0.05)。分娩时C组孕妇体重、体重指数、舒张压及末次超声胎儿头围均大于正常对照组孕妇(P<0.01),但新生儿孕周(38.55±1.86周)小于正常对照组孕妇(39.14±1.57周,P<0.01)。189例低甲状腺素血症孕妇依据甲状腺过氧化物酶抗体(TPOAb)浓度分组后发现抗体阳性组胎儿末次超声头围明显大于阴性组(45.99±62.36 vs 33.23±2.08cm,P<0.01)。结论不同程度的低FT4血症均会对妊娠结局及胎儿造成影响,尤其是血FT4值低于正常值10%以上或TPOAb阳性时。建议孕妇在孕早期行甲状腺功能检测。
文摘目的:探讨早产儿暂时性低甲状腺素血症(transient hypothyroxinemia of prematurity,THP)发病情况,并对其早期生活质量进行量化观察。方法:将125例早产儿按是否合并其他疾病分成早产儿单纯生活能力低下为生观察组(A组,n=56)和合并其他疾病组(B组,n=69);同期出生的62名正常足月儿作为对照组(C组)。应用电化学发光法检测3组新生儿生后第1、7天静脉血促甲状腺激素(TSH)、总甲状腺素(TT4)、总三碘甲状腺原氨酸(TT3),并对THP组和非THP组早产儿的早期生活质量进行量化观察。结果:早产儿THP发病率为62.4%。3组新生儿TSH、TT4、TT3第7天水平均低于第1天,A、B组均相应低于对照组(P<0.01);B组第1天与A组差异均无统计学意义(P<0.01),第7天TT4低于A组(P<0.01)。3组新生儿TT4/TSH第1天差异无统计学意义(P>0.05),第7天对照组、A组、B组依次降低(P<0.01)。THP组早产儿需氧、规则自行排便、高胆红素血症持续、热量达418.4 kJ.kg-1.d-1、恢复出生体重日龄及住院时间均较非THP组显著延迟(P<0.01)。结论:早产儿下丘脑-垂体-甲状腺轴发育不成熟,生后甲状腺功能可降低,危重早产儿甲状腺功能下降更明显,且降低了早产儿早期生活质量。
