生殖医学杂志

目的分析妊娠合并甲状腺功能减退症(甲减)或亚临床甲减者经过激素替代治疗的妊娠结局。方法回顾性分析2010年1月至2011年9月在本院妇产科分娩的单胎妊娠合并临床甲减(64例)或亚临床甲减(65例)共129例(病例组)患者,均在我院产科和内分泌科定期随诊,其中121例患者孕期甲功控制在正常范围。选取同期正规产检并分娩的无甲状腺疾病合并症产妇2,355例作为对照。比较病例组与对照组的一般情况和妊娠结局,并进一步分析病例组中甲状腺球蛋白抗体(TG-Ab)和抗甲状腺过氧化物酶抗体(TPO-Ab)对妊娠结局的影响。结果(1)临床甲减组妊娠期高血压疾病(子痫前期+妊娠期高血压)的发病率(7.7%)高于对照组(2.3%,P<0.05),新生儿结局(新生儿孕周及出生体重)及其它妊娠并发症[胎心率不可靠(nonassuring fetal heart rate)、妊娠期糖尿病、羊水过少、胎膜早破、新生儿窒息、早产等并发症]的发生率在三组间没有统计学差异(P>0.05)。(2)病例组中,99例患者进行了抗体的检查,TPO-Ab阳性率为48.5%,TG-Ab的阳性率为40.4%,抗体异常与无异常的患者、新生儿结局及妊娠合并症发生率均无显著性差异(P>0.05)。结论本研究纳入病例中,除妊娠期高血压疾病的发生率在临床甲减的孕妇组中有升高以外,孕期临床甲减或亚临床甲减患者经过激素替代治疗控制甲功在正常范围内,妊娠不良结局的发生率较对照组无明显增加,也没有观察到甲状腺自身抗体对妊娠结局的不良影响。

Objective:To compare pregnancy outcome between pregnancy complicated with clinical hypothyroidism(CH) or subclinical hypothyroidism after replacement therapy and those without thyroid disease. Methods:Clinical data of 129 pregnant women complicated with hypothyroidism(64 patients) or subclinical hypothyroidism(65 patients) in Peking Union Medical College Hospital from January 2010 to September 2011 were retrospectively analyzed.Basic information,maternal complications and neonatal outcomes of the patients were analyzed and compared with 2355 control pregnant women during the same period.The effects of anti-thyroglobulin antibodies(TP-Ab),and anti-thyroperoxidase antibodies(TPO-Ab)on pregnancy outcomes were evaluated. Results:The incidence of hypertensive disorder(preeclampsia and pregnancy hypertension) was significantly increased in women complicated with clinical hypothyroidism compared with control group(7.7%vs.2.4%,P<0.05).No significant difference was found in neonatal outcomes(gestational age and birth weight)or other pregnancy complications(non-assuring fetal heart rate,gestational diabetes mellitus, oligohydramnios,premature rupture of membranes,neonatal asphyxia,premature birth) among the three groups(P>0.05).99 patients in the women complicated with hypothyroidism were checked their thyroid autoantibody status.The positive rates of anti-TPOAb and anti-TGAb were 48.5%and 40.4%in clinical and subclinical hypothyroidism respectively.There was no significant difference in pregnancy outcome between antibody positive group and negative group(P>0.05). Conclusions:The incidence of hypertensive disorders of women with hypothyroidism is slightly higher than that of control.After controlling the thyroid function to normal range with hormone replacement therapy,most adverse pregnancy outcomes are not increased compared with control group.There are no observed adverse effects of thyroid auto-antibodies on pregnancy outcomes.