妊娠晚期甲状腺功能减退对母体血糖、血脂水平影响及母婴预后分析

目的 探讨妊娠晚期甲状腺功能减退对妊娠期孕妇血糖、血脂水平及对母婴不良结局的影响.方法 筛选2014年4月至2015年10月在温州医科大学附属第三医院产科就诊符合要求的妊娠晚期孕妇160例,其中甲状腺功能减退孕妇80例,包括临床甲状腺功能减退孕妇35例(临床甲减组)和亚临床甲状腺功能减退孕妇45例(亚临床甲减组),甲状腺功能正常孕妇80例(对照组).对所有研究对象行血液生化检查,检测甲状腺功能指标(TSH、FT4、FT3)、血糖(空腹血糖、餐后1h、2h血糖)、血脂(TC、TG、HDL-C及LDL-C)及妊娠结局(妊娠期高血压、糖尿病、羊水量异常、产后出血、胎儿生长受限、胎儿窘迫及新生儿窒息等).结果 80例妊娠晚期孕妇中,亚临床甲减组和临床甲减组孕妇所占比例分别为56.25%和43.75%,且妊娠晚期甲减(亚临床甲减组及临床甲减组)孕妇的TSH水平高于对照组,FT4、FT3水平低于对照组;血糖水平比较,临床甲减组的空腹血糖、餐后1h、2h血糖水平均显著高于亚临床甲减组,显著高于对照组,差异有统计学意义(t=2.289~5.776,均P<0.05),亚临床甲减组显著高于对照组,差异有统计学意义(t值分别为3.071、7.049、3.115,均P<0.05);血脂水平比较,亚临床甲减组与临床甲减组的TC、TG及LDL-C水平均显著高于对照组,差异有统计学意义(t=4.015~7.962,均P<0.05),且临床甲减组显著高于亚临床甲减组,差异有统计学意义(t值分别为2.015、2.006、2.509,均P<0.05),三组的HDL-C水平比较,差异有统计学意义(t值分别为0.568、0.712、0.279,均P>0.05).不良妊娠结局比较,亚临床甲减组的妊娠高血压及妊娠糖尿病的发生率显著高于对照组,差异具统计学意义(χ2值分别为6.438、5.207,均P<0.05),临床甲减组妊娠高血压、妊娠糖尿病、胎儿生长受限及新生儿窒息的发生率均显著高于对照组,差异有统计学意义(χ2值分别为13.455、12.121、6.737、6.186,均P<0.05),三组的羊水量异常、产后出血和胎儿窘迫等的发生率比较,差异均无统计学意义(χ2=0.000~3.046,均P>0.05).结论 妊娠晚期甲状腺功能减退可引发孕妇血糖及血脂代谢紊乱,增加不良母婴妊娠结局的发生率.

Influence of hypothyroidism on maternal blood glucose and serum lipid level and maternal and neonatal prognosis in third trimester of pregnancy

Objective To investigate the influence of hypothyroidism on maternal blood glucose and blood lipid level and adverse maternal -neonatal outcomes in patients of third trimester of pregnancy .Methods Altogether 160 pregnant women meeting requirements and visiting Department of Obstetrics of Third Affiliated Hospital of Wenzhou Medical University during the period of April 2014 to October 2015 were selected.Among them 80 cases had hypothyroidism, including 35 cases of clinical hypothyroidism (CH) (CH group) and 45 cases of subclinical hypothyroidism (SCH) (SCH group), and 80 cases had normal thyroid function (control group).All cases underwent blood biochemical examination, including thyroid function indexes (TSH, FT4, FT3), blood glucose (fasting blood glucose, postprandial 1h, 2h blood glucose), blood lipid (TC, TG, HDL-C and LDL-C), and pregnancy results (gestational hypertension, diabetes, abnormal amniotic fluid volume , postpartum hemorrhage , fetal growth restriction , fetal distress and neonatal asphyxia ) .Results Among 80 cases of pregnant women with hypothyroidism in late pregnancy , proportion of pregnant women in SCH group and in CH group was 56.25% and 43.75%, respectively.TSH level of patients with hypothyroidism in late pregnancy (SCH group and CH group) was higher than that in the control group, but FT4 and FT3 levels were lower.For comparison of blood glucose levels, the fasting blood glucose, postprandial 1h and 2h blood glucose levels in CH group were significantly higher than those in SCH group and control group ( t value ranged 2.289 to 5.776, all P<0.05), and the above parameters in SCH group were significantly higher than those in the control group with statistical significance (t value was 3.071, 7.049 and 3.115, respectively, all P<0.05).For comparison of blood lipid levels , TC, TG and LDL-C levels in SCH group and CH group were significantly higher than those in the control group , and the differences were statistically significant ( t value ranged 4.015 to 7.962, all P<0.05), and the above parameters in CH group were significantly higher than those in SCH group with statistical significance (t value was 2.015, 2.006 and 2.509, respectively, all P<0.05).There was no significant difference in HDL-C level among three groups (t value was 0.568, 0.712 and 0.279, respectively, all P>0.05).For comparison of adverse pregnancy outcomes, the incidences of gestational hypertension and gestational diabetes mellitus in SCH group were significantly higher than those in the control group, and the differences were statistically significant (χ2 value was 6.438 and 5.207, respectively, both P<0.05).The incidences of gestational hypertension , gestational diabetes mellitus , fetal growth restriction and neonatal asphyxia in CH group were significantly higher than those in the control group , and the differences were statistically significant (χ2 value was 13.455, 12.121, 6.737 and 6.186, respectively, all P<0.05).There were no significant differences among three groups in incidence of abnormal amniotic fluid volume, postpartum hemorrhage and fetal distress (χ2 value ranged 0.000 to 3.046, all P>0.05).Conclusion Hypothyroidism in the third trimester of pregnancy can cause blood glucose and lipid metabolism disorders , and the incidence of adverse maternal and infant pregnancy outcomes will increase .