妊娠合并甲状腺功能减低对妊娠结局和胎儿影响的研究

目的:探讨妊娠合并甲状腺功能减退症对妊娠结局及胎儿的影响。方法:回顾性分析38例妊娠合并甲状腺功能减退症病人在孕期用电化学发光法监测(1次/3月)血清甲状腺刺激激素(TSH)、游离三碘甲状腺原氨酸(FL3)、游离甲状腺素(FL4)浓度,记录左旋甲状腺激素(LT4)剂量变化情况,分析妊娠结局和胎儿情况,包括剖宫产数、流产数、先兆子痫、新生儿体重以及孕周等。结果:妊娠合并甲状腺功能减退症妇女妊娠中期和晚期TSH的浓度水平分别为1.9 mU/L和1.3mU/L,与孕初相比差异均有显著意义(P<0.01)。妊娠中期和晚期对甲状腺素的需求剂量增加,与孕初相比差异具有显著的统计学意义(P<0.01)。妊娠合并甲减者的剖宫产率和流产率明显高于正常对照组,两组比较有显著性差异(P<0.05)。妊娠合并甲减孕妇的并发症增多。结论:对妊娠合并甲状腺功能减退症的孕妇应定期监测血清FT3、FT4、TSH浓度,妊娠期间甲状腺激素的需求量增加,应及时调整用药剂量,并密切关注各类并发症的出现,以减少不良妊娠结局的发生。

Effects of maternal hypothyroidism on neonatal and obstetric outcome

Objective:To investigate these outcomes in patients with hypothyroidism during early and late gestation.Methods:A retrospective study of data from 38 pregnancies managed in this hospital was conducted.The level of FT3,FT4 and TSH were detected by the method of electrochemiluminescence(ECL).Thyroxine dose requirement were close recorded.Outcome variables included rate of caesarean section,abortion,preeclampsia,neonatal weight and gestational age.Results:The median thyroxine dose(μg) increased significantly during pregnancy,associated with appropriate suppression of TSH levels in the second and third trimesters.The caesarean section(CS) rates and abortion rate were higher in the study cohort compared with those in the normal rate(P<0.05).Complication of maternal hypothyroidism was higher.Conclusion:The level of FT3,FT4 and TSH must be monitored throughout gestation.Thyroxine dose requirement increases during pregnancy and thus close monitoring of thyroid function with appropriate adjustment of thyroxine dose to maintain a normal outcome is necessary throughout gestation.