妊娠合并甲状腺功能减退症对子代的影响

妊娠早期孕妇患甲状腺功能减退症会影响胎儿脑神经功能的发育,出生后的婴儿智力受损,神经发育迟缓,语言、精细活动能力受损,学习障碍的概率增加,视觉空间思维能力下降;经治疗甲状腺功能恢复正常的孕妇,胎儿脑功能可发育正常。妊娠合并亚临床甲状腺功能减退症对子代发育的影响文献报道不一,孕期治疗亚临床甲状腺功能减退症的益处未得到证实。     

妊娠期亚临床甲状腺功能减退症对子代神经智力发育的影响研究进展

妊娠期亚临床甲状腺功能减退症(SCH)对其子代神经发育可能产生不利影响,而妊娠期患者使用口服左旋甲状腺素(L-T₄)治疗后对其子代神经发育的影响也受广泛关注,因此本文对妊娠期SCH是否影响子代神经系统发育,及治疗对子代神经发育是否有利的相关研究进展进行综述。最新的研究证据加强了妊娠期SCH与子代神经发育之间的关联,但目前研究结果存在争议,妊娠期SCH是否影响其子代神经智力发育结果不一。另外目前较多的研究表明妊娠期SCH孕妇可从治疗中获益,但L-T₄的治疗能否改善妊娠期SCH孕妇子代的神经智力发育各学者持有不同意见,同时L-T₄治疗起始孕周也可能会影响研究结果。未来还需更多研究来明确妊娠期SCH对子代神经智力发育的影响,以及L-T₄治疗是否对子代神经智力的发育有利,使患者及其子代获得最大程度上受益。     

妊娠期亚临床甲状腺功能减退症对脐动脉血流动力学指标与妊娠结局的影响

目的 探讨妊娠期亚临床甲状腺功能减退症（SCH）对脐动脉血流动力学指标与妊娠结局的影响。方法 选取本院1000名建档并分娩的孕妇为研究对象,依据甲状腺功能检查结果分为SCH组（n=150）和非SCH组（n=850）。比较两组不良妊娠结局发生情况及脐动脉血流动力学指标。结果 SCH组不良妊娠结局发生率为76.67%,显著高于非SCH组的21.65%(P<0.05);孕晚期SCH组脐动脉阻力指数、搏动指数、收缩末期峰值与舒张末期峰值比值明显高于非SCH组（P<0.05）。结论 妊娠期SCH的脐动脉血流动力学指标明显升高,容易影响母胎血流循环状态,导致不良妊娠结局,临床上应加强检测脐动脉血流动力学指标,以改善预后。     

妊娠合并甲状腺功能减退症对妊娠结局影响

育龄妇女甲状腺功能异常影响妊娠的过程和结局。临床甲状腺功能减退症（甲减）及亚临床甲减可引起不孕,并与自发性流产、妊娠期高血压疾病、早产、胎盘早剥、胎儿窘迫及低体重儿的发生有关,还可导致新生儿智力低下,应当推荐孕前和孕期进行甲状腺功能检查。     

妊娠合并甲状腺功能减退症筛查与干预

甲状腺功能减退症(1aypothyroicIism,简称甲减)是妊娠期一种较少见的合并症,文献报道妊娠合并甲减的发生率为1/1600～1/2000,合并亚临床甲状腺功能减退症(简称亚临床甲减)的发生率较高,为2.3% [1-2].近年来,随着对该合并症认识和重视程度的加深,发病率报道有所上升.目前新生儿甲减的筛查已成为常规,但往往忽视了孕期甲减可能已对母儿造成了不良影响.因此,应重视孕期的筛查和处理.现就妊娠合并甲减的筛查与干预综述如下……     

妊娠和甲状腺功能减退症

妊娠合并甲状腺功能减退症(简称甲减)的发生率约为1/1 600～2 000,慢性自身免疫性甲状腺疾病为其常见原因.仅根据临床表现很难对妊娠中的甲减及早诊断,因此,常规筛选显得十分必要,尤其是一些高危人群.血清TSH水平为甲减筛选的敏感指标.妊娠过程中若甲减未能及时控制,可引起多种并发症.母亲甲减对胎儿智力发育的影响正日益受到重视.L-T4为治疗甲减的首选药物.孕期应监测甲状腺功能,并据此调整治疗剂量.     

548例妊娠期甲状腺功能筛查指征及亚临床甲减对妊娠结局影响的分析

目的回顾性分析妊娠期甲状腺功能的筛查指征及阳性率;阐明妊娠合并亚临床甲减对妊娠结局的影响。方法 2008年1月至2010年12月在北京大学第一医院产科分娩的孕妇行甲状腺功能检测者548例,对其筛查指征进行比较;对TSH水平正常孕妇的FT4水平按妊娠时期分类,取妊娠特异性FT4水平的95%可信区间作为本研究FT4的正常参考值,分组比较亚临床甲减组和对照组孕妇不良妊娠结局的差异。结果 548例孕妇中发现高TSH血症111例,应用高危因素筛查策略仅能检出49例（44.1%）;TSH正常组FT4水平行妊娠周期特异性分组,妊娠早、中、晚期FT4的水平呈下降趋势,组间P值均〈0.001;得出的FT4的频率分布95%可信区间作为参考值,对两组（亚临床甲减组和对照组）孕妇不良妊娠结局进行比较,两组间差异无统计学意义（P〉0.05）。结论实施高危因素的甲状腺功能筛查策略甲状腺功能异常漏诊率较高;尚未发现亚临床甲减与孕妇不良妊娠结局之间的相关性。     

妊娠合并甲状腺功能减退症或亚临床甲状腺功能减退症77例临床分析

目的 探讨甲状腺功能减退症(简称甲减)及亚临床甲减对孕产妇妊娠结局及围产儿的影响.方法 回顾性分析2005年1月至2008年3月在北京协和医院妊娠合并甲减(57例)或亚临床甲减(20例)分娩孕妇77例,随机选取同期分娩的正常孕妇79例作为对照,分析三组孕妇的一般临床资料、产时产后并发症及嗣产儿结局.结果 3年间我院妊娠合并甲减的患病率为0.74%,合并亚临床甲减的患病率为0.26%,凡呈逐年升高趋势.妊娠合并甲减组新生儿平均出生体重低于对照组[(3191.8±659.4)g和(3301.9±423.1)g,P<0.05],妊娠期糖代谢异常发生率(24.6%)及小于胎龄儿的发生率(12.3%)均高于对照组(分别为11.4 %和2.5%)(P<0.05).妊娠合并亚临床甲减组各项妊娠期并发症的发生率与对照组比较,均无统计学意义.结论 妊娠合并甲减及亚临床甲减的患病率逐年上升,即使经过治疗,甲减或亚临床甲减孕妇小于胎龄儿等并发症的发生几率仍增加.对高危人群早期筛查、充分治疗是改善妊娠结局的最好方法.     

妊娠合并甲状腺功能减退症的诊治

血清促甲状腺激素是妊娠合并甲状腺功能减退症（甲减）的首选诊断指标。妊娠合并临床甲减的治疗首选左旋甲状腺素。对甲状腺过氧化物酶抗体阳性的亚临床甲减孕妇应进行治疗。对单纯性低甲状腺素血症孕妇不推荐常规治疗。     

妊娠期TPO-Ab阳性亚临床甲状腺功能减退症对妊娠结局的影响

甲状腺激素是胚胎期胎儿大脑发育所必需.妊娠期亚临床甲状腺功能减退症(简称:亚甲减)可能导致流产、早产、胎盘早剥、低出生体重儿、妊娠期糖尿病等不良妊娠结局,重度亚甲减患者发展为甲状腺功能减退症的风险较高.甲状腺过氧化酶抗体(TPO-Ab)是反映自身免疫性甲状腺疾病的特异指标,通过激活补体、抗体依赖细胞介导的细胞毒性作用和...     

妊娠合并甲状腺功能减退症或亚临床甲状腺功能减退症77例临床分析

Objective To investigate the maternal and fetal outcomes of pregnant women with hypothyroidism or subclinical hypothyroidism. Methods From Jan. 2005 to Mar. 2008, clinical records of 77 women with hypothyroidism (n=57) or subclinical hypothyroidism (n = 20) during pregnancy who delivered at Peking Union Medical College Hospital were reviewed. The basic information, maternal complications and neonatal outcomes of the patients were compared with 79 healthy women who delivered during the same period. Results The prevalence of maternal hypothyroidism during the study period was 0.74% ,and that of maternal subclinical hypothyroidism was 0.26%. The mean neonatal birth weight of women with hypothyroidism was lower than that of the control [(3191.8±659.47 g) vs (3301.9±423. 1 g), P<0.05], the incidence of abnormal glucose metabolism was higher (24.6% vs 11.4% ,P<0.05), and small for gestational age infants were more common than in the control group (12. 3% vs 2. 5%, P<0. 05). The maternal and fetal outcomes of women with subclinical hypothyroidism during pregnancy showed no difference compared with the control. Conclusions Early screening for the high risk women and appropriate management are important to improve the neonatal and fetal outcomes of women with hypothyroidism and subclinical hypothyroidism during pregnancy.     

妊娠合并甲状腺功能减退症或亚临床甲状腺功能减退症77例临床分析

Objective To investigate the maternal and fetal outcomes of pregnant women with hypothyroidism or subclinical hypothyroidism. Methods From Jan. 2005 to Mar. 2008, clinical records of 77 women with hypothyroidism (n=57) or subclinical hypothyroidism (n = 20) during pregnancy who delivered at Peking Union Medical College Hospital were reviewed. The basic information, maternal complications and neonatal outcomes of the patients were compared with 79 healthy women who delivered during the same period. Results The prevalence of maternal hypothyroidism during the study period was 0.74% ,and that of maternal subclinical hypothyroidism was 0.26%. The mean neonatal birth weight of women with hypothyroidism was lower than that of the control [(3191.8±659.47 g) vs (3301.9±423. 1 g), P<0.05], the incidence of abnormal glucose metabolism was higher (24.6% vs 11.4% ,P<0.05), and small for gestational age infants were more common than in the control group (12. 3% vs 2. 5%, P<0. 05). The maternal and fetal outcomes of women with subclinical hypothyroidism during pregnancy showed no difference compared with the control. Conclusions Early screening for the high risk women and appropriate management are important to improve the neonatal and fetal outcomes of women with hypothyroidism and subclinical hypothyroidism during pregnancy.     

妊娠合并甲状腺功能减退症或亚临床甲状腺功能减退症77例临床分析

Objective To investigate the maternal and fetal outcomes of pregnant women with hypothyroidism or subclinical hypothyroidism. Methods From Jan. 2005 to Mar. 2008, clinical records of 77 women with hypothyroidism (n=57) or subclinical hypothyroidism (n = 20) during pregnancy who delivered at Peking Union Medical College Hospital were reviewed. The basic information, maternal complications and neonatal outcomes of the patients were compared with 79 healthy women who delivered during the same period. Results The prevalence of maternal hypothyroidism during the study period was 0.74% ,and that of maternal subclinical hypothyroidism was 0.26%. The mean neonatal birth weight of women with hypothyroidism was lower than that of the control [(3191.8±659.47 g) vs (3301.9±423. 1 g), P<0.05], the incidence of abnormal glucose metabolism was higher (24.6% vs 11.4% ,P<0.05), and small for gestational age infants were more common than in the control group (12. 3% vs 2. 5%, P<0. 05). The maternal and fetal outcomes of women with subclinical hypothyroidism during pregnancy showed no difference compared with the control. Conclusions Early screening for the high risk women and appropriate management are important to improve the neonatal and fetal outcomes of women with hypothyroidism and subclinical hypothyroidism during pregnancy.     

妊娠合并甲状腺功能减退症或亚临床甲状腺功能减退症77例临床分析

Objective To investigate the maternal and fetal outcomes of pregnant women with hypothyroidism or subclinical hypothyroidism. Methods From Jan. 2005 to Mar. 2008, clinical records of 77 women with hypothyroidism (n=57) or subclinical hypothyroidism (n = 20) during pregnancy who delivered at Peking Union Medical College Hospital were reviewed. The basic information, maternal complications and neonatal outcomes of the patients were compared with 79 healthy women who delivered during the same period. Results The prevalence of maternal hypothyroidism during the study period was 0.74% ,and that of maternal subclinical hypothyroidism was 0.26%. The mean neonatal birth weight of women with hypothyroidism was lower than that of the control [(3191.8±659.47 g) vs (3301.9±423. 1 g), P<0.05], the incidence of abnormal glucose metabolism was higher (24.6% vs 11.4% ,P<0.05), and small for gestational age infants were more common than in the control group (12. 3% vs 2. 5%, P<0. 05). The maternal and fetal outcomes of women with subclinical hypothyroidism during pregnancy showed no difference compared with the control. Conclusions Early screening for the high risk women and appropriate management are important to improve the neonatal and fetal outcomes of women with hypothyroidism and subclinical hypothyroidism during pregnancy.     

妊娠合并甲状腺功能减退症或亚临床甲状腺功能减退症77例临床分析

Objective To investigate the maternal and fetal outcomes of pregnant women with hypothyroidism or subclinical hypothyroidism. Methods From Jan. 2005 to Mar. 2008, clinical records of 77 women with hypothyroidism (n=57) or subclinical hypothyroidism (n = 20) during pregnancy who delivered at Peking Union Medical College Hospital were reviewed. The basic information, maternal complications and neonatal outcomes of the patients were compared with 79 healthy women who delivered during the same period. Results The prevalence of maternal hypothyroidism during the study period was 0.74% ,and that of maternal subclinical hypothyroidism was 0.26%. The mean neonatal birth weight of women with hypothyroidism was lower than that of the control [(3191.8±659.47 g) vs (3301.9±423. 1 g), P<0.05], the incidence of abnormal glucose metabolism was higher (24.6% vs 11.4% ,P<0.05), and small for gestational age infants were more common than in the control group (12. 3% vs 2. 5%, P<0. 05). The maternal and fetal outcomes of women with subclinical hypothyroidism during pregnancy showed no difference compared with the control. Conclusions Early screening for the high risk women and appropriate management are important to improve the neonatal and fetal outcomes of women with hypothyroidism and subclinical hypothyroidism during pregnancy.     

妊娠合并甲状腺功能减退症或亚临床甲状腺功能减退症77例临床分析

Objective To investigate the maternal and fetal outcomes of pregnant women with hypothyroidism or subclinical hypothyroidism. Methods From Jan. 2005 to Mar. 2008, clinical records of 77 women with hypothyroidism (n=57) or subclinical hypothyroidism (n = 20) during pregnancy who delivered at Peking Union Medical College Hospital were reviewed. The basic information, maternal complications and neonatal outcomes of the patients were compared with 79 healthy women who delivered during the same period. Results The prevalence of maternal hypothyroidism during the study period was 0.74% ,and that of maternal subclinical hypothyroidism was 0.26%. The mean neonatal birth weight of women with hypothyroidism was lower than that of the control [(3191.8±659.47 g) vs (3301.9±423. 1 g), P<0.05], the incidence of abnormal glucose metabolism was higher (24.6% vs 11.4% ,P<0.05), and small for gestational age infants were more common than in the control group (12. 3% vs 2. 5%, P<0. 05). The maternal and fetal outcomes of women with subclinical hypothyroidism during pregnancy showed no difference compared with the control. Conclusions Early screening for the high risk women and appropriate management are important to improve the neonatal and fetal outcomes of women with hypothyroidism and subclinical hypothyroidism during pregnancy.     

妊娠合并甲状腺功能减退症或亚临床甲状腺功能减退症77例临床分析

Objective To investigate the maternal and fetal outcomes of pregnant women with hypothyroidism or subclinical hypothyroidism. Methods From Jan. 2005 to Mar. 2008, clinical records of 77 women with hypothyroidism (n=57) or subclinical hypothyroidism (n = 20) during pregnancy who delivered at Peking Union Medical College Hospital were reviewed. The basic information, maternal complications and neonatal outcomes of the patients were compared with 79 healthy women who delivered during the same period. Results The prevalence of maternal hypothyroidism during the study period was 0.74% ,and that of maternal subclinical hypothyroidism was 0.26%. The mean neonatal birth weight of women with hypothyroidism was lower than that of the control [(3191.8±659.47 g) vs (3301.9±423. 1 g), P<0.05], the incidence of abnormal glucose metabolism was higher (24.6% vs 11.4% ,P<0.05), and small for gestational age infants were more common than in the control group (12. 3% vs 2. 5%, P<0. 05). The maternal and fetal outcomes of women with subclinical hypothyroidism during pregnancy showed no difference compared with the control. Conclusions Early screening for the high risk women and appropriate management are important to improve the neonatal and fetal outcomes of women with hypothyroidism and subclinical hypothyroidism during pregnancy.     

妊娠期亚临床甲状腺功能减退症与妊娠期高血压疾病关系的研究进展

亚临床甲状腺功能减退症（subclinical hypothyroidism,SCH）是妊娠期最常见的甲状腺疾病,SCH患者存在血管内皮功能损伤和自主神经功能障碍,可能会增加心血管疾病的发病风险。妊娠期高血压疾病（hypertensive disorders of pregnancy,HDP）使妊娠复杂化,并导致孕产妇和胎儿不良妊娠结局发生率和死亡率升高。已有研究发现SCH与HDP发病率增加有关,但目前没有统一结论,且SCH孕妇应用左旋甲状腺素（levothyroxine,L-T4）治疗对HDP是否有益也尚存争议。综述妊娠期SCH对HDP的影响及L-T4的治疗效果,以规范临床妊娠管理方案,减少孕妇和胎儿围产期不良妊娠结局的发生。     

妊娠合并甲状腺功能减退症或亚临床甲状腺功能减退症77例临床分析

Objective To investigate the maternal and fetal outcomes of pregnant women with hypothyroidism or subclinical hypothyroidism. Methods From Jan. 2005 to Mar. 2008, clinical records of 77 women with hypothyroidism (n=57) or subclinical hypothyroidism (n = 20) during pregnancy who delivered at Peking Union Medical College Hospital were reviewed. The basic information, maternal complications and neonatal outcomes of the patients were compared with 79 healthy women who delivered during the same period. Results The prevalence of maternal hypothyroidism during the study period was 0.74% ,and that of maternal subclinical hypothyroidism was 0.26%. The mean neonatal birth weight of women with hypothyroidism was lower than that of the control [(3191.8±659.47 g) vs (3301.9±423. 1 g), P<0.05], the incidence of abnormal glucose metabolism was higher (24.6% vs 11.4% ,P<0.05), and small for gestational age infants were more common than in the control group (12. 3% vs 2. 5%, P<0. 05). The maternal and fetal outcomes of women with subclinical hypothyroidism during pregnancy showed no difference compared with the control. Conclusions Early screening for the high risk women and appropriate management are important to improve the neonatal and fetal outcomes of women with hypothyroidism and subclinical hypothyroidism during pregnancy.     

妊娠合并甲状腺功能减退症孕妇的新生儿脐血甲状腺功能筛查的意义

目的 研究妊娠合并甲状腺功能减退症(甲减)者新生儿脐静脉血甲状腺功能检测的临床意义及其影响因素.方法 对67例在北京协和医院产科分娩的妊娠合并甲减行脐血甲状腺功能检查者进行回顾性分析.比较脐血与新生儿生后5～7 d静脉血的甲状腺功能及甲状腺自身抗体(抗-TGAb/抗-TPOAb)结果;分析甲状腺自身抗体水平在母血、脐血和新生儿生后5～7 d静脉血之间的相关性;并进一步分析脐血促甲状腺激素(thyroid stimulating hormone,TSH)的影响因素.TSH结果以中位数(第25～75百分位)表示.结果 (1)母亲患甲减时,新生儿脐血中TSH升高的比例为9.0%(6/67).(2)脐血TSH水平与新生儿生后5～7 d静脉血TSH水平无相关性.阴道分娩组脐血TSH显著高于剖宫产组[10.20 mU/L(6.10～12.80 mU/L)和5.86 mU/L(4.02～7.74 mU/L),P=0.001],胎儿窘迫或早产者脐血TSH分别高于无胎儿窘迫或足月产者[胎儿窘迫:10.36 mU/L(6.61～13.37 mU/L)和6.89 mU/L(4.18～9.70 mU/L),P=0.046;早产:8.90 mU/L(7.60～10.33 mU/L)和6.84 mU/L(4.17～9.80 mU/L),P=0.049].(3)脐血抗-TGAb和抗-TPOAb水平与新生儿5～7 d静脉血水平分别呈正相关(r分别=0.960和0.975,P均=0.000).母血抗-TGAb和抗-TPOAb水平对脐血的抗体结果有显著影响(P=0.003和0.000),但与新生儿TSH水平无关(P>0.05).结论 脐血TSH受多种分娩因素的影响,使其预测新生儿先天性甲减的意义受到影响.但母亲甲减时其新生儿脐血TSH水平升高和抗-TGAb及抗-TPOAb阳性的风险明显增加,成为其发生甲减的危险因素,因此,对这些新生儿需要进一步随访.