妊娠早期抗甲状腺过氧化物酶阴性亚临床甲状腺功能减退症妊娠结局研究

目的探讨妊娠早期抗甲状腺过氧化物酶(TPO-Ab)阴性亚临床甲状腺功能减退症(甲减)患者的妊娠结局及妊娠期并发症和合并症发生情况。方法选择2016年1月至2018年2月上海市亭林医院收治的妊娠早期孕妇4616例,按年龄分为18~24岁组(602例)、25~29岁组(2604例)、30~34岁组(1330例)、≥35岁(80例)组,比较不同年龄组孕妇TPO-Ab阴性的亚临床甲减发生率。再根据TPO-Ab钠片(LT4)治疗分为治疗组160例(接受LT4治疗)和观察组98例(未接受LT4治疗),以同期526例正常孕妇作为对照组,比较3组妊娠期并发症和合并症的发生率及妊娠结局。结果 TPO-Ab阴性亚临床甲减发生率比较:年龄30~34岁组(7.97%)高于25~29岁组(5.99%)和18~24岁组(3.99%);年龄≥35岁组(12.50%)高于25~29岁组(5.99%)和18~24岁组(3.99%),差异均有统计学意义(P0.05)。观察组妊娠期糖尿病发生率(14.29%)高于治疗组(6.25%)和对照组(4.94%);观察组妊娠期贫血发生率(44.90%)高于治疗组(30.00%)及对照组(26.04%);治疗组和对照组新生儿出生体重[分别为(3200±300)g学意义(P0.05)。结论妊娠早期TPO-Ab阴性的亚临床甲减发生率随年龄的增大而升高。及时给予干预治疗,可减少妊娠期糖尿病和妊娠期贫血的发生,且有利于子代生长发育。     

L-T_4治疗妊娠合并甲状腺过氧化物酶抗体阴性的亚临床甲状腺功能减退症的临床观察

目的:观察左旋甲状腺激素(L-T_4)治疗甲状腺过氧化物酶(TPOAb)阴性的妊娠合并亚临床甲状腺功能减退症(SCH)对妊娠结局的影响。方法:回顾分析2018年1月至2019年1月在广东省妇幼保健院行妊娠早期甲状腺激素筛查且有妊娠结局记录的867例孕产妇的临床资料。867例孕产妇中,甲状腺功能正常(N)+TPOAb(-)者584例(对照组),SCH+TPOAb(-)者283例,其中112例未接受左旋甲状腺治疗(观察组),171例接受左旋甲状腺素治疗(治疗组)。比较3组孕妇的妊娠结局及产科并发症情况。结果:观察组孕妇的流产率、妊娠期糖尿病发生率、早产率、出生低体质量儿发生率高于对照组、治疗组,差异均有统计学意义(P0.05)。观察组中3.4%最终发展为临床甲减。结论:妊娠早期合并SCH患者,TPOAb阴性者亦应及时给予L-T_4治疗;L-T_4治疗能有效改善妊娠合并TPOAb阴性的L-T_4患者不良妊娠结局。     

148例妊娠合并甲状腺功能减退症临床分析

目的探讨妊娠合并甲状腺功能减退症(简称"甲减")对妊娠结局的影响。方法选取2014年1月至2014年12月期间在南京市妇幼保健院产科住院分娩的148例妊娠合并甲状腺功能减退症患者,根据分娩前甲状腺功能分为控制组与未控制组,随机抽取同期住院的80例孕妇作为对照组,对临床资料进行回顾性分析研究。结果妊娠合并甲减控制组先兆流产率、胎儿宫内生长受限率、胎儿宫内窘迫率分别为30.8%、10.3%、10.3%,未控制组先兆流产率、胎儿宫内生长受限率、胎儿宫内窘迫率分别为30.0%、10.0%、10.0%,均高于对照组;未控制组新生儿出生体重低于控制组与对照组,差异均有统计学意义(P0.05);控制组与未控制组糖尿病患病率分别为21.8%、18.6%,高于对照组,未控制组妊娠期高血压疾病患病率为18.6%,高于控制组与对照组,差异均有统计学意义(P0.05)。结论妊娠合并甲减的不良妊娠患病率与甲减控制与否密切相关,有必要在孕前或孕早期筛查,早诊断、早治疗,严密监测孕妇、胎儿情况,以改善妊娠合并甲减者的妊娠结局。     

妊娠期糖尿病孕妇甲状腺功能及妊娠结局的研究

目的:探讨妊娠期糖尿病(GDM)孕妇的甲状腺功能及妊娠结局情况。方法:检测569例GDM孕妇及1221例正常孕妇的血清促甲状腺素(TSH)、游离甲状腺素(FT4)和甲状腺过氧化物酶抗体(TPOAb)水平。根据结果将两组孕妇进一步分为甲减组、甲亢组、正常组,比较各组的流产、早产及新生儿窒息发生率。结果:GDM组:甲减91例(1例临床甲减、90例亚临床甲减),甲亢64例(14例临床甲亢、50例亚临床甲亢),正常414例;对照组:亚临床甲减113例,甲亢36例(3例临床甲亢、33例亚甲亢),正常1072例。GDM组的TPOAb总体阳性率显著高于对照组(12.8%vs 8.6%,P0.01)。GDM-甲减组的TPOAb总体阳性率显著高于GDM-正常组(P0.01),GDM其余各组间及对照各组间均无显著差异(P0.05)。GDM合并甲状腺功能异常孕妇的流产、早产率高于甲功正常的GDM孕妇及甲功异常和正常的非GDM孕妇;其分娩的新生儿窒息率亦高于甲功正常的GDM孕妇和甲功正常的非GDM孕妇。其中GDM合并亚临床甲减孕妇的流产、早产率高于单纯GDM孕妇及单纯亚临床甲减孕妇(P0.01),GDM合并甲亢孕妇的新生儿窒息率显著高于甲功正常的GDM孕妇(P0.05)。结论:GDM孕妇出现甲状腺功能异常的风险较高,GDM孕妇同时合并甲状腺功能异常,对母儿风险大。临床应重视孕妇特别是GDM孕妇的甲状腺疾病。     

妊娠合并甲状腺功能减退26例临床分析

目的探讨妊娠合并甲状腺功能减退（甲减）患者的围生期特征及母婴结局。方法对26例妊娠合并甲减患者的临床资料进行回顾性分析,并选择正常孕妇30例作为对照组,比较两组患者的妊娠结局。结果妊娠合并甲减的发病率为1.21‰（26/21 527）。26例患者中,妊娠前诊断22例,妊娠中诊断4例;并发子痫前期3例,其中轻度子痫前期2例,重度子痫前期1例;贫血5例,其中轻度贫血3例,中度贫血2例;流产1例,妊娠32周胎盘早剥致死胎1例,早产3例;新生儿阴茎缺如1例。无新生儿先天性甲减。26例患者中,21例规范治疗,5例未规范治疗;妊娠期平均左旋甲状腺素用量（43.1±40.6）ug/d;规范治疗组并发症发生率（52.3%,11/21）与未规范治疗组（4/5）比较,差异有统计学意义（P〈0.05）;甲减组总并发症发生率（57.6%,15/26）与对照组（13.3%,4/30）比较,差异有统计学意义（P〈0.05）。结论妊娠合并甲减发病率低,妊娠期动态监测甲状腺功能并规范治疗可改善母婴结局。     

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。     

妊娠期甲状腺功能减退症与自然流产关系研究

目的探讨妊娠期甲状腺功能减退症(甲减)与自然流产的关系。方法选取2018年10月至2019年10月于郑州大学第三附属医院就诊的妊娠期甲减患者6336例,其中临床甲减组1825例,亚临床甲减组2190例,单纯低甲状腺素(T4)血症组2321例;选择同期正常健康孕妇2450例作为对照组,分别统计两组血清甲状腺过氧化物酶抗体(TPOAb)和甲状腺球蛋白抗体(TgAb)阳性率及最终发生自然流产的情况。结果 (1)临床甲减组和亚临床甲减组自然流产的发生率高于对照组(P0.05);临床甲减组早期流产和晚期流产的发生率高于对照组(P0.05),亚临床甲减组仅早期流产的发生率高于对照组(P0.05)。(2)临床甲减组自然流产1次和≥2次的发生率高于对照组(P0.05),而亚临床甲减组自然流产1次的发生率与对照组相比升高(P0.05)。(3)妊娠期临床甲减患者合并TPOAb和TgAb同时阳性或其中1项阳性时,自然流产的发生率与抗体阴性者相比,差异均有统计学意义(P0.001),而亚临床甲减患者仅当合并TPOAb和TgAb同时阳性时,自然流产的发生率与抗体阴性者相比,差异有统计学意义(P0.001)。结论妊娠期临床甲减可导致自然流产,而与流产时期、次数及TPOAb、TgAb无关。妊娠期亚临床甲减与自然流产时期、次数有关,且仅当TPOAb和TgAb同时阳性时可导致自然流产。     

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……     

妊娠合并亚临床甲状腺功能减退症的早期治疗对妊娠结局的影响

目的:探讨妊娠合并亚临床甲状腺功能减退症(SCH)的早期治疗对妊娠结局的影响。方法:回顾性分析2012年11月至2013年8月在苏州大学附属第一医院围生期检查并住院分娩的148例SCH孕妇,其中经左甲状腺素钠早期治疗的86例(SCH治疗组),未经药物干预治疗的62例(SCH未治疗组),随机选取同期住院的甲状腺功能正常的孕妇120例(正常对照组),分析3组孕妇的妊娠结局。结果:SCH未治疗组产科并发症、不良妊娠结局的发生率高于SCH治疗组和正常对照组,剖宫产率高于SCH治疗组和正常对照组(P0.05);SCH治疗组的产科并发症及不良妊娠结局和正常对照组差异无统计学意义(P0.05)。结论:妊娠合并SCH对妊娠结局有不良影响,早期治疗可以有效降低产科并发症的发生率,改善妊娠结局。     

妊娠合并甲状腺功能低减患者的临床分析

目的 探讨妊娠合并甲状腺功能低减(甲减)患者的围产期发病率、药物治疗剂量及母婴结局.方法 收集我院1995年1月-2006年5月收治的31例妊娠合并甲减患者的临床资料,31例患者均在产科高危门诊定期保健,每1.0～1.5个月监测1次甲状腺功能,并与内分泌科合作调整患者的左旋甲状腺素剂量.对患者的围产期保健、药物治疗量及母婴结局进行回顾性分析.结果 (1)发病率:我院近11年来妊娠合并甲减的发病率为1.27‰(31/24 327)[0.19‰(1/5251)～2.32‰(15/6456)].(2)左旋甲状腺素用量:左旋甲状腺素的平均剂量孕前、孕早期、孕中期、孕晚期、产后分别为(33±35)、(51±36)、(68±42)、(76±42)、(38±34)μg/d,孕早期及产后与孕前比较,差异无统计学意义(P＞0.05);孕中期及孕晚期与孕前比较,左旋甲状腺素应用量明显增加,差异有统计学意义(P＜0.05),整个孕期的左旋甲状腺素平均用量比孕前增加约35%.(3)妊娠结局:31例患者中有5例妊娠期糖代谢异常,发生率为16%(5/31);1例胎儿六指畸形,1例新生儿窒息(Apgar评分1分钟7分,5分钟10分);31例患者中无一例围产儿死亡,无新生儿先天性甲减.结论 妊娠合并甲减发病率逐年升高.孕期需及时增加左旋甲状腺素用量,对改善妊娠合并甲减患者的妊娠结局具有良好的治疗作用.     

维吾尔族孕妇亚临床甲状腺功能减退症的影响因素及其防治对策

目的:研究维吾尔族孕妇亚临床甲状腺功能减退症(SCH)的影响因素,提出防治对策。方法:选取2015年1月至2015年12月就诊于乌鲁木齐市妇幼保健院的且符合纳入及排除标准的维吾尔族孕妇,采用自行设计的调查问卷对选取的产妇进行面对面调查,收集并分析维吾尔族SCH患者的相关指标,将所有资料建立数据库,采用逐步向前法拟合多因素logistic回归模型探索SCH相关因素。结果:3428例维吾尔族中,妊娠期SCH患者490例,检出率为14.29%。通过逐步回归筛选表明,维吾尔族孕妇年龄、体质指数(BMI)、血红蛋白浓度、既往糖尿病病史对SCH的发生有影响(P0.05)。年龄大于30岁、BMI大于24kg/m~2、贫血及既往合并糖尿病病史的维吾尔族孕妇发生SCH的风险较高。结论:高龄、肥胖、贫血、糖尿病是影响维吾尔族孕妇发生妊娠期SCH的主要因素。应加强孕前、孕期的健康宣教,避免高龄怀孕,控制孕期体质量,积极开展常见疾病监测及诊治,降低妊娠期SCH发生率。     

重度子(癎)前期合并低蛋白血症对围产结局的影响

目的 探讨重度子癎前期合并低蛋白血症对围产结局的影响及其相关性.方法 回顾性分析我院2000年1月至2006年3月收治的233例重度子痢前期患者的临床资料,按血清白蛋白检测结果将其分成低蛋白血症组(A组,133例)和非低蛋白血症组(B组,90例),比较两组孕产妇及围产儿结局.结果 A组孕妇浆膜腔积液(6.8%和0)、肝酶异常(60.9 %和38.9%)、肾功损害(30.1%和11.1%)及并发症(胎盘早剥、产后出血)的发生率(23.3%和11.1%)均高于B组(P<0.05),新生儿出生体重低于B组[(2192.78±795.31)g和(2454.92±776.24)g,P<0.05],围产儿死亡率A组高于B组(26.0%和13.5%)(P<0.05).结论 重度子痢前期合并低蛋白血症可造成母儿的不良结局,应积极防治.充分细致评估母胎状况,尽可能延长孕周改善新生儿结局,若孕妇重要器官受损或并发难治性浆膜腔积液应适时终止妊娠,以改善孕母结局.     

Pregnancy outcomes in women with systemic lupus erythematosus

Objective : The purpose of this study was to examine pregnancy outcomes in women with systemic lupus erythematosus (SLE). Study design : Data from the California Health Information for Policy Project, which links records from birth certificates and hospital discharge records of mothers and newborns who delivered in all civilian hospitals in the state of California between 1 January 1993 and 31 December 1994, were retrospectively reviewed. Patients with a singleton gestation were stratified into the study group if they had a diagnosis of SLE, based on the International Classification of Disease, 9th Revision, or into the control group if they did not have SLE and delivered during the interval from 1 January 1994 to 31 December 1994. Specific maternal outcomes including pregnancy complications and fetal and neonatal outcomes were assessed and compared between the two groups. Results : During the 2-year study period, 555 women had a diagnosis of SLE, and approximately 600 000 women were included in the control group in the year 1994, giving a point prevalence of 0.05%. Specific adverse pregnancy outcomes, including hypertensive complications, renal disease, preterm delivery, non-elective Cesarean section, postpartum hemorrhage and delivery-related deep vein thrombosis all occurred more frequently in the SLE group as compared to controls ( p < 0.001). Additionally, neonatal and fetal outcomes were significantly worse in the SLE group, as documented by a higher prevalence of fetal growth restriction and neonatal death, as well as longer hospital stays ( p < 0.0001). Conclusion : SLE was associated with a significant increase in maternal pregnancy complications and in fetal and neonatal morbidity and mortality as compared to the control population. However, our population-based study found significantly fewer adverse outcomes than were previously reported. This may represent a more accurate clinical picture of the impact of SLE on pregnancy outcomes.     

甲状腺乳头状癌术后妊娠患者母儿结局分析#br#

Objective?To investigate the maternal and fetal outcomes after papillary thyroid cancer surgery. Methods?From January 2014 to January 2020, 57 pregnant women with thyroid papillary cancer after surgery who were registered in the Department of Obstetrics, Peking University People's Hospital and hospitalized for delivery were selected as the research group. A total of 122 single pregnancy cases registered in our hospital were selected as normal control group. The study group was divided into subclinical hyperthyroidism (hyperthyroidism group), subclinical hypothyroidism (hypothyroidism group) and normal thyroid function group according to the thyroid function during pregnancy. Results?There were 61 pregnancies in 57 patients. 56 cases achieved live birth, 4 cases underwent induced labor because of fetal malformation during the second trimester, 1 case underwent inevitable miscarriage. There were 34 cases of vaginal delivery (60.7%) and 22 cases of cesarean section (39.3%). The research group showed higher incidence in gestational diabetes mellitus, cesarean section, postpartum hemorrhage and fetal malformation than the control group（P＜0.05）. In the research group, there were 14 pregnant patients with subclinical hyperthyroidism, 3 with subclinical hypothyroidism, and 44 with normal thyroid function. Compared with normal group, there was no difference in the incidence of maternal and fetal complications between subclinical hyperthyroidism group and subclinical hypothyroidism group (P>0.05). Conclusion?It was suggested that there were maternal and fetal complications among patients after papillary thyroid cancer surgery. Management of these patients requires a careful gestational monitoring and surveillance to improve the outcomes.     

Subclinical hypothyroidism and pregnancy outcomes

BACKGROUND: Clinical thyroid dysfunction has been associated with pregnancy complications such as hypertension, preterm birth, low birth weight, placental abruption, and fetal death. The relationship between subclinical hypothyroidism and pregnancy outcomes has not been well studied. We undertook this prospective thyroid screening study to evaluate pregnancy outcomes in women with elevated thyrotropin (thyroid-stimulating hormone, TSH) and normal free thyroxine levels. METHODS: All women who presented to Parkland Hospital for prenatal care between November 1, 2000, and April 14, 2003, had thyroid screening using a chemiluminescent TSH assay. Women with TSH values at or above the 97.5th percentile for gestational age at screening and with free thyroxine more than 0.680 ng/dL were retrospectively identified with subclinical hypothyroidism. Pregnancy outcomes were compared with those in pregnant women with normal TSH values between the 5th and 95th percentiles. RESULTS: A total of 25,756 women underwent thyroid screening and were delivered of a singleton infant. There were 17,298 (67%) women enrolled for prenatal care at 20 weeks of gestation or less, and 404 (2.3%) of these were considered to have subclinical hypothyroidism. Pregnancies in women with subclinical hypothyroidism were 3 times more likely to be complicated by placental abruption (relative risk 3.0, 95% confidence interval 1.1-8.2). Preterm birth, defined as delivery at or before 34 weeks of gestation, was almost 2-fold higher in women with subclinical hypothyroidism (relative risk, 1.8, 95% confidence interval 1.1-2.9). CONCLUSION: We speculate that the previously reported reduction in intelligence quotient of offspring of women with subclinical hypothyroidism may be related to the effects of prematurity. LEVEL OF EVIDENCE: II-2.     

早发型重度子痫前期孕妇期待治疗中不良妊娠结局的危险因素分析

目的 探讨早发型重度子痫前期孕妇实施期待治疗过程中发生不良妊娠结局的危险因素.方法 选择2007年1月至2008年6月在首都医科大学附属北京妇产医院住院的早发型重度子痫前期并实施期待疗法的孕妇136例.按照妊娠结局分为良好结局组101例和不良结局组35例.采用回顾性分析方法,分析两组孕妇人院时的一般资料、妊娠结局、尿常规、血流动力学及血常规指标、肝肾功能,另分析不良妊娠结局的危险因素.结果 (1)一般资料:良好结局组与不良结局组孕妇入院时出现子痫前期症状的发生率(分别为35.6%及57.1%)比较,差异有统计学意义(P<0.05).两组孕妇年龄、孕次、孕前体质指数、入院时并发症发生率及规律产前检查率比较,差异均无统计学意义(P>0.05).(2)妊娠结局:良好结局组孕妇期待疗法平均天数为(6.5±8.2)d,不良结局组平均为(6.8±10.0)d,两组比较,差异无统计学意义(P>0.05).不良结局组孕妇主要并发症为胎盘早剥13例,心功能衰竭及肺水肿10例,溶血、肝酶升高和低血小板计数(HELLP)综合征5例,胎死宫内5例,无子痫发生.良好结局组孕妇均无以上并发症发生.(3)期待疗法中发病孕周及分娩孕周、血压及尿蛋白比较:良好结局组的发病孕周及分娩孕周[分别为(33.0±4.9)及(34.0±3.6)周]明显晚于不良结局组[分别为(31.3±3.4)及(32.1±3.0)周],收缩压及尿蛋白定量明显低于不良结局组.良好结局组中尿蛋白定性(+++)比例明显低于不良结局组.以上指标两组比较,差异均有统计学意义(P<0.05).(4)血流动力学及血常规:良好结局组孕妇血液黏度[(4.6±0.4)mPa·s]明显低于不良结局组,两组比较,差异有统计学意义(P<0.05).而心输出量、心脏指数、外周阻力及血管顺应性等指标在两组孕妇中比较,差异均无统计学意义(P>O.05).良好结局组孕妇血小板计数[(189±69)×10~9/L]明显高于不良结局组,而红细胞计数[(3.9±0.5)×10~(12)/L]和红细胞压积(0.34±0.05)却明显低于不良结局组.两组比较,差异均有统计学意义(P<0.01).(5)肝肾功能:良好结局组孕妇丙氨酸氨基转移酶[ALT,(18±12)U/L]、天冬氨酸氨基转移酶[AST,(24±9)U/L]、乳酸脱氢酶[LDH,(175±53)U/L]及尿素氮[BUN,(4.6±1.8)mmol/L,]水平明显低于不良结局组.两组比较,差异均有统计学意义(P<0.05).而血浆总蛋白(TP)、血浆白蛋白(Alb)、尿酸(UA)及血肌酐(cr)水平在两组中比较,差异均无统计学意义(P>0.05).(6)不良结局的危险因素分析:进入logistic回归方程的自变量分别为红细胞计数(OR值为3.68,P=0.000),血小板计数(OR值为0.99,P=0.006)及分娩孕周(OR值为0.87,P=0.001).显示红细胞计数越高,则在期待疗法中越有可能出现不良妊娠结局;血小板计数越低、分娩孕周越早,则提示期待疗法中愈易出现不良妊娠结局.结论 红细胞计数升高、血小板计数降低及分娩孕周过早,是早发型重度子痫前期孕妇实施期待疗法过程中发生不良妊娠结局的危险因素.     

Subclinical hypothyroidism and pregnancy

Pregnancy has a considerable impact on thyroid homeostasis that complicates the diagnosis of hypothyroidism. Pregnant women with overt hypothyroidism have appreciable maternal morbidity as well as perinatal morbidity and mortality. Treatment of such women has been shown to improve these outcomes. Controversy regarding the importance of identifying and treating women with subclinical hypothyroidism erupted after several reports have linked variously defined hypothyroidism with impaired neurodevelopment of the fetus. Frequently, these reports are erroneously considered as identifying women with subclinical hypothyroidism, when in fact, none of these studies specifically identified such women. To date, there have been no well-controlled, long-term studies on offspring of pregnant women with subclinical hypothyroidism as contemporaneously defined. Furthermore, these reports have led to conflicting and confusing position statements from several national entities as to whether all pregnant women should be screened for hypothyroidism and treatment prescribed for those found to have subclinical hypothyroidism. Importantly, there are also no published intervention trials specifically assessing the efficacy of such treatment to improve neurodevelopmental outcomes in offspring of women with subclinical hypothyroidism. It is acknowledged that obstetricians are under increasing pressure to screen for and treat pregnant women with subclinical hypothyroidism despite uncertainty that their offspring would benefit from therapy. National endocrine groups recommending such screening and treatment have emphasized that there is a need for large clinical trials to address these issues. Until such studies are completed, routine screening for and treatment of subclinical hypothyroidism during pregnancy is unwarranted and should be considered experimental. TARGET AUDIENCE: Obstetricians and Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader should be able to recall the difficulty in identifying and treating women with subclinical hypothyroidism, summarize the current thinking about the laboratory diagnosis of subclinical hypothyroidism, explain that there are no well-controlled studies that indicate that treatment during pregnancy will improve neurodevelopmental outcome, and state that screening during pregnancy at this time is unwarranted.     

妊娠期糖尿病孕妇糖化血红蛋白水平与母婴结局的关系

目的:分析妊娠期糖尿病(GDM)患者中不同糖化血红蛋白(HbAlc)水平与母婴妊娠结局的相关性,探讨HbAlc在产前糖尿病病情监测中的意义。方法:选取2014年1月至12月在青海省妇女儿童医院行产前检查并分娩的119例GDM孕产妇,根据产前HbAlc控制水平将119例产妇分为达标组(5%≤HbAlc6%,68例)、未达标组(6%≤Hb Alc7%,51例)。选取同期55例HbAlc正常产妇为对照组。比较3组的母婴结局,分析不同HbAlc水平与母婴结局的相关性。结果:妊娠期间高血压(25.5%vs 10.3%vs5.5%)、羊水过多(17.6%vs 7.4%vs 3.6%)、胎膜早破比例(29.4%vs 5.9%vs 3.6%)、子痫前期比例(15.7%vs 5.9%vs 3.6%)及剖宫产比例(76.5%vs 45.6%vs 47.3%)由高到低依次为未达标组达标组正常组。未达标组的妊娠高血压、胎膜早破、妊娠周期、剖宫产比例与达标组比较,差异有统计学意义(P0.05)。Pearson积矩相关分析显示,HbAlc与妊娠周期呈显著负相关(r=-0.166,P=0.028)。围产儿中早产比例(27.5%vs 11.8%vs 7.3%)、巨大儿比例(29.4%vs 10.3%vs 3.6%)、1min Apgar评分≤7分比例(25.5%vs 11.8%vs 7.3%)、新生儿体重[(3702.7±402.5)g vs(3561.3±380.4)g vs(3252.8±345.7)g]、新生儿低血糖比例(33.3%vs 11.8%vs 10.9%)高到低排序为未达标组达标组正常组。未达标组的早产儿比例、巨大儿比例、1min Apgar评分≤7分比例、新生儿低血糖比例均显著高于达标组(P0.05)。Pearson积矩相关分析显示,Hb Alc与新生儿1min Apgar评分呈显著负相关(r=-0.156,P=0.040)。结论:GDM产妇体内HbAlc水平与母婴结局密切相关,HbAlc水平越高,妊娠与分娩期间发生母婴并发症的几率就越大;可将HbAlc作为孕妇血糖控制的重要监测指标。     

阜阳地区妊娠期亚临床甲减诊断标准和筛查策略的探讨

目的:探讨阜阳地区妊娠期亚临床甲减的诊断标准及筛查策略。方法:选取2015年4月至9月于阜阳市人民医院产科门诊建卡注册的孕妇共2421例。患者完成调查问卷,根据既往疾病史分为高危组及低危组,测定甲状腺功能及TPOAb、TGAb。将受试者按下列诊断标准进行诊断:(1)国外标准组:根据2011年ATA指南建立。(2)我国标准组:根据2012年"中国妊娠和产后甲状腺诊治指南推荐标准"建立。比较上述诊断方法所得亚临床甲减患病率的不同,及高危组及低危组的患病率差异。结果:我国标准诊断亚临床甲减的患病率为3.8%,明显低于国外标准18.7%(P0.001);高危组使用我国标准诊断患病率为5.5%,国外标准为24.1%,均高于低危组,但差异无统计学意义(P0.05)。按我国诊断标准,如仅对高危妊娠妇女进行筛查,妊娠合并亚临床甲减的漏诊率为82.7%。结论:应用国外标准诊断阜阳地区妊娠妇女亚临床甲减的患病率明显高于应用我国标准。如仅对妊娠高危人群进行亚临床甲减的筛查,可能会导致高漏诊率。