妊娠期甲状腺功能亢进症和抗甲状腺药物治疗对新生儿低出生体重的影响

目的探讨妊娠期间甲状腺功能亢进症(甲亢)和抗甲状腺药物(ATDS)治疗对新生儿低出生体重(LBW)的影响。方法对1983年1月1日至2003年12月31日住院分娩的妊娠合并甲亢的100例及其新生儿101例进行回顾性分析。根据母亲孕期甲状腺功能(甲功)、开始服用ATDs时间进行分组,对LBW的发生率、特点及其相关的危险因素进行分析,着重于妊娠甲亢和ATDs对LBW的交互作用。结果母亲孕晚期甲亢时,新生儿平均出生体重显著低于甲功正常和甲功恢复正常组(P<0.05);孕晚期开始服用ATDs,新生儿平均出生体重显著低于孕早中期开始用药组(P<0.001)。孕晚期甲亢、孕晚期开始服用ATDs早产儿和早产LBW率均显著增加,且二者对早产儿、早产儿LBW存在正交互作用(L.R Chisq为19.328和7.486,P=0.0001和0.0237)。孕晚期甲亢和孕晚期开始服用ATDs,发生LBW、早产儿和早产LBW的危险性显著增加。结论妊娠期间甲亢,特别是孕晚期甲亢和孕晚期才开始ATDs治疗,可导致LBW,尤其是早产LBW率增加。

The effects of maternal hyperthyroidism and antithyroid drug therapy on low birth weight of newborn infants

Objective: To evaluate the relationship between the incidence of low birth weight(LBW) and maternal hyperthyroidism with antithyroid drugs therapy(ATD).Methods: The clinical data of 100 cases of pregnant women with hyperthyroidism and their 101 offspring in 1983~2003 from Peking Union Medical College Hospital were analyzed retrospectively.Based on the maternal thyroid function and the antithyroid drugs taken during the three trimesters of pregnancy,subjects were divided into different groups.The incidence of LBW infant and its risk factors,especially the effects of maternal hyperthyroidism and antithyroid drug therapy were analysed.Results: The higher incidence of the LBW(10.1%) and preterm birth(16.2%) were found in the infants born to the mothers with hyperthyroidism in pregnancy.The incidences of preterm(40%) and preterm LBW(20%) infant in the group of the third trimester maternal hyperthyroidism were significantly higher than those of the controlled group(5.3% and 7.9%,respectively) and the euthyroid group(6.5% and 3.2%,respectively)(P< 0.05).Both the incidence of preterm birth(63.6%) and preterm LBW(36.4%) in the infants born to the mothers whose ATDs were initated in late pregnancy were significantly higher.Loglinear modern analyses showed the interactions between the third trimester maternal hyperthyroidism,late commencement of ATDs at the third trimester and preterm LBW(L.R Chisq=19.328 and 7.486,P=0.0001 and 0.0237). Conclusion: Maternal hyperthyoidism during the third trimester of pregnancy and delayed treatment may incease the incidence of LBW,preterm and preterm LBW infants.Prompt diagnosis and appropriate treatment of hyperthyroidism in pregnant women are essential for the prevention of undesirable neonatal outcome.