妊娠早中期亚临床甲状腺功能减退对后代甲状腺功能及智力发育的影响

目的探讨妊娠早中期亚临床甲减对后代甲状腺功能和智力发育的影响。方法选择2013年1月至2015年1月福建医科大学附属宁德市医院产科收治的妊娠早中期合并亚临床甲减的孕妇55例,其中甲状腺过氧化物酶抗体(thyroid peroxidase antibody,TPOAb)阳性组35例,TPOAb阴性组20例,单纯TPOAb阳性组30例,健康妊娠者30例为对照组。测定4组孕妇20~30月龄子代的甲状腺功能游离三碘甲状腺原氨酸(free triiodothyronine,FT_3)、游离甲状腺素(free thyroxine,FT_4)、促甲状腺激素(thyroid stimulating hormone,TSH),随访20~30月龄子代的发育商指标,比较4组婴儿有无差异。结果亚临床甲减+TPOAb(+)组、亚临床甲减+TPOAb(-)组、单纯TPOAb(+)组子代TSH水平显著高于对照组,血清FT_3、FT_4水平明显低于对照组(P0.05);亚临床甲减+TPOAb(+)组子代发育商低于其余各组,其中智力显著低于亚临床甲减+TPOAb(-)组和对照组(P0.05),而亚临床甲减+TPOAb(+)组与单纯TPOAb(+)组发育商比较差异无统计学意义(P0.05)。结论妊娠早中期亚临床甲减可能引起子代短期的甲状腺功能异常,亚临床甲减伴TPOAb(+)可能对子代神经系统发育造成影响,妊娠期单纯TPOAb(+)也可能会对子代神经智力与运动发育造成一定影响。建议对妊娠早期母体进行TPOAb的广泛筛查,如出现促甲状腺激素增高,应及时治疗。

Effect of subclinical hypothyroidism on thyroid function and intelligence development in offspring in early and mid-term pregnancy

Objective To investigate impact of subclinical hypothyroidism on thyroid function and intelligence development in offspring in early and mid-term pregnancy.Methods 55 cases of pregnant women with subclinical hypothyroidism in early and mid-term pregnancy treated in Ningde Hospital Affiliated of Fujian Medical University from January 2013 to January 2015 were chosen,in which thyroid peroxidase antibody(TPOAb) was positive in 35 cases and negative in 20 cases.30 cases of simple TPOAb positive and 30 cases of healthy pregnancy(control group) were selected, too.Offspring aged 20~30 months were followed-up,free triiodothyronine(FT3), free thyroxine(FT4),thyroid stimulating hormone(TSH) and intellectual score in the 4 groups were detected and compared.Results Offspring's TSH in the subclinical hypothyroidism + TPOAb(+) group, the subclinical hypothyroidism + TPOAb(-)group and simple TPOAb(+) group was significantly higher than the control group,while FT4 and FT3 levels were lower than the control group.Intellectual score of subclinical hypothyroidism + TPOAb(+) group was lower than the rest groups and significantly lower than the subclinical hypothyroidism+TPOAb(-) group and the control group(P<0.05).While intellectual score of subclinical hypothyroidism + TPOAb(+) group was not significantly different from simple TPOAb(+) group and the control group(P>0.05).Conclusion Subclinical hypothyroidism in early and mid-pregnancy may cause short-term thyroid dysfunction in offspring.Subclinical hypothyroidism with TPOAb positive may affect nervous system development in offspring.Simple TPOAb positive in pregnancy may also affect mental development of the offspring, so we recommend widespread screening of TPOAb in early pregnancy.If maternal TSH rises, they should be treated in time.