过量碘摄入对孕妇甲状腺功能及妊娠结局的影响

目的探讨过量碘摄入对孕妇甲状腺功能及妊娠结局的影响。方法选取河北省沧州市海兴县医院妊娠晚期孕妇210例,平均年龄(27.69±4.73)岁,采集空腹晨尿及静脉血,采用砷-铈催化分光光度法测定尿碘浓度,化学发光法测定血清游离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4)及敏感促甲状腺激素(sTSH),并详细记录妊娠结局。结果被调查的孕妇尿碘中位数为1240.70μg/L,有84.3%的孕妇尿碘超过500μg/L,处于碘过量状态。孕妇甲状腺疾病总患病率为19.5%,其中亚临床甲状腺功能亢进、甲状腺功能减退、亚临床甲状腺功能减退的患病率分别为1.0%、2.4%、16.2%。不同尿碘水平或不同甲状腺功能的孕妇,不良妊娠结局的发生率差异没有统计学意义(P>0.05),但碘过量组孕妇不良妊娠结局的发生率有升高趋势。结论孕妇摄入过量碘时,甲状腺疾病患病率较高,其中以亚临床甲状腺功能减退为主;同时不良妊娠结局的发生率也有随尿碘升高而升高的趋势,提示应重视对高碘地区孕妇碘营养状况的监测。

EFFECTS OF EXCESS IODINE INTAKE ON MATERNAL THYROID FUNCTION AND PREGNANCY OUTCOMES

Objective To explore the effects of excess iodine intake on maternal thyroid function and pregnancy outcomes.Method Two hundred and ten pregnant women in the third trimester were collected from Obstetrics and Gynecology Hospical in Haixing country,Cangzhou city,Hebei province,and the average age of them was(27.69±4.73) years.The morning-urine and venous blood were collected.The urinary iodine level was examined by arsenic-cerium catalytic contact.The levels of free triiodothyronine(FT3),free thyroxine(FT4) and sensitive thyroid-stimulating hormone(sTSH) in serum were measured by chemiluminescence.In addition,pregnancy outcomes were recorded in detail.Results The median urinary iodine of pregnant women investigated was 1240.70 μg/L.The ratio of pregnant women with more than 500μg/L iodine intake was 84.3%,and they were in the status of excess iodine.The whole prevalence rate of thyroid disease was 19.5%.The prevalence rates of subclinical hyperthyroidism,hypothyroidism and subclinical hypothyroidism were 1.0%,2.4% and 16.2% respectively.There were no differences in adverse pregnancy outcomes in women who were different in urinary iodine level or thyroid function(P>0.05),but there was a higher trend of rates of adverse pregnancy outcomes in iodine excess women than that in iodine adequate women.Conclusion Excessive iodine intake during pregnancy may lead to increasing prevalence rates of thyroid diseases,especially subclinical hypothyroidism.There was also an ascending trend of rates of adverse pregnancy outcomes as the urinary iodine concentration increased.It is suggested that we should pay more attention to the monitoring of the iodine status of the pregnant women in high iodine area.