妊娠合并甲状腺功能减退症42例妊娠结局分析

目的探讨妊娠合并甲状腺功能减退症患者经过治疗后妊娠结局。方法回顾性分析42例妊娠合并甲状腺功能减退患者的临床资料,并分析其妊娠结局;终止妊娠前了解外周血促甲状腺素TSH水平,以TSH〈3.0uIU/ml作为治疗目标值并比较其妊娠结局。结果经过治疗后甲状腺功能减退孕妇的剖宫产率,产后出血率,新生儿窒息率与同期相比差异无统计学意义（P〉0.05）,但甲状腺功能减退组孕妇的糖代谢异常风险（OR=4.000,95%CI0.779～20.531）、胎膜早破（OR=2.969,95%CI0.849～10.375）、羊水胎粪污染风险增加（OR=2.969,95%CI0.849～10.375）;以TSH〈3.0uIU/ml做为治疗目标值比较,两组妊娠结局差异无统计学意义（P〉0.05）。结论对于妊娠合并甲状腺功能减退患者及时给予足量甲状腺素补充治疗,可有效地降低不良妊娠结局。晚孕期甲状腺素替代治疗,TSH目标值有待于临床扩大样本量后进一步探讨。

Outcome of pregnant women with hypothyroidism

Objective To analyze the maternal and fetal outcome of pregnant women combined with treated hypothyroidism.Methods Data of 42 cases of pregnant women with hypothyroidism were analyzed retrospectively.The pregnant outcomes were compared between the groups of different TSH concentrations.Results The prevalence of maternal hypothyroidism during the study period in our hospital was 0.1%.The cesarean-section rates, the postpartum hemorrhage rates showed no statistical difference between hypothyroidism and control group (P>0.05).But patients in hypothyroidism group had a higher risk of abnormal glucose metabolism(OR=4.000,95% CI 0.779~20.531), premature rupture of membranes(OR=2.969,95% CI 0.849~10.375) and meconium-stained amniotic fluid(OR=6.833,95% CI 0.785~59.479).Conclusion Early screening and proper treatment for the pregnant women combined with hypothyroidism can improve the maternal and fetal outcome.