妊娠期单纯TPO抗体阳性对妊娠结局的影响

目的研究单纯TPO抗体阳性、甲状腺功能正常的孕妇随着妊娠进展出现甲状腺功能减退的比例,并评估TPO抗体对妊娠结局的影响。方法 2011年9月∽2013年1月对筛查出的839例单纯TPO抗体阳性、甲状腺功能正常且既往无糖尿病史的单胎孕妇在孕24∽28w和/或32∽36w随访甲状腺功能。随机选择1685例同期分娩的TPO抗体阴性、既往无甲状腺疾病史和糖尿病史、甲状腺功能正常且TSH〈3mIU/L的单胎孕妇作为对照组。分析TPO抗体阳性对妊娠结局如妊娠期高血压疾病、妊娠期糖尿病、胎盘早剥、前置胎盘、胎盘植入、臀位、低出生体重儿、早产儿、巨大儿的影响。结果单纯TPO抗体阳性、初次筛查甲状腺功能正常孕妇约4.5%随着妊娠进展出现亚临床甲减,无1例出现甲减。校正孕妇年龄及孕次后Logistic回归法分析发现单纯TPO抗体阳性并不增加妊娠期高血压疾病、妊娠期糖尿病、胎盘早剥、前置胎盘、臀位、低出生体重儿、早产、巨大儿的危险性,而胎盘植入的危险性是正常对照组的3倍（OR值3.02）。结论妊娠期常规筛查TPO抗体价值有限,并不改善母儿预后。

Pregnancy outcomes in euthyroid pregnant women with positive thyroid peroxidase antibodies.

Objective： The objective of study was to estimate the prevalence of subclinical hypothyroidism in euthyroid women with positive thyroid peroxidase antibodies and to investigate the effects of thyroid peroxidase antibodies on pregnancy outcomes. Methods： Between Sep 2011 and Jan 2013, all pregnant women who presented for antenatal care underwent screening thyroid function and thyroid peroxidase antibodies in the Obstetrics and Gynecology Hospital of Fudan University.839 singleton euthyroid pregnant women with positive thyroid peroxidase antibodies were recruited as study group and thyroid function were determined when the gestational week were between 24 and 28 or between 32-36.1685 singleton euthyroid pregnant women with negative thyroid peroxidase antibodies and thyroid disease were randomly selected as control group whose thyrotropin level was under 3mlU/L. Both groups had negative diabetes mellitus history.Pregnancy outcomes were compared between two groups.Results： 4.5% women with positive thyroid peroxidase antibodies and normal screening of thyroid function became subclinical hypothyroidism in the thyroid function follow-up.Thyroid peroxidase antibodies were not associated with pregnancy complications such as hypertensive disorders complicating pregnancy, gestational diabetes mellitus, plaeental abruption, palcenta previa, breech presentation, low birth weight, preterm birth, macrosomia.Thyroid peroxidase antibodies were associated with placenta acereta （Odds ratio, 3.02） . Conclusions： The values of routinely screening thyroid peroxidase antibodies during pregnancy were limited.