孕晚期亚临床甲状腺功能异常对孕妇糖代谢及妊娠并发症的影响

目的探讨孕晚期亚临床甲状腺功能异常对孕妇糖代谢及妊娠并发症的影响。方法选取62例孕晚期亚临床甲状腺功能减退孕妇(亚甲减组)、38例亚临床甲亢孕妇(亚甲亢组)和50例甲状腺功能正常孕妇(对照组)为研究对象。观察3组甲状腺功能及糖代谢指标情况,对比各组孕妇妊娠并发症和胎儿不良结局情况。结果亚甲减组孕妇血清促甲状腺激素(TSH)水平明显高于对照组,而亚甲亢组TSH水平则明显低于对照组(P<0.05)。亚甲减组孕妇空腹血糖(FBG)、餐后1 h血糖(1hPBG)、2hPBG及糖化血红蛋白(HbA1c)等糖代谢指标均明显高于对照组(P<0.05);而亚甲亢组和对照组孕妇各糖代谢指标比较,差异无统计学意义(P>0.05)。血TSH水平与孕妇FBG、1hPBG、2hPBG及HbA1c呈显著正相关(P<0.05)。亚甲减组和亚甲亢组产妇胎盘早剥发生率均显著高于对照组(P<0.05);亚甲减组产妇妊娠糖尿病以及胎儿窘迫、低出生体重儿、新生儿窒息发生率也高于对照组(P<0.05)。结论孕晚期甲状腺功能与孕妇糖代谢紊乱密切相关,甲状腺功能异常会增加妊娠期并发症和胎儿不良结局的发生率,其中亚甲减对母婴的影响更为严重。

Effects of subclinical thyroid dysfunction in late pregnancy on glucose metabolism and maternal prognosis in pregnant women

Objective To explore the effectof subclinical thyroid dysfunction in late pregnancy on glucose metabolism and maternal prognosis in pregnant women. Methods 62 pregnant women with subclinical hypothyroidism(subclinical hypothyroidism group),38 pregnant women with subclinical hyperthyroidism(subclinical hyperthyroidism group)and 50 healthy pregnant women(control group)were enrolled in this study. The thyroid function and metabolic indicators were observed in three groups. The pregnancy complications and fetal adverse outcomes were compared in each group. Results The level of TSH in subclinical hypothyroidism group were significantly higher than those in control group,while the level of TSH in subclinical hyperthyroidism group were significantly lower than those in control group(P<0.05). The levels of FBG,1 hPBG,2 hPBG and HbA1 c in subclinical hypothyroidism group were significantly higher than the control group(P<0.05). There were no significantly differences in glucose metabolism indexes between the subclinical hyperthyroidism group and control group(P>0.05). Blood TSH was significantly positively correlated with FBG,1 hPBG,2 hPBG and HbA1 c in pregnant women(P<0.05). The occurrence rates of placental abruption in subclinical hypothyroidism group and subclinical hyperthyroidism group were significantly higher than that in control group(P<0.05),and the occurrence rates of gestational diabetes mellitus,fetal distress and low-birth weight,neonatal asphyxia in subclinical hypothyroidism group were higher than that in the control group(P<0.05). Conclusion Thyroid function in the third trimester is closely related to the disorder of glucose metabolism in pregnant women. Abnormal thyroid function will increase the incidence of pregnancy complications and fetal adverse outcomes. Among them,the effect of hypothyroidism on mothers and infants is more serious.