妊娠合并甲状腺功能减退的临床分析

[目的]研究妊娠合并甲状腺功能减退孕妇的患病率、异常孕产史、妊娠合并症、妊娠结局及治疗。[方法]选取2006年5月至2011年5月期间在江苏省人民医院妇产科住院分娩的165例妊娠合并甲减患者,据入院后甲状腺功能分为治疗组与未治疗组,随机抽取同期住院的165例患者为对照组,对临床资料进行回顾性分析研究与比较。[结果]妊娠合并甲状腺功能减退近5年患病率0.90%,呈逐年上升趋势;异常孕产史发生率28.48%;妊娠合并症发生率:妊娠期糖代谢异常15.6%,妊娠期高血压4.2%,妊娠期肝内胆汁淤积(ICP)11.5%,臀位3.6%,双胎5.4%;甲状腺功能未治疗组的糖代谢异常,妊娠期高血压,肝内胆汁淤积发生率显著高于对照组(P0.05);妊娠结局:剖宫产率75.8%,产后出血率4.2%,新生儿窒息发生率1.8%,死胎发生率1.2%,新生儿畸形率1.8%,新生儿甲状腺功能减退0.6%;甲减未治疗组的早产、死胎及新生儿畸形率发生率显著高于对照组(P0.05)。[结论]妊娠合并甲状腺功能减退的患病率逐年上升,孕期及时诊断,调整左旋甲状腺素剂量能有效降低妊娠合并症的发生率,改善妊娠结局。

Clinical Analysis of Hypothyroidism during Pregnancy

[Objective] To investigate the incidence,abnormal pregnancy history,cause,complications,pregnant outcomes,treatment of women with hypothyroidism during pregnancy.[Methods] Retrospective analysis was conducted pregnant outcomes of 165 pregnant women with hypothyroidism.According to thyroid function they were divided into treatment group and untreated group,165 randomly selected patients hospitalized over the same period as the control group.[Results] The incidence of maternal hypothyroidism during the study period was 0.90%,showed an increasing trend;abnormal pregnancy history was 28.48%;pregnancy complications： the incidence of abnormal glucose metabolism was 15.6%,gestational hypertension was 4.2%,intrahepatic cholestasis of pregnancy was 11.5%,breech presentation was 3.6%,twins was 5.4%;the incidence of abnormal glucose metabolism,gestational hypertension,cholestasis in the untreatment hypothyroidism group was significantly higher than the control group.[Outcome] The incidence of Cesarean section was 75.8%,postpartum hemorrhage was 4.2%,asphyxia was 1.8%,fetal death was 1.2%,birth defects was 1.8%,neonatal hypothyroidism was 0.6%;The incidence of premature delivery,stillbirth and fetal malformation were significantly higher than the control group.[Conclusions] The incidence of maternal hypothyroidism is increasing yearly.It is of great value in improving the pregnant outcome through adjusting the LT4 dose during pregnancy.