妊娠期糖尿病孕妇甲状腺功能减退的临床分析

目的:探讨妊娠期糖尿病(GDM)患者甲状腺功能减退(甲减)的情况,以及GDM并发甲减对妊娠结局的影响。方法:(1)根据75g糖耐量试验结果,将2011年9月至2013年3月在产科门诊常规产检的妊娠中期妇女分为GDM组(244例)及对照组(674例)。比较两组患者的甲状腺功能;(2)将2011年9月至2013年3月收入院的妊娠晚期GDM患者分为单纯GDM组(Ⅰ组,370例)、GDM并发甲减组(Ⅱ组,79例),回顾分析两组患者的妊娠结局。结果:(1)与对照组相比,妊娠中期GDM组患者的低甲状腺素血症发生率较高(P0.05),血清游离甲状腺素(FT4)显著降低(P0.01)。两组妇女的促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)、抗甲状腺过氧化物酶抗体(TPOAb)无显著差异,但TPOAb阳性的妊娠妇女TSH平均值高于正常值上限,且显著高于TPOAb阴性妇女(P0.05);(2)GDM并发甲减组的子痫前期、巨大儿、剖宫产发生率均显著高于单纯GDM组(P0.05)。结论:GDM妊娠妇女更易引发甲减,且GDM并发甲减将进一步加重不良妊娠结局。

Clinical analysis of hypothyroidism in pregnant woman with gestational diabetes mellitus

Objective:To investigate the condition of hypothyroidism in pregnant women with gestational diabetes mellitus(GDM) and analyze the pregnancy outcomes in GDM women complicated by hypothyroidism.Methods:(1) According to 75g oral glucose tolerance test,244 cases of outpatient gestational diabetic women with routine antenatal care in our hospital from Sep.2011 to March 2013 were selected as GDM group of mid-pregnancy,674 cases as control group of mid-pregnancy.Clinical information about them during second trimester was collected,the thyroid functions between the two groups were compared and analyzed.(2) 370 cases of inpatient and simple GDM women in our hospital from Sep.2011 to March 2013 were selected as GDM group(Ⅰ group),79 cases as GDM with hypothyroidism group(Ⅱ group),retrospective analysis was conducted between the two groups.Results:(1) Compared with the control group,the prevalence of hypothyroxinemia in GDM group was higher during mid-pregnancy,and mean free thyroxine(FT4) concentration of GDM group was much lower,there was a significant difference(P < 0.01).No differences were found about the TSH,FT3 and TPOAb levels of the two groups,but in the women positive for anti-TPOAb,the mean of TSH was significantly higher than the upper reference range and those negative ones(P < 0.01).(2) In the third trimester,the incidences of preeclampsia,fetal macrosomia and caesarean were higher in group of GDM with hypothyroidism(Ⅱ group) than simple GDM group(Ⅰ group).Conclusion:Risk of hypothyroidism in women with GDM is higher,and GDM women complicated by hypothyroidism will have more severe pregnancy outcomes.