孕早期孕妇游离甲状腺素浓度低与婴儿期精神运动发育受损有关。
Low maternal free thyroxine concentrations during early pregnancy are associated with impaired psychomotor development in infancy.
作者信息
Pop V J, Kuijpens J L, van Baar A L, Verkerk G, van Son M M, de Vijlder J J, Vulsma T, Wiersinga W M, Drexhage H A, Vader H L
机构信息
Department of Social and Behavioural Sciences, University of Tilburg, The Netherlands.
出版信息
Clin Endocrinol (Oxf). 1999 Feb;50(2):149-55. doi: 10.1046/j.1365-2265.1999.00639.x.
BACKGROUND
Maternal thyroid function during early pregnancy is an important determinant of early fetal brain development because the fetal thyroid is unable to produce any T4 before 12-14 weeks' gestation. Overt maternal hypothyroidism as seen in severe iodine-deficient areas is associated with severely impaired neurological development of the offspring. At present, it is not known whether low free T4 (fT4) levels during pregnancy in healthy women from iodine sufficient areas may affect fetal neurodevelopment.
METHODS
Neurodevelopment was assessed at 10 months of age in a cohort of 220 healthy children, born after uncomplicated pregnancies and deliveries, using the Bayley Scales of Infant Development. Maternal TSH, fT4 and TPO antibody status were assessed at 12 and 32 weeks' gestation. Maternal gestational fT4 concentration was defined as an independent parameter for child development.
RESULTS
Children of women with fT4 levels below the 5th (< 9.8 pmol/l, n = 11) and 10th (< 10.4 pmol/l, n = 22) percentiles at 12 weeks' gestation had significantly lower scores on the Bayley Psychomotor Developmental Index (PDI) scale at 10 months of age, compared to children of mothers with higher fT4 values (t test, mean difference: 14.1, 95% confidence interval (CI): 5.9-22 and 7.4, 95% CI: 1.1-13.9, respectively). At 32 weeks' gestation, no significant differences were found. In the group of women with the lowest 10th percentile fT4 concentrations at 12 weeks' gestation, a positive correlation was found between the mothers' fT4 concentration and children's PDI scores (linear regression, R: 0.46, P = 0.03). After correction for confounding variables, a fT4 concentration below the 10th percentile at 12 weeks' gestation was a significant risk factor for impaired psychomotor development (RR): 5.8, 95% CI: 1.3-12.6).
CONCLUSIONS
Low maternal plasma fT4 concentrations during early pregnancy may be an important risk factor for impaired infant development.
背景
孕早期母体甲状腺功能是胎儿早期脑发育的重要决定因素，因为胎儿甲状腺在妊娠12 - 14周之前无法产生任何甲状腺素（T4）。在严重缺碘地区所见的明显母体甲状腺功能减退与后代神经发育严重受损有关。目前，尚不清楚碘充足地区健康女性孕期游离甲状腺素（fT4）水平低是否会影响胎儿神经发育。
方法
使用贝利婴儿发育量表对220名健康儿童进行评估，这些儿童均为孕期和分娩过程无并发症的单胎妊娠，在其10个月大时评估神经发育情况。在妊娠12周和32周时评估母体促甲状腺激素（TSH）、fT4和甲状腺过氧化物酶抗体状态。将母体妊娠fT4浓度定义为儿童发育的独立参数。
结果
妊娠12周时fT4水平低于第5百分位数（< 9.8 pmol/l，n = 11）和第10百分位数（< 10.4 pmol/l，n = 22）的女性所生儿童，在10个月大时的贝利心理运动发育指数（PDI）量表得分显著低于fT4值较高母亲所生儿童（t检验，平均差异分别为：14.1，95%置信区间（CI）：5.9 - 22；7.4，95% CI：1.1 - 13.9）。在妊娠32周时，未发现显著差异。在妊娠12周时fT4浓度处于最低第10百分位数的女性组中，母亲的fT4浓度与儿童的PDI得分之间存在正相关（线性回归，R：0.46，P = 0.03）。在校正混杂变量后，妊娠12周时fT4浓度低于第10百分位数是心理运动发育受损的显著危险因素（相对危险度：5.8，95% CI：1.3 - 12.6）。
结论
孕早期母体血浆fT4浓度低可能是婴儿发育受损的重要危险因素。
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