Mitsuda N, Tamaki H, Amino N, Hosono T, Miyai K, Tanizawa O
Department of Obstetrics and Gynecology, Osaka University Medical School, Japan.
Obstet Gynecol. 1992 Sep;80(3 Pt 1):359-64.
To identify risk factors for disorders of fetal growth and thyroid function in the presence of maternal Graves disease.
Two hundred thirty pregnancies in gravidas with Graves disease were analyzed. Maternal thyroid status was evaluated by serum free thyroxine (T4) or free T4 index, TSH, and TSH-receptor antibody; personal history of thyrotoxicosis and total dose of antithyroid drugs during pregnancy were also noted. Neonatal thyroid function was assessed at birth and on the fifth day after birth.
Fifteen neonates (6.5%) were small for gestational age (SGA), and this occurrence was significantly associated with thyrotoxicosis lasting for 30 weeks or more of pregnancy, TSH-receptor antibody level of 30% or more at delivery, history of Graves disease of 10 years or longer, and onset of Graves disease before 20 years of age. However, no significant correlation was found between maternal thyroid hormone level and SGA neonates. Thyroid dysfunction developed in 38 infants (16.5%), of whom only four were SGA; development of this dysfunction was significantly related to the mother's total dose of antithyroid drugs, duration of thyrotoxicosis in pregnancy, and/or TSH-receptor antibody level at delivery.
Duration of maternal Graves disease or thyrotoxicosis, either mild chemical or overt, in pregnancy is significantly associated with SGA neonates. Neonatal thyroid dysfunction is associated with the maternal thyroid condition, especially the serum TSH-receptor antibody level.
确定患有Graves病的孕妇发生胎儿生长障碍和甲状腺功能紊乱的风险因素。
对230例患有Graves病的孕妇的妊娠情况进行分析。通过血清游离甲状腺素（T4）或游离T4指数、促甲状腺激素（TSH）以及TSH受体抗体评估孕妇的甲状腺状态；还记录了甲状腺毒症个人史以及孕期抗甲状腺药物的总剂量。在出生时及出生后第5天评估新生儿的甲状腺功能。
15例新生儿（6.5%）为小于胎龄儿（SGA），这种情况与孕期持续30周或更长时间的甲状腺毒症、分娩时TSH受体抗体水平达30%或更高、Graves病病史10年或更长以及20岁之前发生Graves病显著相关。然而，未发现孕妇甲状腺激素水平与SGA新生儿之间存在显著相关性。38例婴儿（16.5%）出现甲状腺功能障碍，其中只有4例为SGA；这种功能障碍的发生与母亲抗甲状腺药物的总剂量、孕期甲状腺毒症持续时间和/或分娩时TSH受体抗体水平显著相关。
孕期患有Graves病或甲状腺毒症的持续时间，无论是轻度化学性还是显性的，均与SGA新生儿显著相关。新生儿甲状腺功能障碍与母亲的甲状腺状况有关，尤其是血清TSH受体抗体水平。
