孕期女性甲状腺疾病筛查中的临床争议。

Clinical controversies in screening women for thyroid disorders during pregnancy.

作者信息

Wier Frances A, Farley Cindy L

机构信息

Mercy Medical Center, Baltimore, Maryland, USA.

出版信息

J Midwifery Womens Health. 2006 May-Jun;51(3):152-8. doi: 10.1016/j.jmwh.2005.11.007.

DOI:10.1016/j.jmwh.2005.11.007

PMID:16647667

Abstract

Subclinical hypothyroidism and/or the presence of thyroid peroxidase antibodies (TPOAb) may be associated with subfertility, infertility, spontaneous abortion, placental abruption, preterm delivery, gestational hypertension, preeclampsia, postpartum thyroid dysfunction, depression (including postpartum depression), and impaired cognitive and psychomotor child development. In November 2002, the American Association of Clinical Endocrinologists (AACE) released new guidelines for clinical practice for the diagnosis and treatment of hyperthyroidism and hypothyroidism, which includes a new thyroid-stimulating hormone (TSH) reference range of 0.3 to 3.0 mIU/L. Recently, the AACE recommended screening all women considering conception and/or all gravid women in the first trimester for thyroid dysfunction. However, the American College of Obstetricians and Gynecologists (ACOG) and the United States Preventive Services Task Force (USPSTF) have not endorsed these recommendations. This article reviews the evidence regarding screening women during pregnancy for subclinical hypothyroidism and/or the presence of thyroid peroxidase antibodies.

摘要

亚临床甲状腺功能减退和/或甲状腺过氧化物酶抗体（TPOAb）的存在可能与生育力低下、不孕、自然流产、胎盘早剥、早产、妊娠期高血压、先兆子痫、产后甲状腺功能障碍、抑郁症（包括产后抑郁症）以及儿童认知和精神运动发育受损有关。2002年11月，美国临床内分泌医师协会（AACE）发布了甲状腺功能亢进和减退诊断与治疗的临床实践新指南，其中包括新的促甲状腺激素（TSH）参考范围为0.3至3.0 mIU/L。最近，AACE建议对所有考虑怀孕的女性和/或所有孕早期孕妇进行甲状腺功能障碍筛查。然而，美国妇产科医师学会（ACOG）和美国预防服务工作组（USPSTF）尚未认可这些建议。本文综述了关于孕期筛查女性亚临床甲状腺功能减退和/或甲状腺过氧化物酶抗体存在情况的证据。