Department of Endocrinology, Ludwig-Maximilians-University,
Curr Opin Obstet Gynecol. 2009 Dec;21(6):501-7. doi: 10.1097/GCO.0b013e328332a836.
Thyroid disorders are common in pregnancy and affect maternal and fetal outcome.
The reference values for normal thyroid function during first and second trimester had been re-evaluated recently. Hypothyroxinemia affects the neuropsychological development of the child. Maternal thyroid dysfunction or only the presence of thyroid-specific antibodies is associated with increased risk for early abortion, preterm delivery and neonatal morbidity. Pregnant women under levothyroxine treatment are often undertreated or overtreated. Screening for thyroid dysfunction of pregnant women is recommended and cost-effective.
Recently, the recommended dose for iodine intake during pregnancy had been increased from 200 to 250 microg/day, because recent studies revealed that even mild-to-moderate iodine intake might affect the neuropsychological development of the child. About 5-18% of all pregnant women exhibit elevated thyroid-specific antibodies, but only 0.3% develop overt hypothyroidism and 0.1-0.4% overt hyperthyroidism. However, those pregnant women with autoimmune thyroiditis and normal thyroid function may have a restricted thyroid reserve, followed by hypothyroxinemia and/or thyroid-stimulating hormone increase during pregnancy. The incidence of miscarriage, preterm delivery and small for date offspring might be increased and probably a delayed neuropsychological development. Routine thyroid function testing at least as early as possible in all pregnant women is emphasized.
甲状腺疾病在妊娠中很常见，会影响母婴结局。
最近重新评估了正常甲状腺功能在妊娠早、中孕期的参考值。甲状腺素不足会影响儿童的神经心理发育。母体甲状腺功能障碍或仅存在甲状腺特异性抗体与早期流产、早产和新生儿发病率增加有关。接受左甲状腺素治疗的孕妇常存在治疗不足或过度治疗。建议对孕妇进行甲状腺功能筛查，这是具有成本效益的。
最近，推荐的妊娠期间碘摄入量从 200 微克/天增加到 250 微克/天，因为最近的研究表明，即使是轻度到中度的碘摄入也可能影响儿童的神经心理发育。约 5-18%的孕妇会出现升高的甲状腺特异性抗体，但仅有 0.3%会发展为明显的甲状腺功能减退症，0.1-0.4%会发展为明显的甲状腺功能亢进症。然而，那些患有自身免疫性甲状腺炎且甲状腺功能正常的孕妇可能会出现甲状腺储备受限，随后在妊娠期间会出现甲状腺素不足和/或促甲状腺激素增加。流产、早产和小于胎龄儿的发生率可能会增加，且可能存在神经心理发育延迟。强调至少在所有孕妇中尽早进行常规甲状腺功能检查。
