Harris Birthright Research Centre, King's College Hospital, London, United Kingdom.
Thyroid. 2010 Sep;20(9):989-93. doi: 10.1089/thy.2010.0058.
Studies have shown that overt hypothyroidism is associated with a substantial risk of miscarriage. There is controversy as to whether subclinical hypothyroidism has the same effect and whether such effect is mediated by the presence of antithyroid antibodies. Our hypothesis is that maternal thyroid function in the first trimester is altered in pregnancies ending in miscarriage or fetal death.
Thyroid-stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine, anti-thyroperoxidase antibody, and anti-thyroglobulin antibody at 11-13 weeks of gestation were measured in 202 singleton pregnancies that subsequently resulted in miscarriage or fetal death, and the values were compared with the results of 4318 normal pregnancies.
In the fetal loss group, compared to the unaffected group, there was an increase in median TSH multiple of the normal median (1.133 vs. 1.007 MoM), decrease in median FT4 MoM (0.958 vs. 0.992 MoM), and increase in the incidence of TSH above the 97.5th centile (5.9% vs. 2.5%) and FT4 below the 2.5th centile (5.0% vs. 2.5%). Logistic regression analysis demonstrated that in the prediction of fetal loss there were significant contributions from FT4 MoM, maternal black ethnic origin, history of chronic hypertension, and use of ovulation drugs. The prevalence of antithyroid antibody positivity was not significantly different in the fetal loss group compared to that of normal pregnancies (15.3% vs. 16.8%).
Impaired thyroid function may predispose to miscarriage and fetal death.
研究表明，显性甲状腺功能减退症与流产风险显著增加有关。亚临床甲状腺功能减退症是否具有同样的作用，以及这种作用是否通过抗甲状腺抗体的存在而介导，目前仍存在争议。我们的假设是，在导致流产或胎儿死亡的妊娠中，孕早期的母体甲状腺功能发生改变。
在 202 例随后发生流产或胎儿死亡的单胎妊娠中，测量了妊娠 11-13 周时的促甲状腺激素（TSH）、游离甲状腺素（FT4）、游离三碘甲状腺原氨酸、抗甲状腺过氧化物酶抗体和抗甲状腺球蛋白抗体，并与 4318 例正常妊娠的结果进行了比较。
在胎儿丢失组中，与未受影响组相比，中位数 TSH 倍数（1.133 比 1.007 MoM）增加，中位数 FT4 MoM（0.958 比 0.992 MoM）降低，TSH 超过第 97.5 百分位数（5.9%比 2.5%）和 FT4 低于第 2.5 百分位数（5.0%比 2.5%）的发生率增加。逻辑回归分析表明，在预测胎儿丢失方面，FT4 MoM、母亲黑人种族、慢性高血压病史和使用促排卵药物有显著贡献。与正常妊娠相比，胎儿丢失组抗甲状腺抗体阳性的患病率无显著差异（15.3%比 16.8%）。
甲状腺功能障碍可能导致流产和胎儿死亡。
