Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX 75390-9032, USA.
Obstet Gynecol. 2012 May;119(5):983-8. doi: 10.1097/AOG.0b013e318250aeeb.
To estimate if there is a relationship between subclinical thyroid disease and gestational diabetes.
Between November 2000 and April 2003, serum thyrotropin screening was performed on all women who presented for prenatal care. Women identified with abnormal thyrotropin had a serum free thyroxine reflexively determined. Those women with abnormal serum free thyroxine values were referred for further evaluation and excluded from further analysis. For this analysis, normal thyrotropin values were those between the 2.5th and 97.5th percentiles (0.03-4.13 milliunits/L) not corrected for gestational age and serum free thyroxine were considered normal if they ranged from 0.9 to 2.0 mg/dL. Women with an elevated serum thyrotropin but a normal serum free thyroxine were designated to have subclinical hypothyroidism and those with a low thyrotropin and a normal serum free thyroxine level were designated to have subclinical hyperthyroidism. Euthyroid women had both normal thyrotropin and normal serum free thyroxine values. The incidence of gestational diabetes was compared among these three groups.
Of the 24,883 women included in the study, 23,771 (95.5%) were euthyroid, 584 (2.3%) had subclinical hyperthyroidism, and 528 (2%) had subclinical hypothyroidism. The likelihood of gestational diabetes increased with thyrotropin level (P=.002). For example, when a pregnant Hispanic woman of average age and weight was used, the predicted percent of gestational diabetes increased from 1.9% to 4.9% as thyrotropin increased from 0.001 to 10 milliunits/L (P=.001).
The risk of developing gestational diabetes increases with thyrotropin level. This supports a relationship between subclinical hypothyroidism and diabetes diagnosed during pregnancy.
III.
评估亚临床甲状腺疾病与妊娠糖尿病之间是否存在关系。
在 2000 年 11 月至 2003 年 4 月期间，对所有进行产前保健的女性进行血清促甲状腺激素筛查。发现促甲状腺激素异常的女性会反射性地检测血清游离甲状腺素。那些血清游离甲状腺素值异常的女性会被转介进行进一步评估，并排除在进一步分析之外。在这项分析中，正常的促甲状腺激素值为 2.5 至 97.5 百分位（0.03-4.13 毫单位/升），未按妊娠年龄校正，血清游离甲状腺素值如果在 0.9 至 2.0 毫克/分升之间，则被认为是正常的。促甲状腺激素升高但血清游离甲状腺素正常的女性被指定为亚临床甲状腺功能减退症，促甲状腺激素低而血清游离甲状腺素水平正常的女性被指定为亚临床甲状腺功能亢进症。甲状腺功能正常的女性促甲状腺激素和血清游离甲状腺素值均正常。比较了这三组人群的妊娠糖尿病发生率。
在研究的 24883 名女性中，23771 名（95.5%）为甲状腺功能正常，584 名（2.3%）为亚临床甲状腺功能亢进症，528 名（2%）为亚临床甲状腺功能减退症。妊娠糖尿病的发生几率随着促甲状腺激素水平的升高而增加（P=.002）。例如，当使用年龄和体重平均的妊娠西班牙裔女性时，促甲状腺激素从 0.001 增加到 10 毫单位/升，妊娠糖尿病的预测百分比从 1.9%增加到 4.9%（P=.001）。
发展妊娠糖尿病的风险随着促甲状腺激素水平的升高而增加。这支持了亚临床甲状腺功能减退症与妊娠期间诊断出的糖尿病之间的关系。
III。
