Habimana Laurence, Twite Kabange E, Daumerie Chantal, Wallemacq Pierre, Donnen Philippe, Kalenga Muenze K, Robert Annie
1 Division of Epidemiology and Biostatistics, Institute of Experimental and Clinical Research, Catholic University of Louvain , Brussels, Belgium .
Thyroid. 2014 Mar;24(3):568-75. doi: 10.1089/thy.2013.0261. Epub 2013 Oct 30.
Despite notable progress in the fight against iodine deficiency disorders in the Democratic Republic of Congo, a recent study has shown that pregnant women in Lubumbashi were still iodine deficient. Our objective was to assess thyroid function in this population.
In a cross-sectional study conducted in maternity units from three different socioeconomic areas in Lubumbashi, serum thyrotropin, free thyroxine, thyroglobulin, and thyroperoxidase antibodies were measured in 225 pregnant women attending antenatal visits, in 75 women who recently delivered, and in 75 nonpregnant controls. The outcome was the prevalence of thyroid dysfunction.
Median values in pregnant women, women who recently delivered, and nonpregnant women were 1.80, 2.80, and 1.54 mIU/L for thyrotropin (p<0.001); 0.85, 1.11, and 1.16 ng/dL for free thyroxine (p<0.001); and 13.3, 9.5, and 10.4 ng/mL for thyroglobulin (p=0.01), respectively. The prevalence of thyroid dysfunction in pregnant women, in women who recently delivered, and in nonpregnant women was 31%, 8%, and 20% for isolated hypothyroxinemia (p<0.001); 12%, 24%, and 5% for subclinical hypothyroidism (p=0.002); 8%, 3%, and 3%, for overt hypothyroidism (p=0.09); and 5%, 13%, and 4%, for positive thyroperoxidase antibodies (p=0.03), respectively. In multiple logistic regression, women who were pregnant or who recently delivered, who lived in a poor socioeconomic area, and who had low urinary iodine concentration were more likely to have an increased serum thyrotropin: odds ratio (OR)=3.43 (95% confidence interval [CI] 1.23-9.53) for pregnancy, OR=4.49 [CI 1.66-15.01] for postpartum period, OR=3.68 [CI 1.85-7.35] for semiurban area, and OR=0.44 [CI 0.19-0.96] for urinary iodine concentration ≥ 250 μg/L.
Our results show that there is a high prevalence of thyroid dysfunction in pregnant women of Lubumbashi, and this high prevalence is associated with iodine deficiency. To prevent obstetrical adverse outcomes and neurological damage in children, iodine supplementation is needed before conception or in early pregnancy in Lubumbashi.
尽管刚果民主共和国在防治碘缺乏病方面取得了显著进展，但最近一项研究表明，卢本巴希的孕妇仍存在碘缺乏问题。我们的目的是评估该人群的甲状腺功能。
在卢本巴希三个不同社会经济区域的产科单位进行的一项横断面研究中，对225名参加产前检查的孕妇、75名近期分娩的妇女和75名非孕妇对照者测量了血清促甲状腺激素、游离甲状腺素、甲状腺球蛋白和甲状腺过氧化物酶抗体。结果指标为甲状腺功能障碍的患病率。
孕妇、近期分娩的妇女和非孕妇的促甲状腺激素中位数分别为1.80、2.80和1.54 mIU/L（p<0.001）；游离甲状腺素分别为0.85、1.11和1.16 ng/dL（p<0.001）；甲状腺球蛋白分别为13.3、9.5和10.4 ng/mL（p=0.01）。孕妇、近期分娩的妇女和非孕妇中，单纯低甲状腺素血症的甲状腺功能障碍患病率分别为31%、8%和20%（p<0.001）；亚临床甲状腺功能减退分别为12%、24%和5%（p=0.002）；显性甲状腺功能减退分别为8%、3%和3%（p=0.09）；甲状腺过氧化物酶抗体阳性分别为5%、13%和4%（p=0.03）。在多因素logistic回归分析中，怀孕或近期分娩、生活在社会经济贫困地区且尿碘浓度低的妇女血清促甲状腺激素升高的可能性更大：怀孕的优势比（OR）=3.43（95%置信区间[CI]1.23 - 9.53），产后时期OR=4.49[CI 1.66 - 15.01]，半城市地区OR=3.68[CI 1.85 - 7.35]，尿碘浓度≥250 μg/L时OR=0.44[CI 0.19 - 0.96]。
我们的结果表明，卢本巴希孕妇的甲状腺功能障碍患病率很高，且这种高患病率与碘缺乏有关。为预防产科不良结局和儿童神经损伤，卢本巴希需要在受孕前或孕早期补充碘。
