Khoury M J, Becerra J E, d'Almada P J
Division of Birth Defects and Developmental Disabilities, Centers for Disease Control, Atlanta, Georgia.
Paediatr Perinat Epidemiol. 1989 Oct;3(4):402-20. doi: 10.1111/j.1365-3016.1989.tb00528.x.
We investigated the relationship between maternal thyroid disease and the risk of birth defects in offspring using data from a large population-based, case-control study. Cases included 4904 stillborn and liveborn infants with major anomalies diagnosed in the first year of life and born to residents of metropolitan Atlanta between 1968 and 1980. Controls included 3027 normal babies, frequency-matched to cases by race, hospital of birth and quarter of birth. We compared mothers of cases and controls regarding history of physician-diagnosed hypothyroidism and hyperthyroidism before the infant's birth, age at diagnosis of thyroid condition, duration of illness, and intake of thyroid medications before and during pregnancy. Information obtained from maternal interviews was evaluated for concordance with hospital records. We adjusted for potentially confounding factors using conditional logistic regression analysis. Overall, there was no relationship between the risk of total birth defects and history of maternal hypothyroidism (odds ratio (OR) = 1.05, 95% C.I. 0.84-1.31), maternal hyperthyroidism (OR = 1.00, 95% C.I. 0.66-1.53), and intake of thyroid hormone and antithyroid drugs before and during pregnancy. In an analysis of 66 specific birth defects and defect groups, we found two statistically significant associations with hypothyroidism and three with hyperthyroidism which may reflect chance findings. In an evaluation of babies with multiple anomalies, we observed a two-fold increased risk with hypothyroidism but no discernible pattern of defects. The absolute risk of major birth defects in offspring of women with history of hypothyroidism can be estimated as 2.1%, a finding at odds with the 10-20% risk cited in the literature.
我们利用一项基于人群的大型病例对照研究数据，调查了母亲甲状腺疾病与后代出生缺陷风险之间的关系。病例包括1968年至1980年间在大都市亚特兰大出生、出生后第一年被诊断出患有重大异常的4904名死产和活产婴儿。对照包括3027名正常婴儿，按种族、出生医院和出生季度与病例进行频率匹配。我们比较了病例组和对照组母亲在婴儿出生前医生诊断的甲状腺功能减退和甲状腺功能亢进病史、甲状腺疾病诊断年龄、病程以及孕期前后甲状腺药物的摄入量。对从母亲访谈中获得的信息与医院记录进行了一致性评估。我们使用条件逻辑回归分析对潜在的混杂因素进行了调整。总体而言，总出生缺陷风险与母亲甲状腺功能减退病史（优势比（OR）=1.05，95%置信区间0.84-1.31）、母亲甲状腺功能亢进病史（OR = 1.00，95%置信区间0.66-1.53）以及孕期前后甲状腺激素和抗甲状腺药物的摄入量之间没有关系。在对66种特定出生缺陷和缺陷组的分析中，我们发现甲状腺功能减退有两个具有统计学意义的关联，甲状腺功能亢进有三个，这可能反映了偶然发现。在对患有多种异常的婴儿的评估中，我们观察到甲状腺功能减退的风险增加了两倍，但没有明显的缺陷模式。有甲状腺功能减退病史的女性后代发生重大出生缺陷的绝对风险估计为2.1%，这一发现与文献中引用的10-20%的风险不一致。
