Wang Shaowei, Li Min, Chu Defa, Liang Lin, Zhao Xiaodong, Zhang Junrong
Department of Obstetrics and Gynecology,Beijing Hospital, Beijing 100730, China. Email:
Department of Obstetrics and Gynecology,Beijing Hospital, Beijing 100730, China.
Zhonghua Fu Chan Ke Za Zhi. 2014 Nov;49(11):816-22.
To evaluate the relationship between clinical or subclinical hypothyroidism and positive thyroid autoantibody before 20 weeks pregnancy and risk of preterm birth.
Literature search was done in PubMed, EMBASE, Wanfang Medical Database, China Academic Journal Network Publishing Database and China Biology Medicine disc databases from January 1st, 1980 to December 31th, 2013. The following search terms were used:hypothyroidism, subclinical hypothyroidism, hypothyroxinnism, thyroid antibody, preterm labor, preterm birth, etc. (1) Criteria for inclusion:cohort studies and clinical studies were included; only articles that described at least 10 patients were eligible;the exposure was clinical or subclinical hypothyroidism and positive thyroid autoantihody, and outcome was preterm birth. (2) The excluded subjects were articles that described less than 10 patients; controls were pregnant women without eurothyrodisim. Meta-analysis was performed by RevMan 5. The relationship between clinical or subclinical hypothyroidism and positive thyroid autoantibody and risk of preterm birth was evaluated by OR or RR.
(1) Twenty cohort studies were enrolled. A total of 39 596 cases of preterm birth occurred among 498 418 pregnant women. The controls in these studies were pregnant women with eurothyrodisim. (2) Clinical hypothyroidism in pregnancy: eight studies were included, reported data on 478 418 pregnant women (5 473 women with clinical hypothyroidism and 472 945 euthyroid pregnant women). The risk of preterm birth in pregnant women with clinical hypothyroidism was higher than those eurothyroid pregnant women in control group (OR = 1.25, 95% CI:1.15-1.36, P < 0.01). (3) Subclinical hypothyroidism in pregnancy: ten studies were included, reported data on 277 531 pregnant women (5 257 women with subclinical hypothyroidism and 272 274 euthyroid pregnant women). The risk of preterm birth in pregnant women with subclinical hypothyroidism was higher than those in control group by random effects analysis (OR = 1.25, 95% CI:1.14-1.36, P < 0.01). (4) Thyroid autoantibodys positive in pregnancy:eleven studies were included, reported data on 28 781 pregnant women (3 036 women with thyroid autoanti body positive and 25 745 euthyroid pregnant women). The risk of preterm birth in pregnant women with positive thyroid autoantibody was higher than those negative thyroid autoantibody in control group (OR = 1.47, 95% CI: 1.27- 1.70, P < 0.01). The funnel plots presented symmetrical graphics, indicating that there was no publication bias.
Clinical or subclinical hypothyroidism and positive thyroid autoantibody in pregnant women is risk factors of preterm birth.
评估妊娠20周前临床或亚临床甲状腺功能减退及甲状腺自身抗体阳性与早产风险之间的关系。
于1980年1月1日至2013年12月31日在PubMed、EMBASE、万方医学数据库、中国学术期刊网络出版总库和中国生物医学文献数据库中进行文献检索。使用了以下检索词：甲状腺功能减退、亚临床甲状腺功能减退、甲状腺素缺乏、甲状腺抗体、早产、早产分娩等。（1）纳入标准：纳入队列研究和临床研究；仅纳入描述至少10例患者的文章；暴露因素为临床或亚临床甲状腺功能减退及甲状腺自身抗体阳性，结局为早产。（2）排除标准：描述患者少于10例的文章；对照组为无甲状腺功能正常的孕妇。采用RevMan 5进行荟萃分析。通过OR或RR评估临床或亚临床甲状腺功能减退及甲状腺自身抗体阳性与早产风险之间的关系。
（1）纳入20项队列研究。498418例孕妇中共有39596例发生早产。这些研究中的对照组为甲状腺功能正常的孕妇。（2）妊娠临床甲状腺功能减退：纳入8项研究，报告了478418例孕妇的数据（5473例临床甲状腺功能减退妇女和472945例甲状腺功能正常的孕妇）。临床甲状腺功能减退孕妇的早产风险高于对照组甲状腺功能正常的孕妇（OR = 1.25，95%CI：1.15 - 1.36，P < ）。（3）妊娠亚临床甲状腺功能减退：纳入10项研究，报告了277531例孕妇的数据（5257例亚临床甲状腺功能减退妇女和272274例甲状腺功能正常的孕妇）。通过随机效应分析，亚临床甲状腺功能减退孕妇的早产风险高于对照组（OR = 1.25，95%CI：1.14 - 1.36，P < ）。（4）妊娠甲状腺自身抗体阳性：纳入11项研究，报告了28781例孕妇的数据（3036例甲状腺自身抗体阳性妇女和25745例甲状腺功能正常的孕妇）。甲状腺自身抗体阳性孕妇的早产风险高于对照组甲状腺自身抗体阴性的孕妇（OR = 1.47，95%CI：1.27 - 1.70，P < ）。漏斗图呈现对称图形，表明不存在发表偏倚。
孕妇临床或亚临床甲状腺功能减退及甲状腺自身抗体阳性是早产的危险因素。
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