Bryant Stefanie N, Nelson David B, McIntire Donald D, Casey Brian M, Cunningham F Gary
Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX.
Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX.
Am J Obstet Gynecol. 2015 Oct;213(4):565.e1-6. doi: 10.1016/j.ajog.2015.06.061. Epub 2015 Jul 8.
The purpose of the study was to evaluate pregnancy outcomes of hypothyroidism that were identified in a population-based prenatal screening program.
This is a secondary analysis of a prospective prenatal population-based study in which serum thyroid analytes were obtained from November 2000 to April 2003. Initial screening thresholds were intentionally inclusive (thyroid-stimulating hormone [TSH], >3.0 mU/L; free thyroxine, <0.9 ng/dL); those who screened positive were referred for confirmatory testing in a hospital-based laboratory. Hypothyroidism was identified and treated if TSH level was >4.5 mU/L and if fT4 level was <0.76 ng/dL. Perinatal outcomes in these women and those who screened positive but unconfirmed to have hypothyroidism were compared with women with euthyroidism. Outcomes were then analyzed according to initial TSH levels.
A total of 26,518 women completed initial screening: 24,584 women (93%) were euthyroid, and 284 women (1%) had abnormal initial values that suggested hypothyroidism. Of those referred, 232 women (82%) underwent repeat testing, and 47 women (0.2% initially screened) were confirmed to have hypothyroidism. Perinatal outcomes of women with treated overt hypothyroidism were similar to women with euthyroidism. Higher rates of pregnancy-related hypertension were identified in the 182 women with unconfirmed hypothyroidism when compared with women with euthyroidism (P < .001); however, this association was seen only in women with initial TSH >4.5 mU/L (adjusted odds ratio, 2.53; 95% confidence interval, 1.4-4.5).
The identification and treatment of overt hypothyroidism results in pregnancy outcomes similar to women with euthyroidism. Unconfirmed screening results suggestive of hypothyroidism portend pregnancy risks similar to women with subclinical hypothyroidism, specifically preeclampsia; however, this increased risk was seen only in women with initial TSH levels of >4.5 mU/L and suggests that this is a more clinically relevant threshold than 3.0 mU/L.
本研究旨在评估在一项基于人群的产前筛查项目中所识别出的甲状腺功能减退症患者的妊娠结局。
这是一项对前瞻性基于人群的产前研究的二次分析，该研究于2000年11月至2003年4月期间获取血清甲状腺分析物。初始筛查阈值设定得较为宽松（促甲状腺激素[TSH]，>3.0 mU/L；游离甲状腺素，<0.9 ng/dL）；筛查呈阳性者被转至医院实验室进行确诊检测。若TSH水平>4.5 mU/L且游离甲状腺素水平<0.76 ng/dL，则诊断为甲状腺功能减退症并进行治疗。将这些女性以及筛查呈阳性但未确诊为甲状腺功能减退症的女性的围产期结局与甲状腺功能正常的女性进行比较。然后根据初始TSH水平对结局进行分析。
共有26,518名女性完成了初始筛查：24,584名女性（93%）甲状腺功能正常，284名女性（1%）初始值异常提示甲状腺功能减退症。在被转诊的患者中，232名女性（82%）接受了重复检测，47名女性（最初筛查的0.2%）被确诊为甲状腺功能减退症。接受治疗的显性甲状腺功能减退症女性的围产期结局与甲状腺功能正常的女性相似。与甲状腺功能正常的女性相比，182名未确诊甲状腺功能减退症的女性中妊娠相关高血压的发生率更高（P <.001）；然而，这种关联仅在初始TSH>4.5 mU/L的女性中可见（校正比值比，2.53；95%置信区间，1.4 - 4.5）。
显性甲状腺功能减退症的识别与治疗所产生的妊娠结局与甲状腺功能正常的女性相似。未确诊的提示甲状腺功能减退症的筛查结果预示着与亚临床甲状腺功能减退症女性相似的妊娠风险，尤其是先兆子痫；然而，这种风险增加仅在初始TSH水平>4.5 mU/L的女性中可见，这表明该阈值比3.0 mU/L在临床上更具相关性。
