妊娠早期母体甲状腺素血症与 5 岁子女的学校表现
Maternal hypothyroxinaemia in early pregnancy and school performance in 5-year-old offspring.
机构信息
Department of PediatricsVU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The NetherlandsDepartment of EpidemiologyDocumentation and Health Promotion, Public Health Service Amsterdam, Amsterdam, The NetherlandsDepartment of Developmental PsychologyTilburg University, Tilburg, The NetherlandsDepartment of Public HealthAcademic Medical Center, University of Amsterdam, Amsterdam, The NetherlandsDepartment of Epidemiology and BiostatisticsVU University Medical Center, Amsterdam, The NetherlandsDepartment of Pediatric EndocrinologyAcademic Medical Center, Emma Children's Hospital, University of Amsterdam, Amsterdam, The NetherlandsDepartment of Health SciencesVU University, Amsterdam, The Netherlands.
Department of PediatricsVU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The NetherlandsDepartment of EpidemiologyDocumentation and Health Promotion, Public Health Service Amsterdam, Amsterdam, The NetherlandsDepartment of Developmental PsychologyTilburg University, Tilburg, The NetherlandsDepartment of Public HealthAcademic Medical Center, University of Amsterdam, Amsterdam, The NetherlandsDepartment of Epidemiology and BiostatisticsVU University Medical Center, Amsterdam, The NetherlandsDepartment of Pediatric EndocrinologyAcademic Medical Center, Emma Children's Hospital, University of Amsterdam, Amsterdam, The NetherlandsDepartment of Health SciencesVU University, Amsterdam, The Netherlands Department of PediatricsVU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The NetherlandsDepartment of EpidemiologyDocumentation and Health Promotion, Public Health Service Amsterdam, Amsterdam, The NetherlandsDepartment of Developmental PsychologyTilburg University, Tilburg, The NetherlandsDepartment of Public HealthAcademic Medical Center, University of Amsterdam, Amsterdam, The NetherlandsDepartment of Epidemiology and BiostatisticsVU University Medical Center, Amsterdam, The NetherlandsDepartment of Pediatric EndocrinologyAcademic Medical Center, Emma Children's Hospital, University of Amsterdam, Amsterdam, The NetherlandsDepartment of Health SciencesVU University, Amsterdam, The Netherlands.
出版信息
Eur J Endocrinol. 2015 Nov;173(5):563-71. doi: 10.1530/EJE-15-0397. Epub 2015 Aug 25.
OBJECTIVE
Overt hypothyroidism in pregnant women is associated with a lower intelligence quotient in their children. More recently, subtle decreases in maternal thyroid function have also been associated with neurodevelopmental impairment in offspring. We tested the effect of hypothyroxinaemia during early pregnancy on school performance.
DESIGN
This was a longitudinal study that included the data of 1196 mother-child pairs from the Amsterdam Born Children and Their Development study.
METHODS
Maternal serum free thyroxine (T4) and TSH were obtained at a median gestational age of 12.9 (interquartile range: 11.9-14.3) weeks. School performance was assessed at age 5 years and based on scores obtained in arithmetic and language tests from the national monitoring and evaluation system. Poor school performance was defined as a test result <25th percentile and subnormal school performance as a result <50th percentile of the norm population. To estimate the impact of possible non-response bias, we conducted inverse-probability weighted analyses.
RESULTS
Maternal hypothyroxinaemia (i.e., a maternal free T4 in the lowest 10% of distribution) was associated with a 1.61 (95% CI: 1.05-2.47) -fold increased odds of subnormal arithmetic performance after adjustment for confounders (P=0.03). However, the odds ratio dropped to 1.48 (95% CI: 0.94-2.32) after inverse-probability weighting (P=0.09). No such relations were found with TSH.
CONCLUSIONS
Maternal hypothyroxinaemia at the end of the first trimester was associated with reduced performance in an arithmetic test, but not in a language test, in 5-year-old offspring. However, our results should be interpreted carefully because of possible non-response bias.
目的
孕妇显性甲状腺功能减退与子女智商降低有关。最近，母体甲状腺功能的细微下降也与后代神经发育障碍有关。我们检测了妊娠早期甲状腺功能减退对学校表现的影响。
设计
这是一项纵向研究，纳入了来自阿姆斯特丹出生儿童及其发育研究的 1196 对母婴对的数据。
方法
在中位数妊娠 12.9 周（四分位距：11.9-14.3 周）时获得母亲血清游离甲状腺素（T4）和 TSH。在 5 岁时评估学校表现，根据国家监测和评估系统的算术和语言测试得分。较差的学校表现定义为测试结果<第 25 百分位数，而低于正常值的学校表现定义为测试结果<第 50 百分位数。为了估计可能的无应答偏差的影响，我们进行了逆概率加权分析。
结果
母体甲状腺功能减退（即，母体游离 T4 在分布的最低 10%）与调整混杂因素后，算术表现低于正常值的可能性增加 1.61 倍（95%CI：1.05-2.47）（P=0.03）。然而，在进行逆概率加权后，比值比降至 1.48（95%CI：0.94-2.32）（P=0.09）。与 TSH 无此关系。
结论
妊娠早期末母体甲状腺功能减退与 5 岁儿童的算术测试成绩下降有关，但与语言测试成绩无关。然而，由于可能存在无应答偏差，我们的结果应谨慎解释。
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