Li Jia, Shen Jie, Qin Lan
Altern Ther Health Med. 2017 Mar;23(2):49-58.
Context • Subclinical hypothyroidism (SCH) in pregnancy can be associated with increased complications in pregnant women and neurocognitive deficits in fetuses. Two recently published meta-analyses investigated the effects of levothyroxine (LT4) supplementation on pregnancy outcomes but did not report adverse complications and neonatal outcomes. Objectives • The study intended to assess the effects of LT4 supplementation in the treatment of pregnant women with thyroid dysfunction. Design • The research team performed a meta-analysis of randomized controlled trials (RCTs) published in PubMed, Embase, Web of Science, Chinese BioMedical Literature Service System, and China National Knowledge Infrastructure databases. Participants • Participants were infertile women who had SCH or were TPO antibody positive and who participated in the RCTs examined in the study. Intervention • The participants in the RCTs in the intervention groups received LT4 supplementation and the control groups received a placebo or no treatment. Outcome Measures • The main outcome measures included maternal outcomes-delivery rate, miscarriage rate, fertilization rate, clinical pregnancy rate, preeclampsia, gestational diabetes, and gestational hypertension-and neonatal outcomes-preterm delivery, lower birth weight, intrauterine growth restriction, neonatal death, and congenital malformations. Results were expressed as risk ratios with 95% confidence intervals. Results • A total of 14 RCTs involving 1918 patients were included in the meta-analysis. Compared with control treatments, LT4 supplementation significantly increased the delivery, clinical pregnancy, and fertilization rates. Moreover, LT4 significantly reduced the miscarriage rate, gestational diabetes, and gestational hypertension, but not preeclampsia. For the neonatal outcomes, the study found that the LT4 group had fewer preterm deliveries, birth weights <2500 g, deaths, and congenital malformations.
LT4 supplementation showed beneficial effects in pregnancy outcomes among patients with thyroid dysfunction. Thus, LT4 should be recommended to improve clinical pregnancy outcomes in women with thyroid dysfunction.
背景 • 孕期亚临床甲状腺功能减退（SCH）可能与孕妇并发症增加及胎儿神经认知缺陷有关。最近发表的两项荟萃分析研究了左甲状腺素（LT4）补充剂对妊娠结局的影响，但未报告不良并发症和新生儿结局。目的 • 本研究旨在评估补充LT4治疗甲状腺功能障碍孕妇的效果。设计 • 研究团队对发表于PubMed、Embase、科学网、中国生物医学文献服务系统和中国知网数据库的随机对照试验（RCT）进行了荟萃分析。参与者 • 参与者为患有SCH或TPO抗体阳性的不孕女性，她们参与了本研究中所审查的RCT。干预 • 干预组RCT的参与者接受LT4补充剂，对照组接受安慰剂或不接受治疗。结局指标 • 主要结局指标包括母体结局——分娩率、流产率、受精率、临床妊娠率、先兆子痫、妊娠期糖尿病和妊娠期高血压——以及新生儿结局——早产、低出生体重、宫内生长受限、新生儿死亡和先天性畸形。结果以风险比及95%置信区间表示。结果 • 荟萃分析共纳入14项涉及1918例患者的RCT。与对照治疗相比，补充LT4显著提高了分娩率、临床妊娠率和受精率。此外，LT4显著降低了流产率、妊娠期糖尿病和妊娠期高血压，但未降低先兆子痫。对于新生儿结局，研究发现LT4组的早产、出生体重<2500 g、死亡和先天性畸形较少。
补充LT4对甲状腺功能障碍患者的妊娠结局显示出有益效果。因此，建议使用LT4来改善甲状腺功能障碍女性的临床妊娠结局。
