促甲状腺激素、抗甲状腺抗体与妊娠结局。
Thyroid-stimulating hormone, anti-thyroid antibodies, and pregnancy outcomes.
作者信息
Plowden Torie C, Schisterman Enrique F, Sjaarda Lindsey A, Perkins Neil J, Silver Robert, Radin Rose, Kim Keewan, Galai Noya, DeCherney Alan H, Mumford Sunni L
机构信息
Eunice Kennedy Shriver National Institute of Child Health and Human Development, Epidemiology Branch, Division of Intramural Population Health Research, Rockville, MD; Eunice Kennedy Shriver National Institute of Child Health and Human Development, Epidemiology Branch, Program in Reproductive and Adult Endocrinology, Bethesda, MD.
Eunice Kennedy Shriver National Institute of Child Health and Human Development, Epidemiology Branch, Division of Intramural Population Health Research, Rockville, MD.
出版信息
Am J Obstet Gynecol. 2017 Dec;217(6):697.e1-697.e7. doi: 10.1016/j.ajog.2017.09.001. Epub 2017 Sep 14.
BACKGROUND
Overt thyroid dysfunction has been associated with adverse obstetric outcomes. However, less is known regarding subclinical hypothyroidism or thyroid autoimmunity and their relationship to pregnancy complications.
OBJECTIVE
The purpose of this study was to examine the association between prepregnancy anti-thyroid antibodies and subclinical hypothyroidism and preterm delivery, gestational diabetes mellitus, and preeclampsia.
STUDY DESIGN
We conducted a secondary analysis of a prospective cohort of 18- to 40-year-old women with 1-2 previous pregnancy losses (n=1193) who participated in a multicenter randomized, placebo-controlled trial of low-dose aspirin. Prepregnancy levels of thyroid-stimulating hormone, free thyroxine, thyroglobulin antibody, and thyroid peroxidase antibody were measured. Relative risks and 95% confidence intervals were estimated with the use of generalized linear models with adjustment for age and body mass index.
RESULTS
Among women with an ongoing pregnancy of >20 weeks estimated gestational age, there was no association between prepregnancy thyroid-stimulating hormone level (>2.5 vs ≤2.5 mIU/L) and preterm delivery (adjusted relative risk, 0.77; 95% confidence interval, 0.40-1.47), gestational diabetes mellitus (adjusted relative risk, 1.28; 95% confidence interval, 0.54-3.04), or preeclampsia (adjusted relative risk, 1.20; 95% confidence interval, 0.71-2.04). Similarly, among women with thyroid antibodies, there was no increase in the likelihood of preterm delivery (relative risk, 1.26; 95% confidence interval, 0.65-2.45), gestational diabetes mellitus (relative risk, 1.33; 95% confidence interval, 0.51-3.49), or preeclampsia (relative risk, 1.02; 95% confidence interval, 0.54-1.92), compared with women without these antibodies.
CONCLUSION
Among women with 1-2 previous pregnancy losses, subclinical hypothyroidism and thyroid autoimmunity were not associated with an increased risk of preterm delivery, gestational diabetes mellitus, or preeclampsia. These data support current recommendations that low-risk asymptomatic women should not be screened routinely for thyroid dysfunction or autoimmunity.
背景
显性甲状腺功能障碍与不良产科结局相关。然而，关于亚临床甲状腺功能减退或甲状腺自身免疫及其与妊娠并发症的关系，人们了解较少。
目的
本研究的目的是探讨孕前抗甲状腺抗体和亚临床甲状腺功能减退与早产、妊娠期糖尿病和先兆子痫之间的关联。
研究设计
我们对1193名18至40岁、既往有1至2次流产史的女性进行了一项前瞻性队列研究的二次分析，这些女性参与了一项低剂量阿司匹林的多中心随机、安慰剂对照试验。测量了孕前促甲状腺激素、游离甲状腺素、甲状腺球蛋白抗体和甲状腺过氧化物酶抗体水平。使用广义线性模型并对年龄和体重指数进行调整来估计相对风险和95%置信区间。
结果
在估计孕周>20周的持续妊娠女性中，孕前促甲状腺激素水平（>2.5 vs≤2.5 mIU/L）与早产（调整后相对风险，0.77；95%置信区间，0.40 - 1.47）、妊娠期糖尿病（调整后相对风险，1.28；95%置信区间，0.54 - 3.04）或先兆子痫（调整后相对风险，1.20；95%置信区间，0.
Zotero 插件