Leiva Paz, Schwarze Juan Enrique, Vasquez Pamela, Ortega Carolina, Villa Sonia, Crosby Javier, Balmaceda José, Pommer Ricardo
Obstetrics and Gynecology Department at Universidad de Santiago, Chile.
Reproductive Medicine Unit at Clinica Monteblanco.
JBRA Assist Reprod. 2017 Dec 1;21(4):361-365. doi: 10.5935/1518-0557.20170057.
Women submitted to ART treatments represent a select subgroup of individuals. Several studies have described the relationship between TAI and pregnancy outcomes as a result of ART, with contradictory results. The purpose of this systematic review was to determine the association between TAI and the risk of miscarriage in pregnancies resulting from ART. MEDLINE via PubMed, LILACS and Embase were searched for studies published in peer-reviewed journals from 1999 to 2017. The studies were summarized using the fixed effects model and the Peto's method to calculate RR in order to flesh out the association between TAI and spontaneous abortion. Only four papers were included in this systematic review and meta-analysis. Thirty-one miscarriages were observed in 210 clinical pregnancies of women with antithyroid antibodies; and 158 miscarriages were seen in 1,371 pregnancies without antithyroid antibodies. The meta-analysis failed to find an association between TAI and higher risk of reproductive loss, RR=0.94 95% confidence interval: 0.71-1.24; p=0.879. In conclusion, the presence of antithyroid antibodies was not associated with increased reproductive loss in patients submitted to ART treatments. It is our opinion that the presence of antithyroid antibodies should be considered as a secondary biomarker of autoimmune disease, rather than an actual cause of miscarriage in patients undergoing ART. Due to the small amount of evidence on the matter, the determination of TAI before the initiation of ART should be limited to research contexts.
接受抗逆转录病毒治疗(ART)的女性是一个特定的亚组人群。多项研究描述了甲状腺自身免疫(TAI)与ART所致妊娠结局之间的关系,但结果相互矛盾。本系统评价的目的是确定TAI与ART所致妊娠流产风险之间的关联。通过PubMed、LILACS和Embase检索MEDLINE,查找1999年至2017年发表在同行评审期刊上的研究。采用固定效应模型和Peto法对研究进行总结以计算相对危险度(RR),从而明确TAI与自然流产之间的关联。本系统评价和荟萃分析仅纳入了4篇论文。在210例有抗甲状腺抗体的女性临床妊娠中观察到31例流产;在1371例无抗甲状腺抗体的妊娠中观察到158例流产。荟萃分析未发现TAI与更高的生殖损失风险之间存在关联,RR = 0.94,95%置信区间:0.71 - 1.24;p = 0.879。总之,抗甲状腺抗体的存在与接受ART治疗的患者生殖损失增加无关。我们认为,抗甲状腺抗体的存在应被视为自身免疫性疾病的次要生物标志物,而不是接受ART治疗患者流产的实际原因。由于关于此事的证据较少,在开始ART治疗前测定TAI应仅限于研究背景。