López-Tinoco Cristina, Rodríguez-Mengual Amparo, Lara-Barea Almudena, Barcala Julia, Larrán Laura, Saez-Benito Ana, Aguilar-Diosdado Manuel
Servicio de Endocrinología y Nutrición, Hospital Universitario Puerta del Mar, Departamento de Medicina, Facultad de Medicina, Universidad de Cádiz, Cádiz, España.
Departamento de Medicina, Facultad de Medicina, Universidad de Cádiz, Cádiz, España.
Endocrinol Diabetes Nutr (Engl Ed). 2018 Mar;65(3):150-155. doi: 10.1016/j.endinu.2017.11.013. Epub 2018 Jan 6.
The impact of subclinical hypothyroidism (SH) and thyroid autoimmunity on obstetric and perinatal complications continues to be a matter of interest and highly controversial.
To assess the impact of SH and autoimmunity in early pregnancy on the obstetric and perinatal complications in our population.
A retrospective cohort study in 435 women with SH (TSH ranging from 3.86 and 10 μIU/mL and normal FT4 values) in the first trimester of pregnancy. Epidemiological and clinical parameters were analyzed and were related to obstetric and perinatal complications based on the presence of autoimmunity (thyroid peroxidase antibodies [TPO] > 34 IU/mL).
Mean age was 31.3 years (SD 5.2). Seventeen percent of patients had positive TPO antibodies. Presence of positive autoimmunity was associated to a family history of hypothyroidism (P=.04) and a higher chance of miscarriage (P=.009). In the multivariate analysis, positive TPO antibodies were associated to a 10.25-fold higher risk of miscarriage. No statistically significant associations were found with all other obstetric and perinatal complications.
In our region, pregnant women with SH and thyroid autoimmunity had a higher risk of miscarriage but not of other obstetric and perinatal complications.
亚临床甲状腺功能减退（SH）和甲状腺自身免疫对产科及围产期并发症的影响一直是人们关注的焦点且极具争议性。
评估孕早期SH和自身免疫对我们研究人群中产科及围产期并发症的影响。
对435例孕早期患有SH（促甲状腺激素[TSH]范围为3.86至10 μIU/mL且游离甲状腺素[FT4]值正常）的女性进行回顾性队列研究。分析流行病学和临床参数，并根据自身免疫情况（甲状腺过氧化物酶抗体[TPO]＞34 IU/mL）将其与产科及围产期并发症相关联。
平均年龄为31.3岁（标准差5.2）。17%的患者TPO抗体呈阳性。自身免疫阳性与甲状腺功能减退家族史相关（P = 0.04）以及流产几率较高相关（P = 0.009）。在多变量分析中，TPO抗体阳性与流产风险高10.25倍相关。未发现与所有其他产科及围产期并发症有统计学显著关联。
在我们地区，患有SH和甲状腺自身免疫的孕妇流产风险较高，但其他产科及围产期并发症风险未增加。
