Endocrinology and Nutrition Department, Hospital Universitari Arnau de Vilanova, Lleida, Spain.
Institut de Recerca Biomèdica de Lleida (IRB Lleida), Universitat de Lleida, Lleida, Spain.
Clin Endocrinol (Oxf). 2018 May;88(5):728-734. doi: 10.1111/cen.13575. Epub 2018 Mar 9.
An association of pregnancy outcomes with subclinical hypothyroidism has been reported; however, there still exists a strong controversy regarding whether subclinical hypothyroidism ought to be dealt with or not. The objective of the study was to evaluate the association of foetal-maternal complications with first trimester maternal Thyrotropin (TSH) values.
A retrospective study in a single tertiary care hospital was performed.
A total of 1981 pregnant women were studied during 2012.
Thyrotropin (TSH) universal screening was performed between 9 and 12 weeks of gestation. Outcomes included foetal-maternal complications and newborn health parameters.
Median TSH was 1.72 (0.99-2.61) mIU/L. The incidence of perinatal loss, miscarriage and stillbirth was 7.2%, 5.9% and 1.1%, respectively. Median TSH of women with and without miscarriage was 1.97 (1.29-3.28) vs 1.71 (0.96-2.58) mIU/L (P = .009). Incidence of pre-eclampsia was 3.2%; TSH in these women was 2.10 (1.40-2.74) vs 1.71 (0.98-2.59) mIU/L in those without (P = .027). TSH in women with dystocia in labour was 1.76 (1.00-2.53) vs 1.68 (0.94-2.59) mIU/L in those who gave birth with normal progression (P = .044). Women with TSH 2.5-5.1 mIU/L had a higher risk of perinatal loss [OR 1.589 (1.085-2.329)], miscarriage [OR 1.702 (1.126-2.572)] and premature birth [OR 1.39 (1.013-1.876)], adjusted by mother's age. There was no association with the other outcomes analysed.
There is a positive association between maternal TSH in the first trimester of pregnancy and the incidence of perinatal loss and miscarriage. The TSH cut-off value of 2.5 mIU/L identified women with higher adverse pregnancy outcomes.
有研究报道妊娠结局与亚临床甲状腺功能减退症之间存在关联；然而，对于是否应该处理亚临床甲状腺功能减退症仍存在很大争议。本研究的目的是评估胎儿-产妇并发症与妊娠早期产妇促甲状腺激素（TSH）值之间的关系。
在一家三级保健医院进行了一项回顾性研究。
在 2012 年期间，共研究了 1981 名孕妇。
在妊娠 9-12 周时进行促甲状腺激素（TSH）的通用筛查。研究结果包括胎儿-产妇并发症和新生儿健康参数。
中位数 TSH 为 1.72（0.99-2.61）mIU/L。围产儿丢失、流产和死产的发生率分别为 7.2%、5.9%和 1.1%。流产组和无流产组的中位数 TSH 分别为 1.97（1.29-3.28）和 1.71（0.96-2.58）mIU/L（P=0.009）。先兆子痫的发生率为 3.2%；这些妇女的 TSH 为 2.10（1.40-2.74），而无先兆子痫的妇女为 1.71（0.98-2.59）mIU/L（P=0.027）。分娩时发生难产的妇女的 TSH 为 1.76（1.00-2.53），而产程正常进展的妇女为 1.68（0.94-2.59）mIU/L（P=0.044）。TSH 为 2.5-5.1mIU/L 的孕妇发生围产儿丢失的风险更高[比值比（OR）1.589（1.085-2.329）]、流产[OR 1.702（1.126-2.572）]和早产[OR 1.39（1.013-1.876）]，校正母亲年龄后。与分析的其他结果无关联。
妊娠早期母体 TSH 与围产儿丢失和流产的发生率呈正相关。TSH 截断值为 2.5mIU/L 可识别出不良妊娠结局风险较高的孕妇。
