Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China.
Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, China.
Clin Endocrinol (Oxf). 2018 Jun;88(6):928-935. doi: 10.1111/cen.13590. Epub 2018 Apr 2.
Hypertensive disorders of pregnancy (HDP) have been associated with adverse health outcomes for both mothers and children. Previous studies examining associations of maternal thyroid autoantibodies with HDP indicate conflicting results. The objective of this study was to examine associations of maternal thyroid autoantibody positivity in the first and the second trimesters with the risk of HDP.
DESIGN, PARTICIPANTS AND MEASUREMENTS: In the Ma'anshan Birth Cohort study, a population-based prospective study in China, a total of 3474 pregnant women were enrolled between May 2013 and September 2014. Thyroid autoantibodies, including antithyroperoxidase autoantibody (TPOAb) and antithyroglobulin autoantibody (TgAb), as well as thyroid function tests, were measured in both the first and the second trimesters in 2893 pregnant women. Multivariate logistic regression analyses were conducted to calculate the odds ratio (OR) and 95% confidence interval (CI) for the associations between thyroid autoantibodies and HDP.
Multivariate logistic regression analyses showed that TPOAb positivity in the first trimester was associated with a 1.80 (95% CI = 1.17-2.78) increased odds of HDP after adjustment for confounders, which was mainly due to an increased risk of gestational hypertension (OR = 1.93, 95% CI = 1.17-3.18). In addition, TgAb positivity in the first trimester was associated with a higher risk of HDP (OR = 1.78, 95% CI = 1.16-2.73) after adjustment for confounders, which was mainly due to an increased risk of gestational hypertension (OR = 1.89, 95% CI = 1.15-3.11). These associations were also seen among euthyroid women. Women with positive TPOAb in the second trimester seemed to have a higher risk of gestational hypertension (OR = 1.87, 95% CI = 1.02-3.43) after adjustment for confounders. However, among euthyroid women, TPOAb positivity in the second trimester was not associated with HDP. The TgAb status in the second trimester was not associated with HDP.
Our results show that TPOAb positivity and TgAb positivity in the first trimester are associated with an increased risk of HDP. These data demonstrate that these associations are even seen among euthyroid women.
妊娠高血压疾病（HDP）与母婴不良健康结局有关。既往研究表明，母体甲状腺自身抗体与 HDP 之间存在关联，但结果存在差异。本研究旨在探讨妊娠早期和中期母体甲状腺自身抗体阳性与 HDP 风险的关系。
设计、参与者和测量方法：在 2013 年 5 月至 2014 年 9 月期间，在中国进行的一项基于人群的前瞻性 Ma'anshan 出生队列研究中，共纳入了 3474 名孕妇。在 2893 名孕妇中，在妊娠早期和中期分别测量了甲状腺自身抗体，包括甲状腺过氧化物酶抗体（TPOAb）和甲状腺球蛋白抗体（TgAb）以及甲状腺功能检查。采用多变量 logistic 回归分析计算甲状腺自身抗体与 HDP 之间的关联的比值比（OR）和 95%置信区间（CI）。
多变量 logistic 回归分析显示，校正混杂因素后，妊娠早期 TPOAb 阳性与 HDP 的发生风险增加 1.80 倍（95%CI=1.17-2.78），这主要归因于妊娠期高血压的风险增加（OR=1.93，95%CI=1.17-3.18）。此外，妊娠早期 TgAb 阳性与 HDP 的发生风险增加相关（OR=1.78，95%CI=1.16-2.73），校正混杂因素后，这主要归因于妊娠期高血压的风险增加（OR=1.89，95%CI=1.15-3.11）。这些关联在甲状腺功能正常的女性中也存在。妊娠中期 TPOAb 阳性的女性似乎有更高的妊娠期高血压风险（OR=1.87，95%CI=1.02-3.43），校正混杂因素后。然而，在甲状腺功能正常的女性中，妊娠中期 TPOAb 阳性与 HDP 无关。妊娠中期 TgAb 状态与 HDP 无关。
本研究结果表明，妊娠早期 TPOAb 阳性和 TgAb 阳性与 HDP 风险增加相关。这些数据表明，即使在甲状腺功能正常的女性中，也存在这些关联。
