Wu Mei-Qin, Liu Jin, Wang Ya-Qian, Yang Ying, Yan Chong-Huai, Hua Jing
MOE, Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Nuclear Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China.
Front Endocrinol (Lausanne). 2019 Aug 6;10:522. doi: 10.3389/fendo.2019.00522. eCollection 2019.
Subclinical hypothyroidism (SCH) is a mild form of hypothyroidism that is common among women of childbearing age. The impact of SCH on adverse perinatal outcomes is unclear and universal screening for thyroid function before or during pregnancy is also much debated. In the present retrospective cohort study on 7,587 women from Shanghai, we assessed whether SCH was associated with adverse perinatal outcomes. The relationship between the risks of adverse outcomes and the time of screening and LT4 treatment status for SCH were also evaluated. SCH was associated with hypertensive disorders of pregnancy (HDP) [odds ratio (OR): 4.04; 95% confidence interval (CI): 1.85-8.84; = 0.000]. After classification into four different groups based on the time of screening for thyroid function, the increased likelihood of HDP persisted in those diagnosed with SCH in the first and second trimesters (OR: 9.69; 95% CI: 1.73-54.48; = 0.01 and OR: 3.66; 95% CI: 1.07-12.57, = 0.03, respectively). The diagnosis of SCH in the preconception period and the third trimester was not significantly associated with HDP and other adverse perinatal outcomes. Five out of 120 (5/120) treated women (4.17%) vs. 4/45 untreated women (8.89%) developed HDP, 4/5 were treated after conception. The results indicate that during pregnancy, SCH conferred an increased risk of HDP, particularly in women diagnosed with the disorder in the first and second trimesters.
亚临床甲状腺功能减退症（SCH）是一种轻度甲状腺功能减退症，在育龄妇女中很常见。SCH对围产期不良结局的影响尚不清楚，孕期前或孕期进行甲状腺功能的普遍筛查也备受争议。在这项针对7587名上海女性的回顾性队列研究中，我们评估了SCH是否与围产期不良结局相关。还评估了不良结局风险与SCH筛查时间及左甲状腺素（LT4）治疗状态之间的关系。SCH与妊娠期高血压疾病（HDP）相关[比值比（OR）：4.04；95%置信区间（CI）：1.85 - 8.84；P = 0.000]。根据甲状腺功能筛查时间分为四个不同组后，孕早期和孕中期诊断为SCH的女性发生HDP的可能性仍然增加（OR分别为：9.69；95%CI：1.73 - 54.48；P = 0.01和OR：3.66；95%CI：1.07 - 12.57，P = 0.03）。孕前和孕晚期诊断为SCH与HDP及其他围产期不良结局无显著关联。120名接受治疗的女性中有5名（5/120，4.17%）发生HDP，而45名未接受治疗的女性中有4名（4/45，8.89%）发生HDP，其中4/5是在怀孕后接受治疗的。结果表明，孕期SCH会增加HDP的风险，尤其是在孕早期和孕中期被诊断出患有该疾病的女性中。
