Turunen Suvi, Vääräsmäki Marja, Lahesmaa-Korpinen Anna-Maria, Leinonen Maarit K, Gissler Mika, Männistö Tuija, Suvanto Eila
Department of Obstetrics and Gynecology, PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.
Finnish Institute for Health and Welfare, Information Services Department, Helsinki, Finland.
Clin Endocrinol (Oxf). 2020 Dec;93(6):721-728. doi: 10.1111/cen.14282. Epub 2020 Jul 26.
Maternal hyperthyroidism and antithyroid medications have been associated with adverse pregnancy and perinatal outcomes. This nationwide register-based study investigated the association of maternal hyperthyroidism and antithyroid drug (ATD) use with pregnancy outcomes and included all singleton births in Finland between 2004 and 2013 (N = 571 785).
DESIGN, PATIENTS AND MEASUREMENTS: Hyperthyroid mothers were identified in the Medical Birth Register, and data on ATD use before and/or during pregnancy were collected from the Prescription Register. The odds ratios, with 95% confidence intervals, for adverse outcomes among hyperthyroid mothers and mothers without thyroid disease were compared using logistic regression.
In total, 2144 (0.37%) of all the women had diagnoses of hyperthyroidism, and 580 (27%) of these women had used ATDs before and/or during pregnancy. Compared to the mothers without thyroid disease, maternal hyperthyroidism was associated with older age, multiparity, smoking, previous miscarriages, and overweight or obesity. The mothers diagnosed with hyperthyroidism also had increased odds of gestational hypertensive disorders, caesarean sections, placental abruptions, preterm births, small-for-gestational-age newborns and neonatal intensive care unit treatment. The odds of pregnancy and/or perinatal complications were higher among those who had used ATDs (indicative of active disease), but those who had not received ATD treatment also had increased odds of such complications compared to the mothers without thyroid disease.
Women with active hyperthyroidism and those with histories of hyperthyroidism should be considered at risk of developing pregnancy and perinatal complications and should therefore be monitored during pregnancy.
孕妇甲状腺功能亢进症及抗甲状腺药物与不良妊娠及围产期结局相关。这项基于全国登记处的研究调查了孕妇甲状腺功能亢进症及抗甲状腺药物（ATD）的使用与妊娠结局之间的关联，纳入了2004年至2013年芬兰所有单胎分娩（N = 571785）。
设计、研究对象与测量方法：在医疗出生登记处识别出甲状腺功能亢进的母亲，并从处方登记处收集妊娠前和/或妊娠期间使用ATD的数据。使用逻辑回归比较甲状腺功能亢进母亲和无甲状腺疾病母亲发生不良结局的比值比及95%置信区间。
所有女性中共有2144例（0.37%）被诊断为甲状腺功能亢进症，其中580例（27%）在妊娠前和/或妊娠期间使用过ATD。与无甲状腺疾病的母亲相比，孕妇甲状腺功能亢进症与年龄较大、多胎妊娠、吸烟、既往流产以及超重或肥胖有关。被诊断为甲状腺功能亢进症的母亲发生妊娠期高血压疾病、剖宫产、胎盘早剥、早产、小于胎龄新生儿和新生儿重症监护病房治疗的几率也更高。使用过ATD的母亲（提示疾病活动）发生妊娠和/或围产期并发症的几率更高，但与无甲状腺疾病的母亲相比，未接受ATD治疗的母亲发生此类并发症的几率也增加。
患有活动性甲状腺功能亢进症的女性以及有甲状腺功能亢进症病史的女性应被视为有发生妊娠和围产期并发症的风险，因此在妊娠期间应进行监测。
