Department of Obstetrics and Gynecology, Centre Hospitalier Departemental, 85000, La Roche sur Yon, France.
Clinical Research Center, Centre Hospitalier Departemental, La Roche sur Yon, France.
Arch Gynecol Obstet. 2021 May;303(5):1153-1159. doi: 10.1007/s00404-020-05833-7. Epub 2020 Oct 16.
Placental modifications observed in women with subclinical hypothyroidism (SCH) should be associated with altered fetal development in women with gestational diabetes mellitus (GDM) and worsen perinatal outcome. We aim to determine if SCH is associated with neonatal morbidity in women with GDM.
A secondary analysis of data collected for a prospective population-based cohort study including all pregnant women with singleton pregnancies at diagnosis of GDM in a tertiary care university hospital. Thyroid-stimulating hormone and free thyroxine were measured at diagnosis of GDM. Perinatal outcome was compared between two groups-women with SCH and euthyroid. Neonatal morbidity was defined by at least one of the following criteria: preterm birth, macrosomia, shoulder dystocia, respiratory distress syndrome, 5-min Apgar score < 7, pH < 7.10, and admission to the NICU (neonatal intensive-care unit) for 24 h.
Of the total 200 women enrolled, 150 were evaluable for the study. Of whom, 9 (6%) women presented SCH. The mean gestational age at diagnosis of GDM was 21.7 ± 7.0 weeks. Maternal outcome of women with SCH was similar to euthyroid women. Neonatal morbidity occurred in 17.3% (26/150). Women with SCH had higher rate of neonatal morbidity (44.4% vs. 15.6%; p = 0.03), specifically due to admission to the NICU for 24 h (33.3% vs. 5.7%; p = 0.02). SCH in women with GDM is not associated with neonatal morbidity after controlling for gestational age at birth and admission to NICU (adjusted OR 2.02, 95% CI 0.75-10.23).
Subclinical hypothyroidism is not associated with neonatal morbidity in women with gestational diabetes mellitus.
患有亚临床甲状腺功能减退症（SCH）的女性观察到的胎盘改变，应该与患有妊娠期糖尿病（GDM）的胎儿发育改变有关，并使围产儿结局恶化。我们旨在确定 SCH 是否与患有 GDM 的女性的新生儿发病率有关。
对在一家三级保健大学医院诊断为 GDM 的所有单胎妊娠孕妇进行前瞻性基于人群队列研究的数据进行二次分析。在诊断 GDM 时测量促甲状腺激素和游离甲状腺素。比较 SCH 组和甲状腺功能正常组之间的围产期结局。新生儿发病率通过以下至少一个标准来定义：早产、巨大儿、肩难产、呼吸窘迫综合征、5 分钟 Apgar 评分<7、pH<7.10 和入住新生儿重症监护病房（NICU）24 小时。
在总共纳入的 200 名女性中，有 150 名女性可用于研究。其中，9（6%）名女性患有 SCH。GDM 诊断时的平均孕龄为 21.7±7.0 周。SCH 女性的母体结局与甲状腺功能正常的女性相似。新生儿发病率为 17.3%（26/150）。SCH 女性的新生儿发病率更高（44.4% vs. 15.6%；p=0.03），特别是因入住 NICU 24 小时（33.3% vs. 5.7%；p=0.02）。在控制出生时的胎龄和入住 NICU 后，SCH 对患有 GDM 的女性的新生儿发病率没有影响（调整后的 OR 2.02，95%CI 0.75-10.23）。
SCH 与患有 GDM 的女性的新生儿发病率无关。
