Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital; Dana-Dwek Children's Hospital; Tel Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Department of Obstetrics and Gynecology, Lis Maternity and Women's Hospital; Dana-Dwek Children's Hospital; Tel Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Thyroid. 2021 Dec;31(12):1878-1885. doi: 10.1089/thy.2021.0388. Epub 2021 Nov 5.
Pregnancy and parturition reflect the complex interaction between physiological conditions of the mother and her offspring, and fetal health characteristics may affect maternal health throughout pregnancy and delivery. We aimed to investigate the characteristics of the mother-infant dyad of term infants detected as having congenital hypothyroidism (CH). A retrospective cohort study of 108,717 term infants delivered liveborn at Lis Maternity and Women's Hospital between 2010 and 2017. Infants were detected by the National Newborn Screening Program as having CH (131, 0.12%). Three years of surveillance in the Pediatric Endocrine Clinic revealed that 65 infants had transient CH and 66 had permanent CH. Data on maternal, pregnancy, delivery, and perinatal characteristics of the mother-infant dyads were retrieved from the hospital's electronic database. Mode of delivery differed: a higher proportion of deliveries of CH infants required vacuum assistance, and more infants with CH were born through a cesarean section compared with the general population ( < 0.001). Medication during labor also differed, with higher rates of oxytocin ( < 0.001) and antibiotics ( = 0.008) administered to mothers of CH infants. A multivariate logistic regression model revealed an increased demand for oxytocin administration during the labor of a CH infant in a hypothyroidism severity-dependent manner, expressed as a threefold risk associated with permanent but not transient CH. Our findings of increased utilization of medical interventions during the labor and delivery of CH infants suggest that the prenatal fetal thyroid function may affect the development and progress of labor and delivery, in response to oxytocin.
妊娠和分娩反映了母亲和胎儿生理状况之间的复杂相互作用，胎儿健康特征可能会影响整个妊娠和分娩期间母亲的健康。我们旨在研究足月产婴儿先天性甲状腺功能减退症（CH）患儿母婴对的特征。这是一项回顾性队列研究，纳入了 2010 年至 2017 年期间在利斯妇产医院分娩的 108717 名足月产活产婴儿。通过全国新生儿筛查计划发现婴儿患有 CH（131 例，0.12%）。在儿科内分泌诊所进行了 3 年的监测后发现，65 例婴儿为暂时性 CH，66 例为永久性 CH。从医院电子数据库中检索了母婴对的母亲、妊娠、分娩和围产期特征的数据。分娩方式不同：需要真空辅助分娩的 CH 婴儿比例较高，与一般人群相比，CH 婴儿的剖宫产率更高（<0.001）。分娩期间使用的药物也不同，CH 婴儿的母亲使用催产素（<0.001）和抗生素（=0.008）的比例更高。多变量逻辑回归模型显示，CH 婴儿在甲状腺功能减退严重程度依赖的情况下，在分娩期间使用催产素的需求增加，表现为永久性 CH 与三倍风险相关，而暂时性 CH 则无此关联。我们发现 CH 婴儿在分娩期间增加了医疗干预的使用，这表明产前胎儿甲状腺功能可能会影响催产素作用下的分娩和进展。
