Zhang P H, Sun W J, Zhang Y, Huang Y, Zhang J Q, Yang H X, Gao Ying
Department of Endocrinology, Peking University First Hospital,Beijing 100034, China.
Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China.
Zhonghua Yi Xue Za Zhi. 2022 Feb 15;102(6):423-427. doi: 10.3760/cma.j.cn112137-20210723-01643.
To analyze the pregnancy-related adverse outcomes in patients with severe hypothyroidism during pregnancy. Using cross-sectional study, a total of 47 pregnant women with severe hypothyroidism in the Peking University First Hospital from January 2007 to December 2020 were retrospectively collected by electronic case system. According to the occurrence of adverse pregnancy events (defined as any pregnancy complication or adverse maternal-fetal/neonatal outcomes), the patients were divided into pregnancy-related adverse outcomes group (=33) and no pregnancy-related adverse outcomes group (=15). The demographic data, thyroid function and thyroid autoantibody levels during pregnancy, pregnancy complications and maternal-fetal/neonatal outcomes of the two groups were recorded and analyzed. The age of severe hypothyroidism women was (30.5±4.1) years. The median of gestational week at delivery was 38.6 (36.3, 39.9) weeks, the median of gestational week for diagnosis was 7.0 (6.0, 8.8) weeks, the median of the highest TSH level was 32.7(23.1,60.2)mU/L and the period of reaching the target TSH level for the first time was 6.0(4.0, 10.0)weeks. Most cases (82.5%, 33/40) had thyroid autoimmunity. All women were treated with levothyroxine (L-T) during pregnancy. A total of 37 cases (77.1%, 37/48) of them obtained the recommended target values. Fourty cases (83.3%, 40/48) gave birth. The birth weight of newborns was (3 041±452) g, the body length was (49.4±2.1) cm, and the head circumference was (33.6±0.7) cm. The period of reaching to target TSH level for the first time in patients without pregnancy-related adverse outcomes was shorter [5.0 (3.0, 9.0) vs 8.0 (4.5, 12.5) weeks) ] (=0.033), and the times of thyroid function monitoring were more frequent [ (8.2±3.5) vs (6.0±3.6) times] (=0.049) than the group with pregnancy-related adverse outcomes. The incidence of pregnancy complications and adverse maternal-fetal/neonatal outcomes is high in patients with severe hypothyroidism during pregnancy. Intense follow-up, treatment and restoration of euthyroidism as prompt as possible may improve pregnant outcomes.
分析重度甲状腺功能减退症患者孕期与妊娠相关的不良结局。采用横断面研究，通过电子病历系统回顾性收集了2007年1月至2020年12月北京大学第一医院47例重度甲状腺功能减退症孕妇的资料。根据不良妊娠事件的发生情况（定义为任何妊娠并发症或母婴/新生儿不良结局），将患者分为妊娠相关不良结局组（=33）和无妊娠相关不良结局组（=15）。记录并分析两组的人口统计学数据、孕期甲状腺功能和甲状腺自身抗体水平、妊娠并发症及母婴/新生儿结局。重度甲状腺功能减退症女性的年龄为（30.5±4.1）岁。分娩孕周中位数为38.6（36.3，39.9）周，诊断孕周中位数为7.0（6.0，8.8）周，最高TSH水平中位数为32.7（23.1，60.2）mU/L，首次达到目标TSH水平的时间为6.0（4.0，10.0）周。大多数病例（82.5%，33/40）存在甲状腺自身免疫。所有女性孕期均接受左甲状腺素（L-T）治疗。其中共有37例（77.1%，37/48）达到推荐的目标值。40例（83.3%，40/48）分娩。新生儿出生体重为（3041±452）g，身长为（49.4±2.1）cm，头围为（33.6±0.7）cm。无妊娠相关不良结局患者首次达到目标TSH水平的时间较短[5.0（3.0，9.0）周 vs 8.0（4.5，12.5）周]（=0.033），甲状腺功能监测次数更频繁[（8.2±3.5）次 vs （6.0±3.6）次]（=0.049），均高于妊娠相关不良结局组。重度甲状腺功能减退症患者孕期妊娠并发症及母婴/新生儿不良结局的发生率较高。加强随访、尽早治疗并尽快恢复甲状腺功能正常可能改善妊娠结局。
