Dong Jing, Peng Ting, Li Ming-Qing, Xie Feng, Wu Jiang-Nan
Medical Center of Diagnosis and Treatment for Cervical Diseases, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
Department of Obstetrics, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.
Int J Endocrinol. 2022 Mar 11;2022:3859388. doi: 10.1155/2022/3859388. eCollection 2022.
Evidence for the association between maternal thyroxine concentration and the risk of fetal congenital heart defects (CHDs) is absent. We aimed to study the association of maternal free and total thyroxine (FT4 and TT4) concentrations and the free-to-total thyroxine proportion (FTT4P, %) with the risk of CHD.
The study was a hospital-based cohort study of 52,047 women who received a universal thyroid function test between 2012 and 2016. CHD was screened by ultrasound between 20 and 24 weeks of gestation or diagnosed until the 42 day of birth. Adjusted odds ratios (ORs) of fetal CHD were estimated for maternal FT4 and TT4 concentrations or the FTT4P by multivariate logistic regression.
A total of 41,647 women with singleton pregnancies were included for the analysis and 215 CHD cases were detected. The FT4 concentration was significantly associated with a higher risk of CHDs (OR, 1.04, 95% confidence interval (CI): 1.01 to 1.07). Each 1% higher FTT4P was related to a 1.41-fold (95% CI: 0.27 to 3.59) higher risk of CHDs. The association became stronger for women with a thyroid function test performed between 12 and 18 weeks of gestation (OR = 1.05 (95% CI: 1.01 to 1.09) for the FT4 concentration and 3.32 (95% CI: 1.43 to 7.73) for the FTT4P).
A higher FT4 concentration or FTT4P, measured between 12 and 18 weeks of gestation, was associated with an increased risk of CHDs. These findings may provide new insights into the mechanisms of CHDs and evidence for clinical decisions related to thyroid function tests.
目前尚无证据表明母体甲状腺素浓度与胎儿先天性心脏病（CHD）风险之间存在关联。我们旨在研究母体游离甲状腺素和总甲状腺素（FT4和TT4）浓度以及游离甲状腺素与总甲状腺素比例（FTT4P，%）与CHD风险之间的关联。
本研究是一项基于医院的队列研究，纳入了2012年至2016年间接受常规甲状腺功能检测的52047名女性。在妊娠20至24周期间通过超声筛查CHD，或直至出生后42天进行诊断。通过多因素逻辑回归估计母体FT4和TT4浓度或FTT4P与胎儿CHD的校正比值比（OR）。
共纳入41647名单胎妊娠女性进行分析，检测到215例CHD病例。FT4浓度与CHD风险显著相关（OR，1.04，95%置信区间（CI）：1.01至1.07）。FTT4P每升高1%，CHD风险增加1.41倍（95%CI：0.27至3.59）。对于在妊娠12至18周进行甲状腺功能检测的女性，这种关联更强（FT4浓度的OR = 1.05（95%CI：1.01至1.09），FTT4P的OR = 3.32（95%CI：1.43至7.73））。
妊娠12至18周时测得较高的FT4浓度或FTT4P与CHD风险增加相关。这些发现可能为CHD的发病机制提供新的见解，并为甲状腺功能检测相关的临床决策提供依据。
