超声引导下妊娠早期甲状腺功能障碍对妊娠结局影响的系统评价和荟萃分析。

Systematic review and meta-analysis on the influence of thyroid dysfunction in early pregnancy on pregnancy outcomes under ultrasound guidance.

机构信息

Department of Ultrasound, Shijiazhuang Fourth Hospital, Shijiazhuang, China.

Department of Rehabilitation Medicine, Handan Central Hospital, Handan, China.

出版信息

Ann Palliat Med. 2022 Mar;11(3):1001-1016. doi: 10.21037/apm-22-47.

DOI:10.21037/apm-22-47

PMID:35365030

Abstract

BACKGROUND

Thyroid dysfunction during pregnancy has a certain impact on pregnancy outcomes and neonatal growth, but there is no systematic evaluation of the influence of thyroid dysfunction during early pregnancy under ultrasound guidance on pregnancy outcomes.

METHODS

PubMed, Web of Science, Springer, and Science Direct databases were used to screen clinical studies on the effect of thyroid dysfunction during pregnancy on pregnancy outcomes from January 2010 to June 2021. Meta-analysis of data was conducted using RevMan 5.3 software. Differences of indicators were compared between the normal and abnormal thyroid function groups, including the ratio of primiparas, anemia, intrauterine growth restriction, perinatal fetal death, preterm delivery, fetal distress syndrome, cesarean section, preeclampsia, placental abruption, postpartum hemorrhage, and neonatal complications. Heterogeneity of results was assessed by chi-square test and I2 test in RevMan5.3.

RESULTS

A total of 788,867 pregnant women were included in 13 studies. Cochrane scores were grade B or above, and Jadad scale scores were higher than 3. Anemia [odds ratio (OR) =0.82, 95% confidence interval (CI): 0.70-0.96, Z=2.48, P=0.01], premature birth (OR =0.56, 95% CI: 0.36-0.86, Z=2.66, P=0.008), fetal distress syndrome (OR =0.76, 95% CI: 0.68-0.85, Z=4.74, P<0.00001), Apgar score <7 (OR =0.52, 95% CI: 0.34-0.80, Z=2.97, P=0.003), preeclampsia (OR =0.65, 95% CI: 0.48-0.87, Z=2.91, P=0.004), placental abruption (OR =0.27, 95% CI: 0.19-0.38, Z=7.31, P<0.00001), and the rate of postpartum hemorrhage (OR =0.62, 95% CI: 0.42-0.92, Z=2.38, P=0.02) were dramatically higher in the abnormal thyroid function group compared with the normal group.

DISCUSSION

Few studies were included on the effect of thyroid dysfunction on abortion, and further validation is needed. Thyroid dysfunction was proven to be associated with a variety of adverse pregnancy outcomes.

摘要

背景

妊娠期间甲状腺功能障碍对妊娠结局和新生儿生长有一定影响，但目前尚无系统评价超声引导下妊娠早期甲状腺功能障碍对妊娠结局的影响。

方法

检索 2010 年 1 月至 2021 年 6 月期间PubMed、Web of Science、Springer 和 Science Direct 数据库中关于妊娠期间甲状腺功能障碍对妊娠结局影响的临床研究，采用 RevMan 5.3 软件进行数据的 Meta 分析。比较正常甲状腺功能组和异常甲状腺功能组之间的指标差异，包括初产妇比例、贫血、宫内生长受限、围产儿死亡、早产、胎儿窘迫综合征、剖宫产、子痫前期、胎盘早剥、产后出血和新生儿并发症。采用 RevMan5.3 中的卡方检验和 I2 检验评估结果的异质性。

结果

共纳入 13 项研究的 788867 名孕妇。Cochrane 评分均为 B 级及以上，Jadad 量表评分均高于 3 分。贫血[比值比（OR）=0.82，95%置信区间（CI）：0.70-0.96，Z=2.48，P=0.01]、早产（OR=0.56，95%CI：0.36-0.86，Z=2.66，P=0.008）、胎儿窘迫综合征（OR=0.76，95%CI：0.68-0.85，Z=4.74，P<0.00001）、Apgar 评分<7（OR=0.52，95%CI：0.34-0.80，Z=2.97，P=0.003）、子痫前期（OR=0.65，95%CI：0.48-0.87，Z=2.91，P=0.004）、胎盘早剥（OR=0.27，95%CI：0.19-0.38，Z=7.31，P<0.00001）和产后出血（OR=0.62，95%CI：0.42-0.92，Z=2.38，P=0.02）发生率在异常甲状腺功能组显著高于正常甲状腺功能组。