Ultrasound Department, Shijiazhuang Fourth Hospital, Shijiazhuang, China.
Ann Palliat Med. 2022 Apr;11(4):1441-1452. doi: 10.21037/apm-22-269.
In recent years, the detection rate of pregnancy complicated with hypothyroidism [subclinical hypothyroidism (SCH) during pregnancy] has increased significantly. Levothyroxine sodium tablet is the main drug for the treatment of SCH during pregnancy, but its effect on the treatment of SCH during pregnancy and the effect of pregnancy outcome are still controversial.
PubMed, Web of Science, Medline, and Embase databases were screened to retrieve clinical studies on levothyroxine sodium tablets in the treatment of pregnancy complicated with hypothyroidism from the date of establishment to June 2021. Meta-analysis was performed with RevMan5.3 software. The differences in the incidence of preterm birth, miscarriage, gestational hypertension, postpartum hemorrhage, placental abruption, and abnormal neonatal weight were compared between the observation group and the control group. Heterogeneity of results was assessed with chi-square test and I2 in RevMan5.3 software.
Nine articles with a total of 2,873 pregnant women were included. The Cochrane assessments were all grade B and above, and the Jadad scale scores were all >3 points. The incidences of preterm birth, abortion, postpartum hemorrhage, and low birth weight infants in the pregnant women treated with levothyroxine sodium were lower than those in the control group [odds ratio (OR) =0.42, 0.34, 0.40, and 0.08, respectively; 95% confidence interval (CI): 0.30-0.58, 0.23-0.52, 0.22-0.74, and 0.01-0.51, respectively; Z=5.23, 5.08, 2.97, and 2.70, respectively; P<0.00001, <0.00001, =0.003, and =0.007, respectively].
Levothyroxine sodium in the treatment of SCH can significantly reduce the incidence of premature birth, miscarriage, postpartum hemorrhage, and low birth weight infants. Due to the limited number of included studies, it remained to be further verified whether levothyroxine sodium treatment in SCH patients would affect the incidence of gestational hypertension.
近年来，妊娠合并甲状腺功能减退症（妊娠期亚临床甲状腺功能减退症，SCH）的检出率显著增高。左甲状腺素钠片是治疗妊娠期 SCH 的主要药物，但该药治疗妊娠期 SCH 的效果及对妊娠结局的影响仍存在争议。
检索建库至 2021 年 6 月 PubMed、Web of Science、Medline、Embase 数据库中有关左甲状腺素钠片治疗妊娠合并甲状腺功能减退症的临床研究，采用 RevMan5.3 软件进行 Meta 分析。比较观察组与对照组早产、流产、妊娠期高血压、产后出血、胎盘早剥及新生儿体质量异常的发生率。结果采用 RevMan5.3 软件中的卡方检验和 I2 进行异质性分析。
共纳入 9 篇文献，总计 2873 例孕妇。Cochrane 评价均为 B 级及以上，Jadad 评分均>3 分。左甲状腺素钠治疗后孕妇早产、流产、产后出血及低体质量儿的发生率均低于对照组[比值比（OR）=0.42、0.34、0.40、0.08；95%置信区间（CI）：0.300.58、0.230.52、0.220.74、0.010.51；Z 值分别为 5.23、5.08、2.97、2.70；P 值均<0.00001]。
左甲状腺素钠治疗 SCH 可显著降低早产、流产、产后出血及低体质量儿的发生率。由于纳入研究数量有限，左甲状腺素钠治疗 SCH 患者是否会影响妊娠期高血压的发生率仍需进一步验证。
