Department of clinical epidemiology, Obstetrics and Gynecology Hospital, Fudan University, 566 Fangxie Rd, Shanghai, 200011, China.
Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China.
BMC Pregnancy Childbirth. 2022 Jun 8;22(1):473. doi: 10.1186/s12884-022-04806-9.
Evidence for the association of thyroid dysfunction and autoantibody positivity with preterm birth remains controversial. We aimed to study the association of maternal thyroid dysfunction and autoantibody positivity with the risk of preterm birth.
A hospital-based cohort study of 40,214 women was conducted. Gestational age-specific percentiles of the FT4 and TSH concentrations were used for the definition of thyroid dysfunction. Autoantibody positivity was identified when the concentration > the threshold. The association of thyroid dysfunction and autoantibody positivity with the risk of preterm birth was estimated.
No significant higher risk of preterm birth was found for women with variants of thyroid dysfunction or autoantibody positive than euthyroid women. Sensitivity and stratification analyses indicated that thyroperoxidase antibody (TPOAb) positivity in the first trimester (odds ratio [OR], 1.49; 95% confidence interval [CI], 1.17-1.90) and overt hypothyroidism restricted to women negative for TPOAb (OR, 4.94; 95%CI: 1.64-14.84) was associated with an increased risk of preterm birth. Modification effects of gestational age were found for women who had the test ≤18 and > 18 weeks. Continuous FT4 measurements tested ≤18 weeks of gestation were associated with a higher risk of preterm birth (OR, 1.13, 95% CI: 1.00-1.28), while a negative relationship for FT4 concentrations tested > 18 weeks of gestation (OR = 0.68, 95% CI: 0.48-0.97).
Some specific thyroid function abnormalities were associated with an increased risk of preterm birth. Interaction between gestational age and FT4 concentration on the risk of preterm birth was identified, with a critical node of 18 weeks of gestation.
甲状腺功能障碍和自身抗体阳性与早产之间的关联仍然存在争议。我们旨在研究母体甲状腺功能障碍和自身抗体阳性与早产风险之间的关联。
对 40214 名妇女进行了一项基于医院的队列研究。使用 FT4 和 TSH 浓度的孕龄特异性百分位数来定义甲状腺功能障碍。当浓度>阈值时，确定自身抗体阳性。评估甲状腺功能障碍和自身抗体阳性与早产风险的关联。
与甲状腺功能正常的妇女相比，甲状腺功能障碍或自身抗体阳性的妇女早产风险没有显著增加。敏感性和分层分析表明，妊娠早期甲状腺过氧化物酶抗体（TPOAb）阳性（比值比 [OR]，1.49；95%置信区间 [CI]，1.17-1.90）和 TPOAb 阴性的显性甲状腺功能减退症（OR，4.94；95%CI：1.64-14.84）与早产风险增加相关。对于检测时间≤18 周和>18 周的妇女，发现了妊娠期的修饰效应。在妊娠 18 周之前进行的 FT4 连续测量与早产风险增加相关（OR，1.13，95%CI：1.00-1.28），而在妊娠 18 周之后进行的 FT4 浓度测量呈负相关（OR=0.68，95%CI：0.48-0.97）。
一些特定的甲状腺功能异常与早产风险增加相关。确定了妊娠期和 FT4 浓度对早产风险的相互作用，以 18 周妊娠为关键节点。
