Department of Traditional Chinese Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China.
Department of Gynaecology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, P.R. China.
J Matern Fetal Neonatal Med. 2023 Dec;36(2):2233039. doi: 10.1080/14767058.2023.2233039.
This study aimed to explore the effects of levothyroxine on pregnancy outcomes and thyroid function in recurrent pregnancy loss (RPL) women with subclinical hypothyroidism (SCH) or thyroperoxidase antibody positivity (TPOAb).
Literature search was performed from inception to 24 June 2022. The heterogeneity for each outcome was evaluated using Cochran's test and quantified with I-squared (). Pooled effect sizes were expressed as relative risk (RR) and weighted mean differences (WMD) with 95% confidence intervals (95% CIs). Stability of the results were assessed using the sensitivity analysis.
Fifteen eligible studies with 1911 participants were included in this meta-analysis. The pooled data showed that levothyroxine decreased premature delivery rate (RR = 0.48, 95%CI: 0.32, 0.72), miscarriage rate (RR = 0.59, 95%CI: 0.44, 0.79), premature rupture of membranes (PROM) rate (RR = 0.44, 95%CI: 0.29, 0.66), and fetal growth restriction rate (RR = 0.33, 95%CI: 0.12, 0.89) in RPL women with TPOAb. In RPL women with SCH, live birth rate was elevated (RR = 1.20, 95%CI: 1.01, 1.42) and miscarriage rate was reduced (RR = 0.65, 95%CI: 0.44, 0.97) by levothyroxine. In addition, levothyroxine substantially decreased TSH level (WMD = -0.23, 95% CI: -0.31, -0.16) and TPO level (WMD = -23.48, 95%CI: -27.50, -19.47).
Levothyroxine improved pregnancy outcomes and thyroid function in RPL women with TPOAb or SCH, indicating that levothyroxine may be beneficial for RPL women if TPOAb or SCH occurs. Future studies are needed to verify our findings.
本研究旨在探讨左旋甲状腺素对伴有亚临床甲状腺功能减退症（SCH）或甲状腺过氧化物酶抗体阳性（TPOAb）的复发性流产（RPL）妇女妊娠结局和甲状腺功能的影响。
从建库至 2022 年 6 月 24 日进行文献检索。使用 Cochran's 检验评估每个结局的异质性，并使用 I 平方（）进行量化。汇总效应大小表示为相对风险（RR）和加权均数差（WMD）及其 95%置信区间（95%CI）。通过敏感性分析评估结果的稳定性。
共有 15 项符合纳入标准的研究纳入本 meta 分析，共 1911 名参与者。汇总数据显示，左旋甲状腺素可降低早产率（RR=0.48，95%CI：0.32，0.72）、流产率（RR=0.59，95%CI：0.44，0.79）、胎膜早破率（RR=0.44，95%CI：0.29，0.66）和胎儿生长受限率（RR=0.33，95%CI：0.12，0.89）。在伴有 TPOAb 的 RPL 妇女中，左旋甲状腺素可提高活产率（RR=1.20，95%CI：1.01，1.42）和降低流产率（RR=0.65，95%CI：0.44，0.97）。此外，左旋甲状腺素可显著降低 TSH 水平（WMD=-0.23，95%CI：-0.31，-0.16）和 TPO 水平（WMD=-23.48，95%CI：-27.50，-19.47）。
左旋甲状腺素改善了伴有 TPOAb 或 SCH 的 RPL 妇女的妊娠结局和甲状腺功能，表明如果 TPOAb 或 SCH 发生，左旋甲状腺素可能对 RPL 妇女有益。需要进一步的研究来验证我们的发现。
