Department of Obstetrics, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
Department of Obstetrics, Shenzhen Maternity and Child Healthcare Hospital, Shenzhen, Guangdong, China.
Acta Obstet Gynecol Scand. 2023 Sep;102(9):1183-1192. doi: 10.1111/aogs.14602. Epub 2023 Jul 13.
Subclinical hypothyroidism (SCH) during pregnancy is reported to have detrimental impact on pregnancy and child development. However, its treatment indications require further investigation in different thyroid peroxidase antibody (TPOAb) status.
This was a secondary analysis of a Chinese prospective cohort in a real-world setting. Pregnant women with gestational SCH were enrolled at the first antenatal visit and grouped by TPOAb positivity. Child neurodevelopment was assessed by the Gesell development diagnosis scale (GDDS) at one, three, six, 12, and 24 months of age. Subgroup analyses and sensitivity analyses were also conducted.
ClinicalTrials.gov NCT01744743.
From January 2012 to December 2013, a total of 171 participants were enrolled, including 116 of SCH with TPOAb negative (SCH-TPOAb [-]) and 55 of SCH with TPOAb positive (SCH-TPOAb [+]). Compared to women in the SCH-TPOAb (+) group, those in the SCH-TPOAb (-) group had lower thyroid-stimulating hormone (TSH) levels at enrollment and 12-16 gestational weeks, and unexpectedly higher TSH levels at 30-34 gestational weeks and delivery, with a correspondingly lower levothyroxine dosage throughout pregnancy (all p < 0.05). Offspring in the SCH-TPOAb (-) group displayed lower GDDS scores at one year old than did their counterparts (adjusted p < 0.05), which was possibly related to the worse thyroid function control of maternal SCH-TPOAb (-). No statistically significant difference was found in the GDDS assessments of children at one, three, six, and 24 months of age. These results were also confirmed in subgroup analyses stratified by maternal thyroid characteristics at enrollment, namely TSH levels, free levothyroxine (T ) levels, and anti-thyroglobulin antibody (TgAb) status, as well as in sensitivity analyses excluding participants with no levothyroxine treatment at enrollment.
In the current clinical practice, infants born to mothers with SCH-TPOAb (-) displayed slightly lower neurodevelopmental scores at one year old than did those born to mothers with SCH-TPOAb (+) but this difference was not seen at two years.
妊娠亚临床甲状腺功能减退症（SCH）被报道对妊娠和儿童发育有不良影响。然而，其治疗指征需要在不同甲状腺过氧化物酶抗体（TPOAb）状态下进一步研究。
这是在中国真实环境下的前瞻性队列的二次分析。在第一次产前检查时，招募了患有妊娠 SCH 的孕妇，并根据 TPOAb 阳性将其分组。儿童神经发育在 1、3、6、12 和 24 个月时通过 Gesell 发育诊断量表（GDDS）进行评估。还进行了亚组分析和敏感性分析。
ClinicalTrials.gov NCT01744743。
从 2012 年 1 月至 2013 年 12 月，共纳入 171 名参与者，包括 116 名 TPOAb 阴性的 SCH 患者（SCH-TPOAb [-]）和 55 名 TPOAb 阳性的 SCH 患者（SCH-TPOAb [+]）。与 SCH-TPOAb（+）组的女性相比，SCH-TPOAb（-）组在妊娠和 12-16 周时的促甲状腺激素（TSH）水平较低，而在 30-34 周和分娩时的 TSH 水平较高，整个孕期的左甲状腺素剂量也相应较低（均 p<0.05）。SCH-TPOAb（-）组的婴儿在一岁时的 GDDS 评分低于对照组（调整后 p<0.05），这可能与母体 SCH-TPOAb（-）的甲状腺功能控制较差有关。在一岁、三岁、六岁和 24 个月时，儿童的 GDDS 评估结果无统计学差异。这些结果在按入组时的母体甲状腺特征（即 TSH 水平、游离左甲状腺素（T4）水平和抗甲状腺球蛋白抗体（TgAb）状态）进行的亚组分析中得到了证实，也在排除入组时无左甲状腺素治疗的参与者的敏感性分析中得到了证实。
在目前的临床实践中，与母体 SCH-TPOAb（+）相比，母体 SCH-TPOAb（-）的婴儿在一岁时的神经发育评分略低，但在两岁时没有差异。
