早孕期母体甲状腺功能与妊娠期糖尿病的关系：一项前瞻性队列研究。
Association Between Maternal Thyroid Function in Early Pregnancy and Gestational Diabetes: A Prospective Cohort Study.
机构信息
Department of Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing 100026, China.
Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing 100026, China.
出版信息
J Clin Endocrinol Metab. 2024 Jan 18;109(2):e780-e787. doi: 10.1210/clinem/dgad518.
CONTEXT
Previous studies on the relationship between thyroid gland function and the development of gestational diabetes mellitus (GDM) have reported different results, leading to the need for a cohort study design with a large sample size.
OBJECTIVE
We aimed to investigate the relationship between thyroid function in early pregnancy and GDM.
METHODS
This was a prospective cohort study based on the China Birth Cohort Study (CBCS), from February 2018 to December 2020. The study took place at a tertiary maternal and child health hospital. A total of 36 256 pregnant women were successfully recruited based on the CBCS. The main outcome measure was GDM.
RESULTS
This study consisted of 26 742 pregnant women who met the inclusion criteria, of whom 3985 (14.90%) were diagnosed with GDM, and the women with GDM were older than their healthy counterparts (33.26 ± 4.01 vs 31.51 ± 3.76 years, P < .001). After removing potential influencing variables, we found that increased thyroid-stimulating hormone (TSH) (adjusted odds ratio [aOR] 1.030, 95% CI 1.007, 1.054, P = .012) and subclinical hypothyroidism (aOR 1.211, 95% CI 1.010, 1.451, P = .039), but not free thyroxine or thyroid peroxidase antibody, were associated with the occurrence of GDM. Further analysis indicated a nonlinear relationship between TSH and GDM (P < .05): when TSH ≤ 1.24 mIU/L, the occurrence of GDM was elevated with increasing TSH, but when TSH > 1.24 mIU/L, this trend was not obvious.
CONCLUSION
High TSH might be associated with increased risk of GDM.
背景
此前关于甲状腺功能与妊娠期糖尿病（GDM）发展之间关系的研究结果各异，因此需要采用大样本量的队列研究设计。
目的
探讨早孕期甲状腺功能与 GDM 的关系。
方法
这是一项基于中国生育队列研究（CBCS）的前瞻性队列研究，于 2018 年 2 月至 2020 年 12 月进行，地点为一家三级妇幼保健院。根据 CBCS，共成功招募了 36256 名孕妇。主要结局指标为 GDM。
结果
本研究纳入了 26742 名符合纳入标准的孕妇，其中 3985 名（14.90%）被诊断为 GDM，GDM 组孕妇年龄大于健康对照组（33.26±4.01 岁比 31.51±3.76 岁，P<0.001）。在排除潜在的影响变量后，我们发现，较高的促甲状腺激素（TSH）（校正优势比[aOR]1.030，95%CI 1.007，1.054，P=0.012）和亚临床甲状腺功能减退（aOR 1.211，95%CI 1.010，1.451，P=0.039）与 GDM 的发生有关，但游离甲状腺素或甲状腺过氧化物酶抗体与 GDM 无关。进一步分析表明 TSH 与 GDM 之间存在非线性关系（P<0.05）：当 TSH≤1.24 mIU/L 时，随着 TSH 的升高，GDM 的发生风险升高，但当 TSH>1.24 mIU/L 时，这种趋势并不明显。
结论
高 TSH 可能与 GDM 风险增加有关。
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