Endocrine Unit Centre Hospitalier Universitaire (CHU) Saint Pierre, Université Libre de Bruxelles (ULB), Rue Haute, Brussels, Belgium.
Departement of Gynecology and Obstetrics, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles (ULB), Rue Haute, Brussels, Belgium.
Eur Thyroid J. 2023 Oct 18;12(6). doi: 10.1530/ETJ-23-0112. Print 2023 Dec 1.
The aim of the study was to investigate the impact of suppressed serum TSH levels (sTSH) during early pregnancy on maternal and neonatal outcomes.
In this single-centre, retrospective cohort study 1081 women were screened at 11.8 ± 2.4 weeks of pregnancy for TSH, free T4 (FT4) and TPOAb. Exclusion criteria were twin- and assisted- reproduction pregnancies, women with TSH levels >3.74 mIU/L, severe hyperthyroidism, treated for thyroid dysfunction before or after screening and gestational blood sampling <6 or >16 weeks of pregnancy. The prevalence of adverse pregnancy outcomes was compared between the study group sTSH (TSH: < 0.06 mIU/L; n = 36) and euthyroid controls (TSH: 0.06-3.74 mIU/L; n = 1045), and the impact of sTSH on pregnancy outcomes verified in logistic regression analyses.
Median (IQR) serum TSH level in women with sTSH was 0.03 (0.03-0.03) vs 1.25 (0.81-1.82) mIU/L in controls and FT4 levels 18.0 (14.4-20.3) vs 14.2 (12.9-15.4) pmol/L; both P < 0.001. None of the women with sTSH had thyrotropin receptor antibodies. Compared with controls, the prevalence of TPOAb positivity (TAI) was comparable between groups (5.6% vs 6.6%; P = 0.803). The prevalence of maternal and neonatal pregnancy outcomes was comparable between the study and control group. The logistic regression analyses with corrections for TAI, FT4 and demographic parameters confirmed the absence of an association between sTSH, and the following outcomes: iron deficient anaemia (aORs (95% CI)): 1.41 (0.64-2.99); P = 0.385, gestational diabetes: 1.19 (0.44-2.88); P = 0.713, preterm birth: 1.57 (0.23-6.22);P = 0.574 and low Apgar-1' score: 0.71 (0.11-2.67); P = 0.657.
Suppressed serum TSH levels during the first to early second trimester of pregnancy were not associated with altered maternal or neonatal outcomes.
本研究旨在探讨孕早期抑制性血清促甲状腺激素（sTSH）水平对母婴结局的影响。
在这项单中心、回顾性队列研究中，对 1081 名孕妇在妊娠 11.8 ± 2.4 周时进行 TSH、游离 T4（FT4）和 TPOAb 筛查。排除标准为双胞胎妊娠和辅助生殖妊娠、TSH 水平>3.74mIU/L、严重甲状腺功能亢进症、筛查前或后甲状腺功能障碍治疗、妊娠期采血<6 或>16 周。在逻辑回归分析中，比较研究组 sTSH（TSH：<0.06mIU/L；n=36）和甲状腺功能正常对照组（TSH：0.06-3.74mIU/L；n=1045）的不良妊娠结局发生率，并验证 sTSH 对妊娠结局的影响。
sTSH 组女性血清 TSH 中位数（IQR）为 0.03（0.03-0.03）vs 对照组的 1.25（0.81-1.82）mIU/L，FT4 水平分别为 18.0（14.4-20.3）vs 14.2（12.9-15.4）pmol/L；均 P<0.001。sTSH 组无促甲状腺激素受体抗体。与对照组相比，两组 TPOAb 阳性（TAI）患病率相似（5.6% vs 6.6%；P=0.803）。研究组和对照组的母婴妊娠结局发生率相似。对 TAI、FT4 和人口统计学参数进行校正的逻辑回归分析证实，sTSH 与以下结局之间无关联：缺铁性贫血（比值比（95%CI））：1.41（0.64-2.99）；P=0.385、妊娠期糖尿病：1.19（0.44-2.88）；P=0.713、早产：1.57（0.23-6.22）；P=0.574 和低 Apgar-1'评分：0.71（0.11-2.67）；P=0.657。
妊娠早期至早期第二孕期抑制性血清 TSH 水平与母婴结局改变无关。
