Li Xing, Zhang Zhuyuan, Cai Wen, Zhou Xuexin, Zhang Yan, Wu Cailiang, Xu Xianming, Wu Hao
Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, People's Republic of China.
Int J Womens Health. 2023 Dec 11;15:1951-1957. doi: 10.2147/IJWH.S436651. eCollection 2023.
The relationship of iron deficiency and thyroid hormone has been researched a lot among pregnant or other healthy population. However, invisible iron deficiency, namely shortage of serum ferritin (sFer) level, has been barely investigated among Chinese pregnant women. This study aimed to explore the effects of sFer status on thyroid function and pregnancy outcomes in a population-based upper first-class hospital.
A total of 781 singleton pregnant women of gestation in Shanghai General Hospital took part in this retrospective cohort study. The participants were divided into four groups by quartiles of serum ferritin levels (Q1-4). Binary logistic regressions were used to examine the strength of association between the different traits and the serum ferritin (sFer) quartiles separately, where Q1 (lowest ferritin quartile) was taken as the base reference. One-way ANOVA was adopted to compare the averages of the different variables across sFer quartiles. Categorical measures were compared by Fisher exact test or chi-square test.
As the sFer concentration rises, incidence of premature birth (15.8%vs 12.3% vs 9.20% vs 6.20% p = 0.016) as well as threatened miscarriage (14.8% vs 7.2% vs 8.70% vs 6.70% p = 0.021) presented a downward trend. Compared with the other sFer group, subjects of the low sFer group were older, more often to be found to have lower serum γT3 and FT4 levels in early pregnancy but not in middle pregnancy.
sFer concentration in the first trimester can affect thyroid function. The correction of invisible iron deficiency with inadequate sFer status prior to pregnancy or during early pregnancy is imperative, not only to prevent anemia, but also for maintaining optimum thyroid function and normal fetal development. For clinicians, sFer status of pregnant women should be attached great importance apart from attention to iron level.
缺铁与甲状腺激素之间的关系在孕妇或其他健康人群中已有大量研究。然而，在中国孕妇中，隐形缺铁，即血清铁蛋白（sFer）水平不足，却鲜有研究。本研究旨在以上海市一家三甲医院的人群为基础，探讨sFer状态对甲状腺功能及妊娠结局的影响。
上海交通大学医学院附属新华医院的781名单胎妊娠孕妇参与了这项回顾性队列研究。参与者按血清铁蛋白水平四分位数（Q1 - 4）分为四组。采用二元逻辑回归分别检验不同特征与血清铁蛋白（sFer）四分位数之间的关联强度，其中Q1（最低铁蛋白四分位数）作为基础参照。采用单因素方差分析比较不同变量在sFer四分位数间的均值。分类指标采用Fisher精确检验或卡方检验进行比较。
随着sFer浓度升高，早产发生率（15.8%对12.3%对9.20%对6.20%，p = 0.016）以及先兆流产发生率（14.8%对7.2%对8.70%对6.70%，p = 0.021）呈下降趋势。与其他sFer组相比，低sFer组的受试者年龄更大，并在孕早期更常出现血清γT3和FT4水平较低的情况，但孕中期则不然。
孕早期的sFer浓度可影响甲状腺功能。在妊娠前或妊娠早期纠正sFer状态不足的隐形缺铁至关重要，这不仅是为了预防贫血，也是为了维持最佳甲状腺功能和胎儿正常发育。对于临床医生而言，除关注铁水平外，还应高度重视孕妇的sFer状态。
