Department of Obstetrics and Gynaecology, JIPMER, Puducherry, India.
Department of Endocrinology, JIPMER, Puducherry, India.
Arch Gynecol Obstet. 2024 Oct;310(4):1935-1944. doi: 10.1007/s00404-024-07659-z. Epub 2024 Aug 4.
Subclinical hypothyroidism (SCH) in pregnancy is associated with adverse foetomaternal outcomes. The literature is scarce with respect to maternal and perinatal outcomes in women with mild SCH (TSH levels between 2.5-4 mIU/L).
The primary objective of the study was to compare the pregnancy outcome between SCH and euthyroid women. The secondary objectives were to find out the proportion of women with SCH having thyroid peroxidase antibodies (TPOAb) and to see the effect of TPOAb positivity on foetomaternal outcomes.
A total of 178 pregnant women were recruited in the first trimester, and those with TSH between 0.1 and 2.4 mIU/L were considered as euthyroid and 2.5-4mIU/L were labelled as SCH. Women with SCH underwent testing for TPOAb. All women were followed until delivery, and foetomaternal outcomes were assessed.
Amongst SCH group, there was a significantly higher proportion of overweight and obese women (76/91 (83.51%) vs 59/87 (68%), p = 0.031). The neonatal intensive care unit (NICU) admission was higher with adjusted odds ratio of 3.24 (1.41-7.43) in women with SCH as compared to euthyroid women. Otherwise, there was no difference in foetomaternal outcomes between the two groups. The proportion of gestational diabetes mellitus, intrauterine growth retardation and still birth were higher in SCH women with TPOAb as compared to euthyroid. Amongst SCH women, the proportion of induced labour was lower (aOR:0.27 (0.08-0.93) whereas the proportion of stillbirth and low APGAR scores were higher in TPOAb-positive women with a statistically significant difference and adjusted odds ratio (aOR:20.18 (1.84-220.83)) and (aOR:4.77 (1.06-21.3)), respectively, when compared to TPOAb-negative women.
There appears to be no difference in pregnancy outcomes between women with SCH and euthyroid women except higher NICU admission in SCH group. Future multi-centre large prospective studies are required to understand better about the pregnancy outcomes in these women.
妊娠亚临床甲状腺功能减退症（SCH）与不良母婴结局相关。关于 TSH 水平在 2.5-4mIU/L 之间的轻度 SCH 女性的母婴结局，文献资料较少。
本研究的主要目的是比较 SCH 孕妇与甲状腺功能正常孕妇的妊娠结局。次要目的是确定患有 SCH 的女性中甲状腺过氧化物酶抗体（TPOAb）的比例，并观察 TPOAb 阳性对母婴结局的影响。
共招募了 178 名孕妇在孕早期进行研究，TSH 水平在 0.1-2.4mIU/L 之间的被视为甲状腺功能正常，2.5-4mIU/L 之间的被标记为 SCH。患有 SCH 的女性接受 TPOAb 检测。所有女性均随访至分娩，评估母婴结局。
SCH 组中，超重和肥胖女性的比例明显较高（76/91（83.51%）比 59/87（68%），p=0.031）。SCH 组新生儿入住新生儿重症监护病房（NICU）的调整后优势比为 3.24（1.41-7.43），高于甲状腺功能正常的女性。否则，两组母婴结局无差异。SCH 组中 TPOAb 阳性的妊娠期糖尿病、宫内生长受限和死胎的比例高于甲状腺功能正常的女性。SCH 组中 TPOAb 阳性的女性诱导分娩的比例较低（aOR：0.27（0.08-0.93），而 TPOAb 阴性的女性死胎和低 APGAR 评分的比例较高，差异有统计学意义，调整后优势比（aOR）分别为 20.18（1.84-220.83）和 4.77（1.06-21.3）。
SCH 孕妇与甲状腺功能正常孕妇的妊娠结局似乎无差异，除 SCH 组 NICU 入住率较高外。需要进行更多的多中心大型前瞻性研究，以更好地了解这些女性的妊娠结局。
