Hu Minhui, Gao Shen, Huang Kaikun, Wang Xueran, Li Juan, Li Shuangying, Li Zhan, Yue Wentao, Su Shaofei, Zhang Enjie, Xie Shuanghua, Liu Jianhui, Zhang Yue, Luan Yingyi, Liu Ruixia, Yin Chenghong
Department of Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing 100026, China.
Int J Med Sci. 2025 Jan 1;22(3):575-584. doi: 10.7150/ijms.103874. eCollection 2025.
The relationship between maternal thyroid-stimulating hormone (TSH), free thyroxine (FT4) and thyroid peroxidase antibody (TPOAb) status and hypertensive disorders of pregnancy (HDP) remains uncertain. This was a prospective cohort study based on the China Birth Cohort Study (CBCS). 36,256 women were included at 6 to 13 gestation from February 2018 to December 2020. Generalized linear mixed models were used to investigate the association between thyroid function and HDP/BP. We further performed multiple subgroup analyses to test the robustness of this association. The final study population was 25,608, and the overall incidence of HDP was 8.0%. After adjusting for maternal age, pre-pregnancy BMI, education, household annual income, smoking status, conception method and parity, the odds of HDP increased by 3.0% with a 1-unit increase in TSH (OR 1.03, 95% CI 1.04-1.06). Maternal TSH and TPOAb positivity were associated with a higher risk of preeclampsia or eclampsia but not gestational hypertension (TSH: OR 1.04, 95% CI 1.01-1.07; TPOAb positivity: OR 1.30, 95% CI 1.09-1.56). TSH and TPOAb positivity were significantly and positively associated with systolic pressure (TSH: β 0.02, 95% CI 0.07-0.26; TPOAb positivity: β 0.02, 95% CI 0.12-0.98) and diastolic pressure (TSH: β 0.02, 95% CI 0.02-0.17; TPOAb positivity: β 0.02, 95% CI 0.06-0.75). Subgroup analyses suggested that the association between TSH and diastolic pressure was stronger in those with BMI ≥ 25 kg/m ( = 0.014). Our founds suggest that high TSH and TPOAb positivity in the first trimester are associated with an increased risk of preeclampsia or eclampsia.
孕妇促甲状腺激素（TSH）、游离甲状腺素（FT4）及甲状腺过氧化物酶抗体（TPOAb）状态与妊娠高血压疾病（HDP）之间的关系仍不明确。这是一项基于中国出生队列研究（CBCS）的前瞻性队列研究。2018年2月至2020年12月期间，纳入了36256名妊娠6至13周的女性。采用广义线性混合模型研究甲状腺功能与HDP/血压之间的关联。我们进一步进行了多项亚组分析以检验这种关联的稳健性。最终研究人群为25608人，HDP的总体发病率为8.0%。在调整了孕妇年龄、孕前体重指数、教育程度、家庭年收入、吸烟状况、受孕方式和产次后，TSH每增加1个单位，HDP的发病几率增加3.0%（比值比1.03，95%置信区间1.04 - 1.06）。孕妇TSH及TPOAb阳性与子痫前期或子痫的较高风险相关，但与妊娠期高血压无关（TSH：比值比1.04，95%置信区间1.01 - 1.07；TPOAb阳性：比值比1.30，95%置信区间1.09 - 1.56）。TSH及TPOAb阳性与收缩压（TSH：β0.02，95%置信区间0.07 - 0.26；TPOAb阳性：β0.02，95%置信区间0.12 - 0.98）和舒张压（TSH：β0.02，95%置信区间0.02 - 0.17；TPOAb阳性：β0.02，95%置信区间0.06 - 0.75）显著正相关。亚组分析表明，在体重指数≥25kg/m²的人群中，TSH与舒张压之间的关联更强（P = 0.014）。我们的研究结果表明，孕早期TSH升高及TPOAb阳性与子痫前期或子痫的风险增加有关。
