孕期铁状态指标与甲状腺激素浓度的关联：一项系统评价和荟萃分析。
Association of iron status indicators with thyroid hormone concentrations during pregnancy: a systematic review and meta-analysis.
作者信息
Parsaei Mohammadamin, Dashtkoohi Mohadese, Amirkhalili Elahe, Chashmyazdan Mohammadreza, Korevaar Tim I M, Nazeri Pantea
机构信息
Breastfeeding Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Vali-e-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
出版信息
Front Endocrinol (Lausanne). 2025 Jan 28;16:1533169. doi: 10.3389/fendo.2025.1533169. eCollection 2025.
BACKGROUND
Maternal thyroid hormones play a vital role in fetal development, and imbalances can lead to adverse outcomes. Iron deficiency may impair thyroid function due to iron's essential role in iodine oxidation during thyroid hormone synthesis. This review examines the relationship between various indicators of maternal iron status and thyroid function during pregnancy.
METHODS
We conducted a systematic search in MEDLINE/PubMed, Web of Science, Embase, Scopus, and the Cochrane Library for studies published up to 2023. Meta-analyses determined pooled thyroid hormone levels in patients with and without iron deficiency, using serum ferritin (cut-off = 30 µg/L) and hemoglobin (cut-off = 11 g/dL). Meta-regression analyses examined linear relationships between iron status indicators and thyroid hormones.
RESULTS
Forty-seven studies involving 53,152 pregnant women were included. Meta-analysis showed no significant difference in thyroid-stimulating hormone, free T4, or total T4 when considering serum ferritin levels in iron-deficient versus iron-sufficient individuals. However, regarding hemoglobin levels, iron deficiency was associated with higher thyroid-stimulating hormone (2.31 mIU/L vs. 1.75 mIU/L) and lower free T4 (10.7 pmol/L vs. 13.3 pmol/L), but not total T4. Meta-regression revealed no significant associations between serum ferritin and thyroid hormones. Conversely, maternal hemoglobin levels were inversely associated with thyroid-stimulating hormone (P-value = 0.009) and directly associated with free T4 (P-value < 0.001), with no significant link to total T4.
CONCLUSIONS
Maternal hemoglobin levels are more strongly correlated with thyroid function than serum ferritin levels. This suggests that monitoring hemoglobin could enhance the early detection and management of thyroid dysfunction during pregnancy.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO, identifier CRD4202451820.
背景
母体甲状腺激素在胎儿发育中起着至关重要的作用，其失衡可能导致不良后果。缺铁可能会损害甲状腺功能，因为铁在甲状腺激素合成过程中的碘氧化中起着关键作用。本综述探讨了孕期母体铁状态的各种指标与甲状腺功能之间的关系。
方法
我们在MEDLINE/PubMed、Web of Science、Embase、Scopus和Cochrane图书馆中进行了系统检索，以查找截至2023年发表的研究。荟萃分析使用血清铁蛋白（临界值 = 30 µg/L）和血红蛋白（临界值 = 11 g/dL）确定缺铁和不缺铁患者的合并甲状腺激素水平。荟萃回归分析研究了铁状态指标与甲状腺激素之间的线性关系。
结果
纳入了47项涉及53152名孕妇的研究。荟萃分析表明，在考虑缺铁个体与铁充足个体的血清铁蛋白水平时，促甲状腺激素、游离T4或总T4没有显著差异。然而，就血红蛋白水平而言，缺铁与较高的促甲状腺激素（2.31 mIU/L对1.75 mIU/L）和较低的游离T4（10.7 pmol/L对13.3 pmol/L）相关，但与总T4无关。荟萃回归显示血清铁蛋白与甲状腺激素之间无显著关联。相反，母体血红蛋白水平与促甲状腺激素呈负相关（P值 = 0.009），与游离T4呈正相关（P值 < 0.001），与总T4无显著关联。
结论
母体血红蛋白水平与甲状腺功能的相关性比血清铁蛋白水平更强。这表明监测血红蛋白可以加强孕期甲状腺功能障碍的早期检测和管理。
系统评价注册
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