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孕期左甲状腺素治疗亚临床甲状腺功能减退对后代结局影响的荟萃分析。

Meta-analysis of the effects of levothyroxine therapy for subclinical hypothyroidism during pregnancy on offspring outcomes.

作者信息

You Zhiying, Zhang Yayu, Liu Sen, Li Jia, Xu Xiaofang, Song Dan

机构信息

Department of Neonatology, Affiliated Hospital of Inner Mongolia Medical University, Huhhot, China.

Department of Ultrasound, The Inner Mongolia Hospital of Peking University Cancer Hospital, Hohhot, China.

出版信息

Front Pediatr. 2025 Jul 10;13:1530859. doi: 10.3389/fped.2025.1530859. eCollection 2025.

DOI:10.3389/fped.2025.1530859
PMID:40708901
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12287073/
Abstract

OBJECTIVE

To conduct a systematic evaluation of the impact of levothyroxine (L-T4) therapy on birth outcomes in pregnancies complicated by subclinical hypothyroidism (SCH).

METHODS

A thorough literature review was conducted across several databases, including PubMed, Embase, Cochrane Library, Web of Science, Sinomed, Wanfang Data Knowledge Service Platform, China National Knowledge Internet (CNKI), and VIP Chinese Science and Technology Journal Database (VIP), to investigate the impact of L-T4 treatment of SCH during pregnancy on birth outcomes in offspring. Based on predefined inclusion and exclusion criteria, two researchers were appointed to extract data and assess the quality of the literature. Subsequently, meta-analysis was performed using RevMan 5.4 and Stata 14 software.

RESULTS

The study incorporated a total of thirty randomized controlled trials (RCTs) and cohort studies, encompassing four countries and regions. The sample included 18,568 pregnant women with SCH and 5,578 pregnant women undergoing L-T4 treatment. The meta-analysis indicated that L-T4 treatment for SCH during pregnancy may reduce the incidence of preterm birth (RCTs (RR = 0.56, 95% CI = 0.41-0.77), cohort studies (RR = 0.71, 95% CI = 0.51-0.99)) and low birth weight infants (LBWI) (RCTs (RR = 0.56, 95% CI = 0.35-0.89), cohort studies (RR = 0.71, 95% CI = 0.58-0.88)), while it does not significantly affect the risk of macrosomia (RCTs (RR = 0.29, 95% CI = 0.06-1.38), cohort studies (RR = 0.70, 95% CI = 0.30-1.62)), small for gestational age (SGA) infants (RCTs (RR = 1.18, 95% CI = 0.74-1.90)), or congenital hypothyroidism (CH) (cohort studies (RR = 1.27, 95% CI = 0.16-10.07)) in children. No significant difference in birth weight (RCTs (RR = 0.10, 95% CI = -0.04-0.24), cohort studies (RR = 0.10, 95% CI = -0.08-0.28)) was observed between the L-T4 treatment group and the non L-T4 treatment group. Regarding neonatal cord blood thyroid function, the TSH levels in the L-T4 treatment group were lower compared to the non L-T4 group (RCTs (RR = -2.48, 95% CI = -4.51--0.45), cohort studies (RR = -3.53, 95% CI = -4.27 - -2.79)); however, no significant differences were found in FT3 (RCTs (RR = 0.06, 95% CI = -0.24-0.36), cohort studies (RR = 0.08, 95% CI = -0.72-0.88)) and FT4 levels (RCTs (RR = 0.07, 95% CI = -0.41-0.56), cohort studies (RR = 0.03, 95% CI = -1.18-1.24)) between the two groups.

CONCLUSION

L-T4 treatment appears to reduce the incidence of preterm birth and LBWI in pregnant mothers with SCH, but it does not significantly affect the incidence of macrosomia, SGA, CH, or birth weight. Regarding the thyroid function in neonatal umbilical cord blood, L-T4 treatment in SCH pregnant women can reduce TSH levels in the umbilical cord blood of their newborns, while having no significant effect on FT3 and FT4 levels.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420251016450, PROSPERO CRD420251016450.

摘要

目的

对左甲状腺素（L-T4）治疗对合并亚临床甲状腺功能减退症（SCH）的妊娠分娩结局的影响进行系统评价。

方法

在多个数据库中进行全面的文献检索，包括PubMed、Embase、Cochrane图书馆、Web of Science、中国生物医学文献数据库、万方数据知识服务平台、中国知网（CNKI）和维普中文科技期刊数据库（VIP），以研究孕期L-T4治疗SCH对后代分娩结局的影响。根据预先设定的纳入和排除标准，指定两名研究人员提取数据并评估文献质量。随后，使用RevMan 5.4和Stata 14软件进行荟萃分析。

结果

该研究共纳入30项随机对照试验（RCT）和队列研究，涉及4个国家和地区。样本包括18568例SCH孕妇和5578例接受L-T4治疗的孕妇。荟萃分析表明，孕期L-T4治疗SCH可能降低早产发生率（RCT（RR = 0.56，95%CI = 0.41 - 0.77），队列研究（RR = 0.71，95%CI = 0.51 - 0.99））和低出生体重儿（LBWI）发生率（RCT（RR = 0.56，95%CI = 0.35 - 0.89），队列研究（RR = 0.71，95%CI = 0.58 - 0.88）），而对巨大儿风险（RCT（RR = 0.29，95%CI = 0.06 - 1.38），队列研究（RR = 0.70，95%CI = 0.30 - 1.62））、小于胎龄（SGA）儿（RCT（RR = 1.18，95%CI = 0.74 - 1.90））或儿童先天性甲状腺功能减退症（CH）（队列研究（RR = 1.27，95%CI = 0.16 - 10.07））无显著影响。L-T4治疗组与非L-T4治疗组在出生体重方面无显著差异（RCT（RR = 0.10，95%CI = -0.04 - 0.24），队列研究（RR = 0.10，95%CI = -0.08 - 0.28））。关于新生儿脐血甲状腺功能，L-T4治疗组的TSH水平低于非L-T4组（RCT（RR = -2.48，95%CI = -4.51 - -0.45），队列研究（RR = -3.53，95%CI = -4.27 - -2.79））；然而，两组之间的FT3（RCT（RR = 0.06，95%CI = -0.24 - 0.36），队列研究（RR = 0.08，95%CI = -0.72 - 0.88））和FT4水平（RCT（RR = 0.07，95%CI = -0.41 - 0.56），队列研究（RR = 0.03，95%CI = -1.18 - 1.24））无显著差异。

结论

L-T4治疗似乎可降低SCH孕妇早产和LBWI的发生率，但对巨大儿、SGA、CH的发生率或出生体重无显著影响。关于新生儿脐血甲状腺功能，SCH孕妇接受L-T4治疗可降低新生儿脐血TSH水平，而对FT3和FT4水平无显著影响。

系统评价注册

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420251016450，PROSPERO CRD420251016450。

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