Eshkoli Tamar, Burrack Nitzan, Gordon-Irshai Adi, Cohen Bracha, Fraenkel Merav, Yoel Uri
Endocrinology Unit, Soroka University Medical Center, Beer-Sheva 84101, Israel.
Department of Obstetrics and Gynecology, Soroka University Medical Center, Beer-Sheva 84101, Israel.
J Clin Med. 2025 Jul 25;14(15):5278. doi: 10.3390/jcm14155278.
: Overt hypothyroidism during pregnancy has been linked to adverse outcomes, including preterm birth, low birth weight, and impaired fetal neurocognitive development. This study aimed to evaluate pregnancy complications in women with overt hypothyroidism (TSH ≥ 10) through a cross-sectional study. : Data from 259,897 live-birth pregnancies (2013-2022) from Clalit Health Services (CHS) were analyzed. The study included all CHS-insured women aged ≥ 18 years with available TSH results during pregnancy. Overt hypothyroidism was defined as a mean TSH ≥ 10 mIU/L, while the euthyroid reference group had TSH levels < 4 mIU/L and no history of hypothyroidism or levothyroxine use. Cases of overt hypothyroidism were matched with 15 controls using propensity score-based matching. Covariates included maternal age, ethnicity, socioeconomic status, IVF use, recurrent pregnancy loss, and smoking. Pregnancy complications were compared between groups using descriptive statistics and univariate analysis. A quasi-Poisson regression model was used to assess complication risk in overt hypothyroidism versus matched controls. : The final analysis included 9125 euthyroid and 611 overt hypothyroid pregnancies, with comparable baseline characteristics between groups. No significant differences were found in maternal age, ethnicity, socioeconomic scores, IVF rates, recurrent pregnancy loss, diabetes, smoking, gestational age at delivery, or rates of preterm birth, pre-eclampsia, gestational diabetes, cesarean section, and intrauterine growth restriction. Overall, overt hypothyroidism was not associated with increased complications. Sensitivity analyses using maximum TSH levels during pregnancy showed a slightly elevated risk for pregnancy complications (IRR 1.1, CI 1.04-1.18; = 0.002). : Overt hypothyroidism was not associated with an increased risk of adverse pregnancy outcomes when adjusted for confounding factors, suggesting that treatment decisions should be made on an individual basis.
妊娠期显性甲状腺功能减退与不良结局有关，包括早产、低出生体重和胎儿神经认知发育受损。本研究旨在通过横断面研究评估显性甲状腺功能减退（促甲状腺激素[TSH]≥10）女性的妊娠并发症。
分析了来自克拉利特健康服务机构（CHS）的259,897例活产妊娠（2013 - 2022年）的数据。该研究纳入了所有年龄≥18岁、妊娠期有可用TSH结果且由CHS承保的女性。显性甲状腺功能减退定义为平均TSH≥10 mIU/L，而甲状腺功能正常的参照组TSH水平<4 mIU/L且无甲状腺功能减退或左甲状腺素使用史。采用倾向得分匹配法将显性甲状腺功能减退病例与15名对照进行匹配。协变量包括产妇年龄、种族、社会经济地位、体外受精（IVF）使用情况、复发性流产和吸烟情况。使用描述性统计和单因素分析比较两组之间的妊娠并发症。采用准泊松回归模型评估显性甲状腺功能减退组与匹配对照组的并发症风险。
最终分析纳入了9125例甲状腺功能正常和611例显性甲状腺功能减退的妊娠病例，两组之间基线特征具有可比性。在产妇年龄、种族、社会经济评分、IVF率、复发性流产、糖尿病、吸烟、分娩时孕周或早产、子痫前期、妊娠期糖尿病、剖宫产和胎儿宫内生长受限发生率方面未发现显著差异。总体而言，显性甲状腺功能减退与并发症增加无关。使用妊娠期最高TSH水平进行的敏感性分析显示妊娠并发症风险略有升高（发病率比[IRR] 1.1，置信区间[CI] 1.04 - 1.18；P = 0.002）。
在对混杂因素进行调整后，显性甲状腺功能减退与不良妊娠结局风险增加无关，这表明治疗决策应基于个体情况做出。
