孕妇糖代谢异常及维生素D缺乏对子代甲状腺功能的影响  

The effect of abnormal glucose metabolism and vitamin d deficiency of pregnant women on the thyroid functions of their offspring

作　　者：尉全平[1] 杨建宝[2] 翟洪然 侯凤香[1] 付晓康 孙子梅[1] YU Quan-ping;YANG Jian-bao;ZHAI Hong-ran;HOU Feng-xiang;FU Xiao-kang;SUN Zi-mei(Department of Pediatrics,the Second Affiliated Hospital of Hebei North University,Hebei Province,Zhangjiakou 075100,China;Department of Laboratory Medicine,the Second Affiliated Hospital of Hebei North University,Hebei Province,Zhangjiakou 075100,China;Digestive Endoscopy Center,the Second Affiliated Hospital of Hebei North University,Hebei Province,Zhangjiakou 075100,China)

机构地区：[1]河北北方学院附属第二医院儿科,河北张家口075100 [2]河北北方学院附属第二医院检验科,河北张家口075100 [3]河北北方学院附属第二医院消化内镜中心,河北张家口075100

出　　处：《河北医科大学学报》2023年第5期553-556,578,共5页Journal of Hebei Medical University

基　　金：张家口市市级科技计划财政资助项目(1911022D)。

摘　　要：目的探究妊娠期糖尿病(gestational diabetes mellitus,GDM)孕妇血糖及25-羟维生素D[25-hydroxyvitamin D,25-(OH)D]水平对子代新生儿甲状腺功能的影响。方法分析186例GDM孕妇的临床资料,按血糖控制情况分为GDM控制组102例和GDM未控制组84例,并随机选取同期健康孕妇98例作为对照组,对比3组孕妇的空腹血糖(fasting plasma glucose,FPG)、糖化血红蛋白(glycated hemoglobin,HbA_(1)c)、25-(OH)D水平、甲状腺功能指标及对应新生儿甲状腺功能指标。依据孕妇维生素D水平分为维生素D缺乏组和维生素D不缺乏组,比较2组对应新生儿先天性甲状腺功能减低症(congenital hypothyroidism,CH)的发病率。结果GDM未控制组孕妇FPG、HbA_(1)c高于其他2组;GDM未控制组孕妇血25-(OH)D水平最低,GDM控制组次之,对照组最高。GDM未控制组孕妇促甲状腺激素(thyroid stimulating hormone,TSH)最高,GDM控制组次之,对照组最低;GDM未控制组孕妇游离三碘甲状腺原氨酸(free triiodothyronine,FT3)、游离甲状腺激素(free thyroxin,FT4)低于其他两组。GDM未控制组子代的TSH高于GDM控制组、对照组,且FT3、FT4均低于其他两组。孕妇维生素D缺乏组对应新生儿CH发病率高于维生素D不缺乏组。结论孕妇糖代谢异常和维生素D缺乏可引起子代甲状腺功能减低,根据GDM孕妇的血糖及维生素D相关监测指标,采取针对性干预治疗,对预防新生儿甲状腺功能异常、生长发育异常等疾病有重要临床意义。Objective To explore the effect of blood glucose and 25-hydroxyvitamin D[25-(OH)D]level of pregnant women with gestational diabetes mellitus(GDM)on the thyroid functions of their offspring newborns.Methods A total of 186 pregnant women with GDM were divided into GDM intervention group(n=102)and GDM non-intervention group(n=84)according to their blood glucose control.Another 98 healthy pregnant women in the same period were randomly selected as the control group.The levels of fasting plasma glucose(FPG),glycated hemoglobin(HbA_(1)c),25-(OH)D,thyroid function indexes and corresponding neonatal thyroid function indexes were compared in the three groups.All pregnant women were divided into vitamin D deficiency group and vitamin D non-deficiency group according to their 25-(OH)D levels,and the corresponding incidence rate of neonatal congenital hypothyroidism(CH)was compared between two groups.Results The levels of FPG and HbA_(1)c of pregnant women in GDM non-intervention group were higher than those in other two groups.The blood 25-(OH)D level of pregnant women was the lowest in GDM non-intervention group,followed by GDM intervention group,and the highest in control group.The thyroid stimulating hormone(TSH)of pregnant women was the highest in GDM non-intervention group,followed by GDM intervention group,and the lowest in control group.The free triiodothyronine(FT3)and free thyroxin(FT4)in GDM non-intervention group were lower than those of the other two groups.The TSH of the offspring of GDM non-intervention group was higher than those of GDM intervention group and control group.The FT3 and FT4 of the offspring of GDM non-intervention group were lower than those of the other two groups,and the corresponding incidence rate of neonatal CH of vitamin D deficiency group was higher than that of vitamin D non-deficiency group.Conclusion Abnormal glucose metabolism and vitamin D deficiency of pregnant women can cause hypothyroidism of their offspring.According to the blood glucose and vitamin D related monitoring indexes

关 键 词：糖尿病 妊娠 血糖 25-羟维生素D 

分 类 号：R714.256[医药卫生—妇产科学]