妊娠期甲状腺功能、糖脂代谢变化及增重与妊娠期糖尿病发生风险关系  

correlation between the hypothyroidism,metabolic changes,and weight gain of pregnant women and their risk of gestational diabetes mellitus occurrence

作　　者：赵林芳 陈丹丹 ZHAO Linfang;CHEN Dandan(Shaoxing Keqiao District Maternal and Child Health Care Hospital,Shaoxing,Zhejiang Province,312000)

机构地区：[1]浙江省绍兴市柯桥区妇幼保健医院,312000

出　　处：《中国计划生育学杂志》2023年第7期1727-1731,共5页Chinese Journal of Family Planning

摘　　要：目的:探讨妊娠期甲状腺功能减退(甲减)、血糖血脂水平变化及孕期体重增加与妊娠期糖尿病(GDM)发生关系。方法:回顾性收集2019年1月—2021年12月本院产科门诊筛查出的331例GDM孕妇作为GDM组,同期糖耐量检查正常孕妇340例为对照组,对比两组孕早期促甲状腺激素(TSH)水平异常率、甲状腺功能减退率、甲状腺过氧化物酶抗体(TPOAb)阳性率、血清游离三碘甲状原氨酸(FT3)、游离甲状腺素(FT4)水平,分析两组孕期生理指标、血糖血脂指标差异,采用logistic回归模型分析GDM与上述指标关系。结果:GDM组孕期增重、糖尿病家族史占比高于对照组(均P<0.05),年龄、孕前体质指数、初产妇占比、收缩压、舒张压两组无差异(P>0.05);GDM组孕早期TSH增高、甲状腺功能减退、TPOAb阳性占比高于对照组(均P<0.05),血清FT3、FT4水平两组无差异(P>0.05);GDM组空腹血糖、糖化血红蛋白、甘油三酯(TG)、低密度脂蛋白均高于对照组(均P<0.05),血清总胆固醇、高密度脂蛋白水平两组无差异(P>0.05)。logistic回归分析,孕期体重增加较多、糖尿病家族史、甲状腺功能减退、血清TG高水平是GDM发生的独立危险因素(P<0.05)。结论:孕早期TSH水平增加;孕期体重增加较多、合并糖尿病家族史、合并甲状腺功能减退、血清TG高水平是GDM发生的独立危险因素。Objective:To explore the correlation between the hypothyroidism,metabolic changes,and weight gain of pregnant women and their risk of gestational diabetes mellitus(GDM)occurrence.Methods:331pregnant women with GDM screened in the obstetric clinic from January 2019to December 2021were collected in study group retrospectively,and 340pregnant women with normal glucose tolerance during the same period were selected in control group.The abnormal rate of thyrotropic stimulating hormone(TSH)level,the hypothyroidism rate,the positive rate of thyroid peroxidase antibody(TPOAb),and the serum free triiodothyronine(FT3)and free thyroxine(FT4)levels of the women were compared between the two groups.The differences of the individual physiological indicators and blood glucose and lipid indicators of the women during pregnancy were statistically analyzed.The correlation between the GDM occurrence of the women and their above indicators was analyzed by logistic regression model.Results:The proportions of the pregnancy weight gain and the family history of diabetes of the women in the study group were significantly higher than those of the women in the control group(all P<0.05).There were no significant differences in the age,the pre-pregnancy body mass index,the proportion of primipara,and the values of systolic blood pressure and diastolic blood pressure of the women between the two groups(P>0.05).The proportions of the increase of TSH level,the hypothyroidism,and the TPOAb positive of the women in the study group during the first trimester of pregnancy were significantly higher than those of the women in the control group(all P<0.05).There were no significant differences in the serum FT3and FT4levels of the women between the two groups(P>0.05).The levels of fasting blood glucose,glycated hemoglobin,triglyceride(TG),and low density lipoprotein of the women in the study group were significantly higher than those of the women in the control group(all P<0.05).There were no significant differences in the serum total cholesterol and

关 键 词：妊娠期糖尿病 妊娠期甲状腺功能减退 促甲状腺激素 甲状腺过氧化物酶抗体 血糖 血脂 影响因素 

分 类 号：R714.256[医药卫生—妇产科学]