妊娠早期单纯低甲状腺素血症增加巨大儿及大于胎龄儿风险:回顾性队列研究  

Isolated Maternal Hypothyroxinemia in the First Trimester Increases the Risks of Macrosomia and Large for Gestational Age During Pregnancy:a Retrospective Cohort Study

作　　者：魏占超 王佳 刘程 郑薇 李光辉[1] WEI Zhanchao;WANG Jia;LIU Cheng;ZHENG Wei;LI Guanghui(Division of Endocrinology and Metabolism,Department of Obstetrics,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing 100026,China;Department of Gynecology and Obstetrics,the Second Hospital of Jilin University,Changchun 130062,China;Department of Obstetrics,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing 100026,China)

机构地区：[1]首都医科大学附属北京妇产医院围产内分泌代谢科,北京市100026 [2]吉林大学第二医院妇产科,吉林省长春市130062 [3]首都医科大学附属北京妇产医院围产医学部,北京市100026

出　　处：《中国全科医学》2024年第29期3595-3601,共7页Chinese General Practice

基　　金：国家自然科学基金资助项目(82301916,82171671);北京市卫生健康委员会高层次公共卫生技术人才建设项目培养计划(领军人才-02-02);国家重点研发计划(2016YFC1000304)。

摘　　要：背景甲状腺激素对胎儿的生长发育至关重要。妊娠期临床甲状腺功能减退症和妊娠合并Graves病甲亢是众所周知的小于胎龄儿(SGA)的危险因素。但妊娠早期单纯低甲状腺素血症(IMH)是否影响新生儿出生体质量,目前研究较少且结果不一致。目的探讨妊娠早期IMH与新生儿出生体质量的关系。方法本研究为回顾性队列研究,选择2016年1月—2020年10月在首都医科大学附属北京妇产医院产科建档、产检并分娩或终止妊娠的单胎孕妇,根据本研究制定的妊娠早期血清游离甲状腺素(FT4)及促甲状腺激素(TSH)的2.5th和97.5th分成IMH组(344例)和对照组(19426)例,采用二分类Logistic回归分析妊娠早期IMH与新生儿出生体质量的相关性,再依据孕前BMI(PPBMI)将研究对象分为超重/肥胖(PPBMI≥24.0 kg/m2,IMH组69例/对照组3376例)和非超重/肥胖(PPBMI<24.0 kg/m2,IMH组275例/对照组16050例)。比较不同分组及亚组孕妇的妊娠结局以及IMH与妊娠结局之间的关系。结果多因素Logistic回归分析结果显示,IMH组巨大儿及大于胎龄儿(LGA)发生率分别为对照组的1.627倍(OR=1.627,95%CI=1.103~2.399,P=0.014)和1.681倍(OR=1.681,95%CI=1.288~2.196,P<0.001);两组低出生体质量儿(LBW)及SGA发生率间差异均无统计学意义(P>0.05)。在PPBMI<24.0 kg/m2中,IMH组巨大儿及LGA发生率分别为对照组的2.021倍(OR=2.021,95%CI=1.320~3.093,P=0.001)和1.788倍(OR=1.788,95%CI=1.322~2.418,P<0.001)。而在PPBMI≥24.0 kg/m2中,两组巨大儿、LBW、LGA及SGA发生率间差异均无统计学意义(P>0.05)。结论孕妇在妊娠早期患IMH会增加分娩巨大儿或LGA的发生风险,尤其在孕前非超重/肥胖孕妇中。在孕前超重/肥胖孕妇中,妊娠早期患IMH并不会增加巨大儿或LGA的发生风险。而LBW及SGA发生率在整体及孕前超重/肥胖、孕前非超重/肥胖孕妇中均无明显差异。Background Thyroid hormones are very important for normal growth and development of fetus.Hypothyroidism during pregnancy and Graves'hyperthyroidism in pregnancy are well-known risk factors for small for gestational age(SGA).However,the influence of isolated maternal hypothyroxinemia(IMH)in the first trimester during pregnancy on birthweight is less analyzed and controversial.Objective To examine the correlation of IMH in the first trimester during pregnancy with birthweight.Methods This was a retrospective cohort study involving singleton pregnant women with medical files and receiving prenatal examination,delivery or termination of pregnancy in the Beijing Obstetrics and Gynecology Hospital,Capital Medical University from January 2016 to October 2020.According to the 2.5th and 97.5th percentiles of free thyroxine(FT4)and thyroid stimulating hormone(TSH),participants were assigned into IMH group(n=344)and control group(n=19426).Binary Logistic regression was used to analyze the correlation of IMH in the first trimester during pregnancy with birthweight.Then according to the pre-pregnancy body mass index(PPBMI),participants were assigned into the overweight/obesity group(PPBMI≥24.0 kg/m2,69 cases in IMH group and 3376 cases in control group)and non-overweight/obesity group(PPBMI<24.0 kg/m2,275 cases in IMH group and 16050 cases in control group).The pregnancy outcomes of different groups were compared and the relationship between IMH and pregnancy outcomes was compared.Results The results of multivariate Logistic regression analysis showed that,the incidence of macrosomia and large for gestational age(LGA)in the IMH group was 1.627 times(OR=1.627,95%CI=1.103-2.399,P=0.014)and 1.681 times higher than the control group(OR=1.681,95%CI=1.288-2.196,P<0.001),respectively.However,there were no significant differences in the incidences of low birth weight(LBW)and SGA between the two groups(P>0.05).Among participants with PPBMI<24.0 kg/m2(non-overweight/obesity group),the incidence of macrosomia and LGA in the IMH group

关 键 词：单纯低甲状腺素血症 巨大儿 大于胎龄儿 孕前BMI 妊娠结局 

分 类 号：R581[医药卫生—内分泌]