妊娠期亚临床甲状腺功能减退对子代发育的影响  

Effect of subclinical hypothyroidism during pregnancy on the growth and development of offspring

作　　者：吴妍琳 李蓓荃[1] 陆晓婷 陈欣欣 昌文静 叶侃[1] WU Yan-lin;LI Bei-quan;LU Xiao-ting;CHEN Xin-xin;CHANG Wen-jing;YE Kan(Department of Child Health,Suzhou Hospital Affiliated to Nanjing Medical University,Suzhou 215500;Department of Pediatrics,Changshu fifth People’s Hospital,Suzhou 215505;Department of Endocrinology,Suzhou Hospital Affiliated to Nanjing Medical University,Suzhou 215500;Nanjing Medical University,Nanjing 210000)

机构地区：[1]南京医科大学附属苏州医院儿童保健科,苏州215500 [2]常熟市第五人民医院儿科,苏州215505 [3]南京医科大学附属苏州医院内分泌科,苏州215500 [4]南京医科大学,南京210000

出　　处：《生殖医学杂志》2025年第3期286-290,共5页Journal of Reproductive Medicine

基　　金：2022年度南京医科大学姑苏学院科研项目(GSKY20220409);2021年度江苏省妇幼健康科研项目(F202149)。

摘　　要：目的探讨妊娠期亚临床甲状腺功能减退症(SCH)对子代生理及心理发育的影响。方法选取2019年1月至2020年12月在南京医科大学附属苏州医院产科就诊的411例孕妇为研究对象,根据孕妇的甲状腺功能情况及治疗情况分为正常组(n=218)、SCH治疗组(n=72)和非治疗组(n=121)。观察孕妇妊娠期甲状腺功能指标及接受左甲状腺素(LT_(4))治疗情况,比较3组子代出生时情况、足跟血甲状腺功能,12月龄、36月龄的体格发育情况及12月龄、36月龄时使用贝利婴幼儿发育量表第三版评估神经发育情况。结果3组孕妇的子代早产、低体重、巨大儿发生率及不良结局总发生率均无显著差异(P>0.05),子代的足跟血TSH筛查均正常。子代体格发育情况比较:12月龄时治疗组和非治疗组的身长Z值[(0.56±0.94)、(0.58±0.73)vs.(0.79±0.82)]、体重Z值[(0.58±0.93)、(0.59±0.70)vs.(0.81±0.81)]均显著低于正常组(P<0.05),且非治疗组在36月龄时身长Z值[(0.25±0.67)vs.(0.50±0.73)]仍显著落后于正常组(P<0.05)。12月龄贝利量表五个能区评估结果显示,非治疗组精细运动发育延迟的发生率(12.4%vs.3.2%)显著高于正常组(P<0.05)。结论妊娠亚临床甲状腺功能减退进行早期LT_(4)干预治疗,其子代甲状腺功能、神经发育与健康产妇子代无明显差异,但体格发育可能在短期内存在落后情况。Objective:To investigate the effects of subclinical hypothyroidism on physiological and psychological development of offspring.Methods:A total of 411 pregnant women who visited Suzhou Hospital Affiliated to Nanjing Medical University from January 2019 to December 2020 were included.All subjects were divided into the normal group(n=218),subclinical hypothyroidism treatment group(SCH group,n=72)and subclinical hypothyroidism non-treatment group(non-treatment group n=121)according to their thyroid function and treatment status.The thyroid function indexes during pregnancy and the treatment status of levothyroxine(LT_(4))were observed among the recruited women.The birth information and the thyroid function of heel blood sample among offspring of these women were evaluated.In addition,physical development at 12 months and 36 months of age was measured as well as neurodevelopment at 12 months and 36 months of age were assessed with the Bayley Scales of Infant and Toddler Development-Third Edition(Bayley-Ⅲ).Results:There was no significantly difference in the incidence of premature birth,low birth weight,macrosomia and adverse pregnancy outcomes among the three groups(P>0.05),and the level of thyroid stimulating hormone of heel blood sample was normal.At 12 months of age,the Z-scores of body length[(0.56±0.94),(0.58±0.73)vs.(0.79±0.82),P<0.05]and weight[(0.58±0.93),(0.59±0.70)vs.(0.81±0.81),P<0.05]in SCH group and non-treatment group were significantly lower than those in the normal group.At 36 months of age,the Z-scores of body length in the non-treatment group still lower than that in the normal group[(0.25±0.67)vs.(0.50±0.73),P<0.05].At 12 months of age,the results of evaluation with five energy regions of the Bayley Scale showed that the incidence of fine motor delay in the non-treatment group was higher than that in the normal group(12.4%vs.3.2%,P<0.05).Conclusions:There was no significant difference in the thyroid function,neurological development between the offspring of women with subclinical hypothyro

关 键 词：妊娠期 亚临床甲状腺功能减退症 子代体格发育 子代神经智力发育 

分 类 号：R725.8[医药卫生—儿科]