Chinese Medical E-ournals Database
Adv Search
中华妇幼临床医学杂志(电子版)

Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) ›› 2024, Vol. 20 ›› Issue (02): 140 -147. doi: 10.3877/cma.j.issn.1673-5250.2024.02.003

Pregnancy Complications

Pregnancy outcomes in pregnant women with subclinical hypothyroidism

Saijun Jia1,†(), Ying Zhang1, Jiayi Wan2   

  1. 1. Department of Endocrinology, Beijing Shunyi District Hospital, Beijing 101300, China
    2. Department of Obstetrics, Beijing Shunyi District Hospital, Beijing 101300, China
  • Received:2023-12-12 Revised:2024-03-01 Published:2024-04-01
  • Corresponding author: Saijun Jia
HTML ( ) PDF ( )
Objective

To investigate the pregnancy outcomes in pregnant women with subclinical hypothyroidism.

Methods

A total of 97 pregnant women with subclinical hypothyroidism admitted to Beijing Shunyi District Hospital from January 2021 to December 2022 were selected in this study. They were divided into intervention group (n=62, treated with levothyroxine sodium) and control group (n=35, not taking levothyroxine sodium) based on whether they received intervention treatment during pregnancy. The levels of thyroid-stimulating hormone (TSH), free thyroxine (FT4), total thyroxine (TT4), thyroid peroxidase antibodies (TPOAb), thyroglobulin antibodies (TgAb), total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) before treatment, two and six weeks after treatment, and before delivery, as well as adverse pregnancy outcomes, were compared between two groups. The procedures followed in this study were in accordance with the ethical standards set by the Ethics Committee of the Beijing Shunyi District Hospital and were approved by the committee (Approval No. 2024-L-011). Informed consents were obtained from all participants.

Results

① There were no statistically significant differences in general clinical data such as age, body mass index (BMI), gestational age, ethnic composition, gravidity, and parity between two groups (P>0.05). ② Repeated measures analysis of variance of serum TSH, FT4, and TT4 levels before treatment, two weeks and six weeks after treatment, and before delivery between two groups showed that effect of different treatment measures and time factors was statistically significant (Ftreatment × time=18.49, 15.88, 13.06; Ptreatment×timeall <0.001). ③ Analysis of variance of repeated measurement data of variance of TPOAb and TgAb levels before treatment, two weeks and six weeks after treatment, and before delivery between two groups showed that effect of different treatment measures and time factors was statistically significant (Ftreatment×time=21.06, 19.48; Ptreatment×time all <0.001). ④ Analysis of variance of repeated measurement data of TC, TG, LDL-C, and HDL-C levels before treatment, two weeks and six weeks after treatment, and before delivery between two groups showed that effect of different treatment measures and time factors was not statistically significant (Ftreatment×time=0.51, 0.76, 0.62, 0.85; Ptreatment×time=0.600, 0.244, 0.594, 0.153). ⑤ The incidence of threatened abortion and premature rupture of membranes (PROM)were lower in intervention group than those in control group, and there were statistically significant differences between two groups (P<0.05). ⑥ There were no statistically significant differences in incidence of intrauterine fetal growth restriction, abortion, and preterm birth between two groups (P>0.05).

Conclusions

Intervention with levothyroxine sodium in pregnant women with subclinical hypothyroidism can improve subclinical hypothyroidism state during pregnancy, reduce levels of autoimmune antibodies in thyroid tissue, and decrease incidence of threatened abortion and PROM.

Key words: Hypothyroidism, subclinical state, Thyrotropin, Levothyroxine sodium, Pregnancy outcome, Fetal growth retardation, Pregnant women
表1 2组妊娠合并亚临床甲状腺功能减退孕妇的一般临床资料比较
组别 例数 年龄(岁，±s) BMI(kg/m2，±s) 民族[例数(%)] 孕龄[例数(%)]
汉族 少数民族 6周 7周
干预组 62 29.2±2.5 23.5±0.7 56(90.3) 6(9.7) 37(59.7) 25(40.3)
对照组 35 28.9±2.6 23.3±0.9 29(82.9) 6(17.1) 19(54.3) 16(45.7)
统计量   t＝0.68 t＝1.35 χ2＝0.57 χ2＝0.27
P值   0.502 0.179 0.452 0.606
组别 例数 孕次[例数(%)] 产次[例数(%)] 受孕方式[例数(%)]
1次 ≥2次 0次 ≥1次 自然受孕 胚胎移植
干预组 62 39(62.9) 23(37.1) 17(27.4) 45(72.6) 61(98.4) 1(1.6)
对照组 35 20(57.1) 15(42.9) 8(22.9) 27(77.1) 32(91.4) 3(8.6)
统计量   χ2＝0.31 χ2＝0.24 χ2＝1.26
P值   0.577 0.622 0.261
表2 2组妊娠合并亚临床甲状腺功能减退孕妇甲状腺功能比较(±s)
组别 例数 TSH(mU/L)
治疗前 治疗后2周 治疗后6周 分娩前
干预组 62 3.9±1.0 2.4±0.7 1.8±0.3 1.6±0.3
对照组 35 3.8±0.9 3.9±0.9 4.3±1.3 5.6±1.7
F治疗值/P治疗值   16.82/<0.001
F时间值/P时间值   19.12/<0.001
F治疗×时间值/P治疗×时间值   18.49/<0.001
组别 例数 FT4(pmol/L)
治疗前 治疗后2周 治疗后6周 分娩前
干预组 62 16.2±3.5 15.8±3.4 15.4±3.1 14.2±3.0
对照组 35 16.0±3.1 15.2±3.2 13.3±3.7 11.1±2.9
F治疗值/P治疗值   17.33/<0.001
F时间值/P时间值   12.02/<0.001
F治疗×时间值/P治疗×时间值   15.88/<0.001
组别 例数 TT4(nmol/L)
治疗前 治疗后2周 治疗后6周 分娩前
干预组 62 116.5±19.3 153.3±22.8 149.0±17.3 141.5±19.8
对照组 35 118.9±21.7 130.6±25.8 128.8±21.6 120.0±17.4
F治疗值/P治疗值   14.93/<0.001
F时间值/P时间值   11.66/<0.001
F治疗×时间值/P治疗×时间值   13.06/<0.001
表3 2组妊娠合并亚临床甲状腺功能减退孕妇TPOAb、TgAb水平比较(±s)
组别 例数 TPOAb(IU/mL)
治疗前 治疗后2周 治疗后6周 分娩前
干预组 62 72.3±28.5 69.9±25.4 57.3±19.4 50.3±13.7
对照组 35 68.1±24.6 74.0±27.0 86.6±23.7 92.3±29.9
F治疗值/P治疗值   14.74/<0.001
F时间值/P时间值   11.52/<0.001
F治疗×时间值/P治疗×时间值   21.06/<0.001
组别 例数 TgAb(IU/mL)
治疗前 治疗后2周 治疗后6周 分娩前
干预组 62 67.9±21.9 61.8±19.5 54.3±16.4 47.3±15.0
对照组 35 64.0±20.8 68.5±23.8 75.9±25.2 96.7±31.2
F治疗值/P治疗值   15.13/<0.001
F时间值/P时间值   17.26/<0.001
F治疗×时间值/P治疗×时间值   19.48/<0.001
表4 2组妊娠合并亚临床甲状腺功能减退孕妇血脂水平比较(±s)
组别 例数 TC(mmol/L)
治疗前 治疗后2周 治疗后6周 分娩前
干预组 62 4.8±0.8 4.7±0.6 4.9±0.6 4.9±0.8
对照组 35 4.9±0.9 4.8±0.8 5.0±0.6 4.9±0.8
F治疗值/P治疗值   0.42/0.745
F时间值/P时间值   0.30/0.816
F治疗×时间值/P治疗×时间值   0.51/0.600
组别 例数 TG(mmol/L)
治疗前 治疗后2周 治疗后6周 分娩前
干预组 62 1.4±0.4 1.4±0.4 1.4±0.4 1.5±0.3
对照组 35 1.4±0.4 1.3±0.4 1.5±0.4 1.5±0.4
F治疗值/P治疗值   0.39/0.805
F时间值/P时间值   0.81/0.162
F治疗×时间值/P治疗×时间值   0.76/0.244
组别 例数 TC(mmol/L)
治疗前 治疗后2周 治疗后6周 分娩前
干预组 62 2.1±0.9 2.1±0.9 2.1±0.8 2.2±0.8
对照组 35 2.0±0.9 1.9±0.9 2.2±0.8 2.2±0.8
F治疗值/P治疗值   0.54/0.598
F时间值/P时间值   0.64/0.580
F治疗×时间值/P治疗×时间值   0.62/0.594
组别 例数 HDL-C(mmol/L)
治疗前 治疗后2周 治疗后6周 分娩前
干预组 62 1.1±0.2 1.0±0.2 1.1±0.2 1.1±0.1
对照组 35 1.1±0.2 1.1±0.2 1.1±0.2 1.0±0.2
F治疗值/P治疗值   0.69/0.432
F时间值/P时间值   0.72/0.326
F治疗×时间值/P治疗×时间值   0.85/0.153
表5 2组妊娠合并亚临床甲状腺功能减退孕妇不良妊娠结局发生率比较[例数(%)]
组别 例数 妊娠期高血压疾病 妊娠期糖尿病 羊水量异常 先兆流产 流产 PROM 胎盘早剥
干预组 62 1(1.6) 2(3.2) 4(6.4) 2(3.2) 0(0) 2(3.2) 0(0)
对照组 35 4(11.4) 3(8.6) 7(20.0) 12(34.3) 1(2.9) 8(22.9) 2(5.7)
χ2值   2.63 0.44 2.85 17.48 － 7.32 1.34
P值   0.105 0.506 0.092 <0.001 0.361 0.007 0.247
表6 2组妊娠合并亚临床甲状腺功能减退孕妇所分娩新生儿不良分娩结局发生率比较[例数(%)]
组别 例数 宫内生长受限 窒息 早产
干预组 62 1(1.6) 0(0) 1(1.6)
对照组 35 3(8.6) 1(2.9) 4(11.4)
χ2值   1.26 － 2.63
P值   0.261 0.361 0.105
[1]
Lee SY, Pearce EN. Testing, monitoring, and treatment of thyroid dysfunction in pregnancy [J]. J Clin Endocrinol Metab, 2021, 106(3): 883-892. DOI: 10.1210/clinem/dgaa945.
[2]
Yap YW, Onyekwelu E, Alam U. Thyroid disease in pregnancy [J]. Clin Med (Lond), 2023, 23(2): 125-128. DOI: 10.7861/clinmed.2023-0018.
[3]
樊祯翠，徐志红. 妊娠期甲状腺功能减退发生情况及影响因素[J].中国计划生育学杂志，2021，29(2)：388-391. DOI: 10.3969/j.issn.1004-8189.2021.02.044.
[4]
Toloza F, Derakhshan A, Männistö T, et al. Association between maternal thyroid function and risk of gestational hypertension and pre-eclampsia: a systematic review and individual-participant data meta-analysis [J]. Lancet Diabetes Endocrinol, 2022, 10(4): 243-252. DOI: 10.1016/S2213-8587(22)00007-9.
[5]
Mayhew CE, Simonson KR, Ellsworth-Bowers ER. Antepartum care for pregnant people with overt hypothyroidism, subclinical hypothyroidism, and positive thyroid autoantibodies [J]. J Midwifery Womens Health, 2022, 67(3): 295-304. DOI: 10.1111/jmwh.13306.
[6]
Pop VJ, Hulsbosch LP, Boekhorst M, et al. Hypothyroid symptoms throughout pregnancy are predominantly associated with thyroxine and not with thyrotropin concentrations [J]. Thyroid, 2022, 32(10): 1249-1258. DOI: 10.1089/thy.2022.0244.
[7]
Chen J, Zhu J, Huang X, et al. Subclinical hypothyroidism with negative for thyroid peroxidase antibodies in pregnancy: intellectual development of offspring [J]. Thyroid, 2022, 32(4): 449-458. DOI: 10.1089/thy.2021.0374.
[8]
白芳，徐澈. 亚临床甲状腺功能减退个体化诊治的研究进展[J].中国医师进修杂志，2019, 42(12): 1146-1149. DOI: 10.3760/cma.j.issn.1673-4904.2019.12.021.
[9]
《妊娠和产后甲状腺疾病诊治指南》(第2版)编撰委员会，中华医学会内分泌学分会，中华医学会围产医学分会. 妊娠和产后甲状腺疾病诊治指南(第2版) [J]. 中华内分泌代谢杂志，2019, 35(8) : 636-665. DOI: 10.3760/cma.j.issn.1000-6699.2019.08.003.
[10]
Wu M, Wang Y, Yan C, et al. Study on subclinical hypothyroidism in pregnancy: a bibliometric analysis via CiteSpace [J]. J Matern Fetal Neonatal Med, 2022, 35(3): 556-567. DOI: 10.1080/14767058.2020.1729731.
[11]
Lecorguillé M, Léger J, Forhan A, et al. Pregnancy outcomes in women with preexisting thyroid diseases: a French cohort study [J]. J Dev Orig Health Dis, 2021, 12(5): 704-713. DOI: 10.1017/S2040174420001051.
[12]
Solha S, Mattar R, Teixeira P, et al. Screening, diagnosis and management of hypothyroidism in pregnancy [J]. Rev Bras Ginecol Obstet, 2022, 44(10): 999-1010. DOI: 10.1055/s-0042-1758490.
[13]
阮郑，白奇峰，钟海燕. 彩色多普勒超声联合甲状腺自身抗体检测在甲状腺癌早期诊断中的应用价值[J].中国医师进修杂志，2023, 46(8): 731-735. DOI: 10.3760/cma.j.cn115455-20220825-00754.
[14]
陈絮，詹玉茹，王纯华. 孕妇ABO血型联合甲状腺功能检测对预测妊娠期糖尿病的临床价值[J/OL]. 中华妇幼临床医学杂志(电子版), 2023, 19(5): 604-610. DOI: 10.3877/cma.j.issn.1673-5250.2023.05.015.
[15]
陈爱兰，曾小变，罗婕妤. 先兆流产早期血清Hcy、TPOAb、TGAb水平的变化及其预后分析[J].海南医学，2021, 32(7): 864-867. DOI: 10.3969/j.issn.1003-6350.2021.07.012.
[16]
孙春萍，刘皆，张伟，等. 左甲状腺素钠早期治疗对妊娠合并亚临床甲状腺功能减退症妊娠结局和胎儿的影响[J].安徽医药，2022, 26(12): 2520-2524. DOI: 10.3969/j.issn.1009-6469.2022.12.041.
[17]
Zhang J, Chen H, Dou X, et al. Association between gestational blood lipids and TSH levels and pregnancy outcome of patients with subclinical hypothyroidism [J]. Pak J Med Sci, 2023, 39(3): 721-725. DOI: 10.12669/pjms.39.3.7150.
[18]
李晶晶，许雅娟，蔡琰钧，等. 妊娠期亚临床甲状腺功能减退与脂质代谢的相关性研究[J].中国实用妇科与产科杂志，2022，38(2)：211-215. DOI: 10.19538/j.fk2022020119.
[19]
吴雪辉，李薇，吴欣瑜，等. 妊娠期甲状腺功能减退症患者血糖血脂水平与病情严重程度及妊娠结局的关系[J].中国计划生育学杂志，2023, 31(1): 182-186. DOI: 10.3969/j.issn.1004-8189.2023.01.039.
[20]
杨威，高爽，张慧芳. 妊娠合并甲减行左甲状腺素钠早期干预的有效性分析[J]. 中华内分泌外科杂志，2022, 16(2): 207-210. DOI: 10.3760/cma.j.cn.115807-20220127-00026.
[21]
Dash SC, Sahoo N, Rout U, et al. Outcomes with levothyroxine treatment in early pregnancy with subclinical hypothyroidism [J]. Cureus, 2022, 14(5): e24984. DOI: 10.7759/cureus.24984.
[22]
Leng T, Li X, Zhang H. Levothyroxine treatment for subclinical hypothyroidism improves the rate of live births in pregnant women with recurrent pregnancy loss: a randomized clinical trial [J]. Gynecol Endocrinol, 2022, 38(6): 488-494. DOI: 10.1080/09513590.2022.2063831.
[1] Jingyu Qian, Mingming Zheng. Interpretation of the Italian guidelines on non-invasive and invasive prenatal diagnosis：executive summary of recommendations for practice the Italian Society for Obstetrics and Gynecology（SIGO）[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 486-492.
[2] Xialin Li, Fang He. Risk assessment and early warning system for postpartum hemorrhage[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 498-503.
[3] Ziyang Liu, Jianjian Cui, Yin Zhao. Current research status on obstetric disseminated intravascular coagulation and its scoring system[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 511-518.
[4] Fanying Zeng, Jie Ruan, Xinghui Liu, Guolin He. Current status of perinatal medicine advances under the new reproductive situation and coping strategies in prenatal care[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 519-524.
[5] Xiaofei Li, Hongli Liu, Qiuling Shi, Jing Tian, Li Li, Hongbo Qi, Xin Luo. A prospective randomized controlled study of low intensity focused ultrasound uterine involution treatment for prevention and treatment of postpartum hemorrhage in natural childbirth women[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 534-539.
[6] Rong Huang, Ziyu Liang, Wenjin Qi. Expression and significance of NLRP3 inflammasome in serum of pregnant women with premature rupture of membranes[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 540-548.
[7] Xia He, Rong Huang, Wenjin Qi. High-throughput sequencing study on the abundance of placenta and fetal membrane flora in pregnant women with premature rupture of membranes[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 549-555.
[8] Jiangyan Xie, Yafei Wang, Fang He. Pregnancy complicated with thrombotic thrombocytopenic purpura：two cases report and literature review[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 556-563.
[9] Xiaoyan Han, Hua Yang. Relationship between low level of serum placental growth factor in the second trimester pregnancy women and adverse fetal prognosis[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(04): 398-402.
[10] Jiali Du, Rui Bao, Chunhong Qiao, Wei Han. Construction of a prediction model for adverse pregnancy outcomes after emergency cervical cerclage in pregnant women with cervical incompetence during the second trimester[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(04): 403-409.
[11] Tingting Xu, Yongchi Zhan, Xiaodong Wang, Xiaodong Wang. Perinatal outcomes of fetomaternal hemorrhage syndrome pregnant women with sinusoidal fetal heart tracing[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(04): 382-389.
[12] Jing Han, Shaolong Hao, Hua Kang. Retrospective analysis of clinical features of single-center thyroid carcinoma patients in Beijing[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(05): 490-493.
[13] Huihui Yu, Zongzhi Yin. Gastric perforation during pregnancy[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2024, 13(04): 209-213.
[14] Shan Lu, Yunshan Yao, Seni Liao, Zien Chen, Yijian Zhang, Jianhao Lan, Wei Wei, Yanyang Liu, Yanhong Chen, Duijin Chen. Clinical study of 100 cases of suspected pregnancy complicated with acute appendicitis[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2024, 13(04): 214-219.
[15] Wenyan Wang, Jianlan Zheng, Lici Zhu. Clinical study on the risk of pregnancy and perinatal period after in vitro fertilization and embryo transfe[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2024, 13(04): 220-226.
Viewed
Full text


Abstract

Copyright © Chinese Medical Association, Chinese Medical Multimedia Press  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号