[email protected]

国际临床研究杂志

International Journal of Clinical Research

您当前位置：首页 > 精选文章

International Journal of Clinical Research. 2025; 9: (4) ; 10.12208/j.ijcr.20250175 .

A preliminary study on the impact of changes in thyrotropin levels during pregnancy on pregnancy outcomes
妊娠期促甲状腺素水平变化对妊娠结局影响的初步研究

作者： 黄靖然 *, 谢昕

澳门镜湖医院妇产科 澳门

*通讯作者： 黄靖然,单位：澳门镜湖医院妇产科 澳门；

引用本文: 黄靖然, 谢昕 妊娠期促甲状腺素水平变化对妊娠结局影响的初步研究[J]. 国际临床研究杂志, 2025; 9: (4) : 15-20.
Published: 2025/4/28 10:20:46

摘要

目的 探讨妊娠早期及晚期促甲状腺素水平变化与不良妊娠结局之间的关系。方法 纳入2022年6月至2024年5月期间在澳门镜湖医院门诊建档并分娩的孕妇2832例，收集其临床资料，检测其妊娠早期血清促甲状腺激素（TSH）水平及妊娠晚期TSH、游离甲状腺素（FT4）、血清铁蛋白水平。按血清铁蛋白水平分为铁缺乏组及正常组，比较两组妊娠期甲状腺功能障碍疾病的发生率。按TSH变化趋势分为正常/正常组（2442例）、正常/异常组（195例）、异常/正常组（134例）和异常/异常组（61例），对四组的甲状腺功能指标及妊娠结局进行比较。结果 妊娠晚期甲状腺功能异常以低甲状腺素血症及甲状腺功能减退更为常见，铁缺乏组的发生率更高（P<0.05)。患有子痫前期、妊娠高血压的孕妇妊娠晚期TSH水平高于正常人群（P<0.05)，子痫前期、分娩低出生体重儿的孕妇妊娠晚期FT4水平高于正常人群（P<0.05)。与妊娠早期及晚期甲状腺功能均正常的孕妇相比，妊娠早期TSH水平异常妊娠晚期正常的孕妇患有妊娠期糖尿病及妊娠期高血压疾病的风险较低（aOR=0.19，95%CI：0.10-0.36；aOR=0.20，95%CI：0.06-0.64），妊娠早期TSH水平正常妊娠晚期异常的孕妇患有妊娠期糖尿病及妊娠期高血压疾病的风险增加（aOR=3.02，95%CI：2.21~4.11；aOR=3.39，95%CI：1.52~7.58）。结论 妊娠晚期甲状腺功能异常也有可能导致不良妊娠结局的发生，临床上应引起重视。

关键词： 妊娠期甲状腺功能异常；促甲状腺素；妊娠结局

Abstract

Objective To investigate the relationship between the changes of thyrotropin levels in the first and third trimester of pregnancy and adverse pregnancy outcomes.
Methods From June 2022 to May 2024, a total of 2832 pregnant women who gave birth in Kiang Wu Hospital were enrolled in the study. We collected the subjects’ clinical data, thyrotropin (TSH) levels in the first trimester and third trimester, free thyroxine (FT4) levels and ferritin in the third trimester. According to ferritin levels, the subjects were divided into iron deficiency group and normal group. The incidence of thyroid dysfunction in pregnancy was compared between the two groups. According to the trend of TSH changes, they were divided into 4 groups: normal/normal group (n=2442), normal/abnormal group (n=195), abnormal/normal group (n=134) and abnormal/abnormal group (n=61).Thyroid function indexes and pregnancy outcomes of the 4 groups were compared.
Results Hypothyroinemia and hypothyroidism were more common in the third trimester, and the incidence was higher in the iron deficiency group (P<0.05). Third trimester TSH levels of pregnant women with preeclampsia and gestational hypertension were higher than that of the normal pregnant women (P<0.05), and third trimester FT4 levels of pregnant women with preeclampsia and low birth weight infants was higher than that of the normal pregnant women (P<0.05). Women in the abnormal/normal group had a lower risk of developing gestational diabetes (GDM) and hypertensive disorders in pregnancy (HDP) than the women in the normal/normal group (aOR=0.19, 95%CI: 0.10-0.36; aOR=0.20, 95%CI: 0.06-0.64), and the women in the normal/abnormal group had a higher risk of developing GDM and HDP than the women in the normal/abnormal group (aOR=3.02, 95%CI: 2.21-4.11; aOR=3.39, 95%CI: 1.52~7.58).
Conclusion   Thyroid dysfunction in the third trimester may also lead to adverse pregnancy outcomes, which should be taken seriously in clinical practice.

Key words： Thyroid dysfunction in pregnancy; Thyrotropin; Pregnancy outcomes

参考文献 References

[1] Zhang Y, Dai X, Yang S, et al. Maternal low thyroxin levels are associated with adverse pregnancy outcomes in a Chinese population[J]. PLoS One. 2017;12(5):e0178100. 

[2] 《孕产期甲状腺疾病防治管理指南》编撰委员会,中华医学会内分泌学分会,中华预防医学会妇女保健分会. 孕产期甲状腺疾病防治管理指南 [J]. 中华内分泌代谢杂志, 2022, 38(07)：539-551.

[3] Alexander EK, Pearce EN, Brent GA,et al. 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum [J]. Thyroid. 2017,27(3):315-389.

[4] 《妊娠和产后甲状腺疾病诊疗指南》(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 [J]. 中华围产医学杂志, 2019, 22(8):505-53.

[5] Ka Wai CHOI, & Hoi Kei LEONG. Trimester-Specific Reference Intervals of Thyroid Function in Healthy Pregnant Women in Macau [J]. International Journal of Engineering Research & Science , 2022,8(5): 06-14. 

[6] Korevaar TI, Schalekamp-Timmermans S, de Rijke YB, et al. Hypothyroxinemia and TPO-antibody positivity are risk factors for premature delivery: the generation R study [J]. J Clin Endocrinol Metab. 2013;98(11):4382-4390.

[7] Karakosta P, Alegakis D, Georgiou V, et al. Thyroid dysfunction and autoantibodies in early pregnancy are associated with increased risk of gestational diabetes and adverse birth outcomes [J]. J Clin Endocrinol Metab. 2012;97(12):4464-4472. 

[8] Medici M, Korevaar TI, Schalekamp-Timmermans S, et al. Maternal early-pregnancy thyroid function is associated with subsequent hypertensive disorders of pregnancy: the generation R study [J]. J Clin Endocrinol Metab. 2014;99(12):E2591-E2598. 

[9] Yang S, Shi FT, Leung PC, Huang HF, Fan J. Low Thyroid Hormone in Early Pregnancy Is Associated With an Increased Risk of Gestational Diabetes Mellitus [J]. J Clin Endocrinol Metab. 2016;101(11):4237-4243. 

[10] Chen L, Ye E, Sun M, Lin H, Yu L, Lin Z, Peng M, Lin D, Lu X. Association between third trimester maternal isolated hypothyroxinemia and adverse pregnancy outcomes [J]. Endocr J. 2023 Jun 28;70(6):611-618. 

[11] Liu X, Zhang C, Lin Z, Zhu K, He R, Jiang Z, Wu H, Yu J, Luo Q, Sheng J, Fan J, Pan J, Huang H. Association of maternal mild hypothyroidism in the first and third trimesters with obstetric and perinatal outcomes: a prospective cohort study [J]. Am J Obstet Gynecol. 2024 Aug 30:S0002-9378(24)00902-5.

[12] Ge GM,Leung MTY,Man KKC,et al. Maternal Thyroid Dysfunction During Pregnancy and the Risk of Adverse Outcomes in the Offspring: A Systematic Review and Meta⁃Analysis [J]. J Clin Endocrinol Metab,2020,105(12): dgaa555.

[13] Luo J, Wang X, Yuan L, Guo L. Iron Deficiency, a Risk Factor of Thyroid Disorders in Reproductive-Age and Pregnant Women: A Systematic Review and Meta-Analysis [J]. Front Endocrinol (Lausanne). 2021;12:629831. 

[14] Wang F, Zhang Y, Yuan Z, Li Y, Liu S, Zeng X, Qiu X, Ye L, Huang D. The association between iron status and thyroid hormone levels during pregnancy [J]. J Trace Elem Med Biol. 2022 Dec;74:127047.

[15] Teng X, Shan Z, Li C, Yu X, Mao J, Wang W, Xie X, Du J, Zhang S, Gao Z, Zhang X, Li L, Fan C, Teng W. Iron Deficiency May Predict Greater Risk for Hypothyroxinemia: A Retrospective Cohort Study of Pregnant Women in China [J]. Thyroid. 2018 Aug;28(8):968-975.

[16] Huang X, Mao M, Guo T, Wu Y, Xu Q, Dai J, Huang Y. Iron Status, Thyroid Dysfunction, and Iron Deficiency Anemia: A Two-Sample Mendelian Randomization Study [J]. Ann Nutr Metab. 2024;80(6):295-306.

[17] Kubota K, Tamura J, Kurabayashi H, Shirakura T, Kobayashi I. Evaluation of increased serum ferritin levels in patients with hyperthyroidism [J]. Clin Investig. 1993 Dec;72(1):26-9. 

[18] 车蕾,项国谦. 妊娠期甲状腺功能异常与妊娠期糖尿病和妊娠期高血压疾病的关系 [J].中国妇幼保健,2024,39(14): 2592-2595.

[19] Huang K, Su S, Wang X, Hu M, Zhao R, Gao S, Zhang E, Liu J, Xie S, Luan Y, Sun Y, Zhang Y, Yue W, Liu R, Yin C. Association Between Maternal Thyroid Function in Early Pregnancy and Gestational Diabetes: A Prospective Cohort Study [J]. J Clin Endocrinol Metab. 2024 Jan 18;109(2):e780-e787.

[20] Fernández Alba JJ, Castillo Lara M, Jiménez Heras JM, Moreno Cortés R, González Macías C, Vilar Sánchez Á, San Laureano FC, Moreno Corral LJ. High First Trimester Levels of TSH as an Independent Risk Factor for Gestational Diabetes Mellitus: A Retrospective Cohort Study [J]. J Clin Med. 2022 Jun 29;11(13):3776.

[21] Chen GD, Gou XY, Pang TT, Li PS, Zhou ZX, Lin DX, Fan DZ, Guo XL, Wang LJ, Liu ZP. Associations between thyroid function and gestational diabetes mellitus in Chinese pregnant women: a retrospective cohort study [J]. BMC Endocr Disord. 2022 Feb 21;22(1):44. 

[22] Tian L, Wang J, Wang Y, Fan X, Wang L. Thyroid-stimulating hormone and total bile acids can predict adverse pregnancy outcome among patients with gestational hypertension [J]. Am J Transl Res. 2024 Apr 15;16(4):1199-1208. 

[23] Roef GL, Taes YE, Kaufman J-M, Van Daele CM, De Buyzere ML, Gillebert TC, et al. Thyroid Hormone Levels Within Reference Range Are Associated with Heart Rate, Cardiac Structure, and Function in Middle-Aged Men and Women [J]. Thyroid. 2013;23:947–954. 

[24] Liu Y, Gao B, Zeng X, et al. Association between thyroid-stimulating hormone and maternal hemodynamics in hypertensive disorders of pregnancy: an observational study [J]. BMC Pregnancy Childbirth. 2019;19(1):396.

[25] Klein I, Ojamaa K. Thyroid hormone and the cardiovascular system [J]. N Engl J Med. 2001;344:501–509.

[26] Barjaktarovic M, Korevaar TIM, Chaker L, Jaddoe VWV, de Rijke YB, Visser TJ, et al. The association of maternal thyroid function with placental hemodynamics [J]. Hum Reprod. 2017;32:653–661.

[27] 李红,曹涛,崔献梅,等. 妊娠期合并甲状腺功能异常现状及影响因素研究 [J]. 分子诊断与治疗杂志, 2024,16(10): 1948-1951.

[28] 袁妙兰,李意,冯慧芳,等. 妊娠期糖尿病危险因素研究及对妊娠结局的影响[J]. 中国医师杂志,2017,19(10):1538-1541.

[29] Korevaar TIM,Derakhshan A,Taylor PN,et al. Association of thyroid function test abnormalities and thyroid autoimmunity with preterm birth:a systematic review and meta-analysis [J].JAMA,2019,322(7):632-641.

[30] 王淑萍,刘欣,王维波,等. 妊娠早期促甲状腺激素水平及甲状腺过氧化物酶抗体状态对妊娠结局的影响 [J]. 中国医师杂志,2020,22(7):1053-1059.