血清维生素A、D、E水平与妊娠晚期甲状腺功能减退的关系及对妊娠结局的影响

Relationship between serum vitamin A, D and E levels and hypothyroidism in the third trimester of pregnancy and its influence on pregnancy outcomes

摘要

目的 探讨血清维生素A、D、E水平与妊娠晚期甲状腺功能减退的关系及对妊娠结局的影响。方法 选取2019年5月至2023年4月于宝鸡市妇幼保健院按计划产检并住院分娩的妊娠晚期女性196例为研究对象,根据妊娠晚期甲状腺功能检测结果分为甲状腺功能正常组(n=120)和甲状腺功能减退组(n=76)。测定两组血清维生素A、D、E水平,采用多因素Logistic回归分析妊娠晚期甲状腺功能减退危险因素,并分析血清维生素A、D、E摄入情况对孕产妇妊娠结局的影响。结果 甲状腺功能减退组血清维生素A、D水平与TSH水平呈负相关性,与FT₄水平呈正相关性(r值分别为-0.673、-0.742、0.653、0.695,P<0.05);血清维生素E水平与TSH水平呈正相关性,与FT₄水平呈负相关性(r值分别为0.524、-0.561,P<0.05);年龄较大、初产妇、孕前BMI较低、妊娠期贫血、血清维生素A低水平、血清维生素D低水平、血清维生素E高水平是妊娠晚期甲状腺功能减退的独立危险因素(OR值介于1.076~3.672之间,P<0.05)。维生素A不足的孕产妇胎儿窘迫、胎膜早破、宫缩乏力和低出生体重儿发生率高于维生素A正常者,维生素A过量的孕产妇早产和流产发生率高于维生素A正常者,差异具有统计学意义(χ²值介于14.577~74.862,P<0.05);维生素D不足的孕产妇低出生体重儿发生率高于维生素D正常者,差异具有统计学意义(χ²=5.814,P<0.05);维生素E不足的孕产妇流产发生率高于维生素E正常者,维生素E过量的孕产妇胎膜早破、早产和低出生体重儿发生率高于维生素E正常者,差异具有统计学意义(χ²值介于7.349~28.161之间,P<0.05)。结论 血清维生素A、D低水平和维生素E高水平是妊娠晚期甲状腺功能减退的独立危险因素,且合理摄入和补充维生素A、D、E对降低不良妊娠结局具有重要意义。

Abstract

Objective To explore the relationship between serum vitamin A, D and E levels and hypothyroidism in the third trimester of pregnancy and its influence on pregnancy outcomes. Methods A total of 196 pregnant women in the third trimester who underwent planned prenatal examinations and were hospitalized for delivery at Baoji Maternal and Child Health Hospital from May 2019 to April 2023 were selected as study subjects, according to the results of thyroid function test, they were divided into normal thyroid function group (n=120) and hypothyroidism group (n=76). Serum levels of vitamins A, D and E were measured in both groups, multivariate logistic regression analysis was used to assess the risk factors for hypothyroidism in the third trimester of pregnancy, and the influence of serum levels of vitamins A, D and E on pregnancy outcomes was analyzed. Results Serum vitamin A and D levels in hypothyroidism group were negatively correlated with TSH level and positively correlated with FT₄ level (r values were -0.673, -0.742, 0.653 and 0.695, respectively, P<0.05); the serum vitamin E level was positively correlated with TSH level and negatively correlated with FT₄ level (r values were 0.524 and -0.561, respectively, P<0.05). Advanced age, primiparity, low pre-pregnancy BMI, gestational anemia, low serum vitamin A levels, low serum vitamin D levels, and high serum vitamin E levels were identified as independent risk factors for hypothyroidism in the third trimester of pregnancy (OR values ranged from 1.076 to 3.672, P<0.05). The incidence of fetal distress, premature rupture of membranes, uterine atony, and low birth weight infants in pregnant women with insufficient vitamin A was higher than that in those with normal vitamin A, the incidence of preterm birth and spontaneous abortion in pregnant women with excessive vitamin A was higher than that in those with normal vitamin A, and the differences were statistically significant (χ² values ranged from 14.577 to 74.862, P<0.05). The incidence of low birth weight infants in pregnant women with insufficient vitamin D was higher than that in those with normal vitamin D, and the difference was statistically significant (χ²=5.814, P<0.05). The incidence of spontaneous abortion in pregnant women with insufficient vitamin E was higher than that in those with normal vitamin E, while the incidence of premature rupture of membranes, preterm birth, and low birth weight infants in pregnant women with excessive vitamin E was higher than that in those with normal vitamin E, and the differences were statistically significant (χ² values ranged from 7.349 to 28.161, P<0.05). Conclusion Low levels of serum vitamins A, D, and high levels of vitamin E are independent risk factors for hypothyroidism in the third trimester of pregnancy, and reasonable intake and supplementation of vitamins A, D and E are of great significance in reducing adverse pregnancy outcomes.

关键词

甲状腺功能减退 / 妊娠晚期 / 维生素A / 维生素D / 维生素E / 妊娠结局

Key words

hypothyroidism / the third trimester of pregnancy / vitamin A / vitamin D / vitamin E / pregnancy outcome

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基金资助

中华国际科学交流基金会检验检测科技专项基金(Z2018LSXB007)