妊娠期亚临床甲状腺功能减退对小于胎龄儿的影响因素分析

Factors associated with small for gestational age infants in pregnant women with subclinical hypothyroidism

摘要

目的 通过回顾性研究探讨亚临床甲状腺功能减退对小于胎龄儿的影响。方法 选取2019-2021年苏州市分娩的孕产妇及其子女为研究对象,提取孕产妇妊娠早期产检信息和检验指标,新生儿出生信息如体重、性别等资料从出生记录中获取,按照妊娠期甲状腺功能分为正常组和亚临床甲状腺功能减退组,采用二元Logistic回归分析探索亚临床甲状腺功能减退组各因素与小于胎龄儿的关联。结果 最终共纳入86 089例有效样本,小于胎龄儿(SGA)检出率4.91%。正常组和亚临床甲状腺功能减退组妊娠早期体质指数(BMI)(OR=0.90,95%CI:0.89~0.92;OR=0.90,95%CI:0.86~0.94)和经产妇(OR=0.60,95%CI:0.54~0.67;OR=0.60,95%CI:0.41~0.88)是SGA的影响因素(P<0.01);正常组妊娠早期血清游离甲状腺素(FT4)(OR=1.02,95%CI:1.01~1.03)、促甲状腺激素(TSH)(OR=1.14,95%CI:1.10~1.20)和少数民族(OR=1.32,95%CI:1.06~1.64)是SGA的危险因素(P<0.05),孕妇的妊娠经历是小于胎龄儿的保护因素(OR=0.87,95%CI:0.78~0.96,P=0.005)。而亚临床甲状腺功能减退组未观察到此种关联。结论 经产妇、妊娠经历和妊娠早期合理的体重范围是SGA的保护因素。妊娠期亚临床甲状腺功能减退群体采取的治疗干预措施是有效的。

Abstract

Objective To investigate the effect of subclinical hypothyroidism (SCH) on small for gestational age (SGA) infants through a retrospective study. Methods Pregnant women who delivered in Suzhou from 2019 to 2021 and their offspring were included.Maternal data from early pregnancy examinations and laboratory tests were extracted,and neonatal information such as birth weight and sex was obtained from birth records.According to thyroid function during pregnancy,participants were divided into a normal group and an SCH group.Binary logistic regression analysis was performed to examine the associations between various factors and SGA in the SCH group. Results A total of 86 089 eligible cases were included,with an SGA incidence of 4.91%.In both the normal group and the SCH group,early pregnancy body mass index (BMI) (OR=0.90,95%CI:0.89-0.92;OR=0.90,95%CI:0.86-0.94) and multiparity (OR=0.60,95%CI:0.54-0.67;OR=0.60,95%CI:0.41-0.88) were significantly associated with SGA (P<0.01).In the normal group,early pregnancy serum free thyroxine (FT4) (OR=1.02,95%CI:1.01-1.03),thyroid stimulating hormone (TSH) (OR=1.14,95%CI:1.10-1.20),and minority ethnicity (OR=1.32,95%CI:1.06-1.64) were identified as risk factors for SGA (P<0.05),whereas maternal reproductive history was a protective factor (OR=0.87,95%CI:0.78-0.96,P=0.005).However,these associations were not observed in the SCH group. Conclusion Multiparity,maternal reproductive history,and an appropriate body mass index in early pregnancy are protective factors against SGA.Therapeutic interventions in pregnant women with SCH appear to be effective.

关键词

妊娠期 / 亚临床甲状腺功能减退 / 小于胎龄儿 / 影响因素

Key words

pregnancy / subclinical hypothyroidism / small for gestational age infant / influential factor

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基金资助

苏州市PM10、PM2.5污染与先天性心脏病发生风险关联性的时间序列研究(F202129)