妊娠期合并甲状腺功能减退的筛查及转归

目的：筛查妊娠期合并甲状腺功能减退（甲减）的发生情况及临床转归。方法2013年6月至2015年6月期间我院妇产科门诊首次就诊早孕妇女2656例，筛查其甲减发生情况，甲减孕妇中TPOAb阳性者在征得其同意后予以左旋甲状腺素(L~T4)治疗(甲减治疗组)，未治疗甲减孕妇为甲减未治疗组，甲状腺功能正常孕妇中随机抽取40例为对照组，随访至产后统计三组的妊娠结局。结果本组2656例接受筛查的孕妇中66例为甲减（25例临床甲减，41例亚临床甲减)，检出率为2.48%。妊娠合并甲减中甲减未治疗组(29例)的剖宫产率为65.52%，明显高于甲减治疗组(37例)的27.03%及对照组的20.00%，差异均有统计学意义(P<0.05)；甲减未治疗组的妊娠及产科并发症（晚期流产、早产、贫血、GDM、HDP、胎膜早破、羊水异常)、围产儿不良结局(胎儿宫内窘迫、FGR、低出生体重儿)发生率及新生儿出生体重均明显高于甲减治疗组及对照组，差异均有统计学意义(P<0.05)，而甲减治疗组与对照组间各项指标比较差异均无统计学意义(P>0.05)。结论早期筛查妊娠期甲减发生情况并及时采取干预处理，能够有效降低胎儿宫内生长发育迟缓及母婴不良结局发生率。

Screening and prognosis of hypothyroidism during pregnancy

Objective To screen the incidence and clinical outcome of hypothyroidism during pregnancy. Methods A total of 2 656 cases of early pregnant women, who admitted to Department of Obstetrics of our hospital from June 2013 to June 2015, were selected, and the incidence of the hypothyroidism was screened. After obtaining the consent, pregnant women with hypothyroidism (TPOAb positive) who received levothyroxine (L-T4) treatment were en-rolled as hypothyroidism treatment group, and pregnant women with hypothyroidism who did not receive hypothyroid-ism treatment were selected as the untreated group. Forty pregnant women with normal thyroid function were randomly selected as the control group. The subjects were followed up to postpartum, and the pregnancy outcomes of the three groups were statistically analyzed. Results Among the 2 656 cases of pregnant women, 66 cases had hypothyroidism (25 cases of clinical hypothyroidism, 41 cases of subclinical hypothyroidism), and the detection rate was 2.48%. The ce-sarean section rate of pregnant women with hypothyroidism in the untreated group was 65.52%(n=29), which was signif-icantly higher than 27.03% (n=37) in hypothyroidism treatment group and 20.00% in the control group (P<0.05). The pregnancy and obstetric complications of the untreated group (late abortion, premature delivery, anemia, gestational dia-betes mellitus, hypertensive disorders of pregnancy, premature rupture of membranes, abnormal amniotic fluid), perina-tal adverse outcomes (fetal distress, fetal growth restriction, low birth weight infants) and neonatal birth weight were sig-nificantly higher than those in the hypothyroidism treatment group and the control group (P<0.05). However, there was no statistically significant difference between the hypothyroidism group and the control group in these indexes (P>0.05). Conclusion Early screening for gestational hypothyroidism and timely intervention treatment, can effectively reduce the incidences of intrauterine growth retardation and maternal adverse outcomes.