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目的探讨妊娠期并发亚临床甲状腺功能减退症(SCH)的影响因素及对妊娠结局的影响,为妊娠期并发SCH的防治提供依据。方法选择2013年5月-2016年12月在天津市宁河区医院产检的孕妇1 036例为研究对象,其中妊娠期并发SCH 104例(73例接受左甲状腺素钠片正规治疗并达到治疗目标者作为治疗组,31例未接受治疗及治疗未达标者作为未治疗组),906例甲状腺功能正常孕妇作为对照组,观察各组孕妇并发症发生情况及妊娠结局。并应用单因素和多因素Logistic回归分析对年龄、孕前体质指数(BMI)、文化程度等因素进行分析,分析妊娠期并发SCH危险因素。结果未治疗组孕妇妊娠期糖尿病、贫血、胎膜早破发生率显著高于治疗组和对照组(P<0.05),治疗组妊娠期糖尿病、妊娠期高血压、贫血、前置胎盘、胎盘早剥、胎膜早破、产后出血发生率与对照组比较,差异无统计学意义(P>0.05)。未治疗组流产、剖宫产、死胎、早产、新生儿窒息不良结局发生率显著高于治疗组和对照组(P<0.05),而治疗组与对照组差异无统计学意义(P>0.05)。单因素相关分析显示年龄、孕前BMI、孕产史、吸烟与妊娠并发SCH有关(P<0.05)。多因素Logistic回归分析显示年龄≥30岁且初产、孕前BMI<18 kg/m~2、吸烟是妊娠并发SCH的危险因素,年龄20~35岁是妊娠并发SCH的保护因素(P<0.05)。结论妊娠期并发SCH可以增加孕妇妊娠期糖尿病、贫血、胎膜早破发生率和流产、剖宫产、死胎、早产、新生儿窒息不良结局发生率,年龄≥30岁且初产、孕前BMI<18 kg/m~2、吸烟是妊娠并发SCH的危险因素,应针对危险因素进行干预,降低妊娠并发SCH发生率。
Objective To investigate the influencing factors of subclinical hypothyroidism (SCH) in pregnancy and its impact on pregnancy outcome, and to provide evidence for the prevention and treatment of concurrent SCH during pregnancy. Methods From May 2013 to December 2016, 1 036 pregnant women in Ninghe District Hospital of Tianjin were enrolled as the study subjects, of which 104 cases were complicated by SCH during pregnancy (73 cases received regular treatment of levothyroxine sodium tablets and achieved therapeutic goals As the treatment group, 31 patients who did not receive treatment and did not meet the standard of treatment as untreated group), 906 normal pregnant women with thyroid function as control group, the incidence of complications and pregnancy outcome in each group were observed. Univariate and multivariate logistic regression analysis were used to analyze the age, pre-pregnancy body mass index (BMI), educational level and other factors, and to analyze the risk factors for concurrent SCH during pregnancy. Results The incidence of gestational diabetes mellitus, anemia and premature rupture of membranes in pregnant women without treatment group were significantly higher than those in the treatment group and the control group (P <0.05). The gestational diabetes mellitus, gestational hypertension, anemia, placenta previa, placenta previa Peel, premature rupture of membranes, postpartum hemorrhage incidence compared with the control group, the difference was not statistically significant (P> 0.05). The incidence of miscarriage, cesarean section, stillbirth, premature birth and neonatal asphyxia in untreated group was significantly higher than that in treatment group and control group (P <0.05), but there was no significant difference between treatment group and control group (P> 0.05) . Univariate correlation analysis showed that age, pre-pregnancy BMI, pregnancy history, smoking and pregnancy complicated by SCH (P <0.05). Multivariate Logistic regression analysis showed that the age at birth was more than 30 years old and the primiparous and prenatal BMI was <18 kg / m ~ 2. Smoking was a risk factor for pregnancy complicated with SCH. The age of 20 ~ 35 years old was the protective factor of SCH during pregnancy (P <0.05) . Conclusion Concurrent SCH during pregnancy can increase the incidence of gestational diabetes mellitus, anemia, premature rupture of membranes, abortion, cesarean section, stillbirth, premature birth and neonatal asphyxia. 18 kg / m ~ 2, smoking is a risk factor for pregnancy complicated with SCH, intervention should be targeted at risk factors to reduce the incidence of concurrent SCH during pregnancy.