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当前位置：国际临床研究杂志 > 2025年 9卷 (4)期

Open Access Article

International Journal of Clinical Research. 2025; 9: (4) ; 15-20 ; DOI: 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；

发布时间: 2025-04-28 总浏览量: 111

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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

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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.

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