JCEM：甲状腺疾病与妊娠并发症增加有关

在甲状腺疾病增加妊娠并发症风险方面有不一致的报道。为了探讨妊娠并发症与常见和不常见甲状腺疾病的关系，来自美国国立卫生研究院的Pauline Mendola教授及其团队进行了一项研究，该研究发现甲状腺疾病与产科、临产和分娩并发症有关。该研究结果在线发表在2013年6月6日的《临床内分泌代谢杂志》（The journal of clinical endocrinology & metabolism）上。

该研究分析了来自一个回顾性美国队列（2002-2008年期间安全分娩的患者）的单胎妊娠（223512例）病例状腺疾病和妊娠结局来源于电子病历。多元logistic回归联合广义估计方程评估99%可信区间（99%CI）的校正比值比（ORs）。分析高血压病、糖尿病、早产、剖宫产、引产、以及重症监护病房（ICU）住院。

该研究结果表明，原发性甲状腺功能减退与子痫前期（OR=1.47，99%CI=1.20-1.81）、并发先兆子痫（OR=2.25,99%CI=1.53-3.29）、妊娠糖尿病（OR=1.57,99%CI=1.33-1.86）、早产（OR=1.34,99%CI=1.17-1.53）、引产（OR=1.15,99%CI=1.04-1.28）、剖宫产（临产前OR=1.31,99%CI=1.11-1.54；自然临产后OR=1.38,99%CI=1.14-1.66）、以及ICU住院（OR=2.08,99%CI=1.04-4.15）的几率增加有关。医源性的甲状腺功能减退与胎盘早剥（OR=2.89,99%CI=1.14-7.36）、臀先露（OR=2.09,99%CI=1.07-4.07）、以及自然临产后剖宫产（OR=2.05,99%CI=1.01-4.16）几率增加有关。甲状腺功能亢进与子痫前期（OR=1.78.99%CI=1.08-2.94）、并发先兆子痫（OR=3.64,99%CI=1.82-7.29）、早产（OR=1.81，99%CI=1.32-2.49）、引产（OR=1.40,99%CI=1.06-1.86）、以及ICU住院（OR=3.70,99%CI=1.16-11.80）几率增加有关。

该研究发现，甲状腺疾病与产科、临产和分娩并发症有关。尽管缺乏妊娠期间治疗的信息，这些全国性的数据提示在妊娠期间需要更好的甲状腺疾病管理，或者甲状腺疾病可以导致不良妊娠结局的内在问题。

Thyroid Diseases and Adverse Pregnancy Outcomes in a Contemporary US Cohort.
Context
Thyroid diseases are inconsistently reported to increase risk for pregnancy complications.
Objective
The objective of this study was to study pregnancy complications associated with common and uncommon thyroid diseases.
Design, Setting, and Participants
We analyzed singleton pregnancies (N = 223 512) from a retrospective US cohort, the Consortium on Safe Labor (2002-2008). Thyroid diseases and outcomes were derived from electronic medical records. Multivariable logistic regression with generalized estimating equations estimated adjusted odds ratios (ORs) with 99% confidence intervals (99% CI).
Main Outcome Measures
Hypertensive diseases, diabetes, preterm birth, cesarean sections, inductions, and intensive care unit (ICU) admissions were analyzed.
Results
Primary hypothyroidism was associated with increased odds of preeclampsia (OR = 1.47, 99% CI = 1.20-1.81), superimposed preeclampsia (OR = 2.25, 99% CI = 1.53-3.29), gestational diabetes (OR = 1.57, 99% CI = 1.33-1.86), preterm birth (OR = 1.34, 99% CI = 1.17-1.53), induction (OR = 1.15, 99% CI = 1.04-1.28), cesarean section (prelabor, OR = 1.31, 99% CI = 1.11-1.54; after spontaneous labor OR = 1.38, 99% CI = 1.14-1.66), and ICU admission (OR = 2.08, 99% CI = 1.04-4.15). Iatrogenic hypothyroidism was associated with increased odds of placental abruption (OR = 2.89, 99% CI = 1.14-7.36), breech presentation (OR = 2.09, 99% CI = 1.07-4.07), and cesarean section after spontaneous labor (OR = 2.05, 99% CI = 1.01-4.16). Hyperthyroidism was associated with increased odds of preeclampsia (OR = 1.78, 99% CI = 1.08-2.94), superimposed preeclampsia (OR = 3.64, 99% CI = 1.82-7.29), preterm birth (OR = 1.81, 99% CI = 1.32-2.49), induction (OR = 1.40, 99% CI = 1.06-1.86), and ICU admission (OR = 3.70, 99% CI = 1.16-11.80).
Conclusions
Thyroid diseases were associated with obstetrical, labor, and delivery complications. Although we lacked information on treatment during pregnancy, these nationwide data suggest either that there is a need for better thyroid disease management during pregnancy or that there may be an intrinsic aspect of thyroid disease that causes poor pregnancy outcomes.