目的 分析年龄及孕早期亚临床甲减(SCH)与早产及其亚型的相关性,为不同年龄孕早期亚甲减患者孕期监测制定个体化策略提供科学依据。方法 以2016年2月-2018年6月在甘肃省妇幼保健院高危产科产检的单胎活产孕妇2 868例为研究对象,使用Logistic回归模型分别分析年龄及孕早期亚甲减与早产的相关性。结果 控制混杂因素后,与适龄孕妇相比,高龄孕妇(≥35岁)发生早产风险增加0.67倍(OR=1.67,95%CI:1.32~2.13);年龄较小孕妇发生早期/极早期早产风险升高2.65倍(OR=3.65,95%CI:2.21~6.05)。与甲功正常孕妇相比,亚甲减孕妇发生早产风险增加2.07倍(OR=3.07,95%CI:2.28~4.12)、发生中晚期早产风险增加1.67倍(OR=2.67,95%CI:1.86~3.83)。交互作用分析显示,年龄与亚临床甲减对早产的发生风险存在相乘的交互作用。结论 不同年龄亚甲减孕妇发生早产及其亚型的风险不一致。建议对孕早期亚甲减患者应根据年龄进行风险分层,开展个体化孕期管理和用药指导。
Abstract
Objective To investigate the association of preterm birth with pregnant women age and subclinical hypothyroidism (SCH), in order to provide scientific evidence for making individualized strategies for pregnant women with SCH. Methods A total of 2 868 pregnant women in Gansu Provincial Maternity and Child Care Hospital were enrolled in this study from February 2016 and June 2018. Unconditional Logistic regression model was used to evaluate the associations between age, SCH and the risk of preterm birth. Results Compared with moderate age women, women of advanced reproductive age had higher risk of preterm birth (OR=1.67,95%CI: 1.32-2.13). Younger women had higher risk for very preterm birth (OR=3.65, 95%CI: 2.21-6.05).Compared with women with normal thyroid function, women with SCH had higher risk of preterm birth and moderate preterm birth (preterm birth,OR=3.07, 95%CI:2.28-4.12; moderate preterm birth OR=2.67, 95%CI:1.86-3.83).Interaction analysis revealed a multiplier interaction between age and SCH on the risk of preterm birth. Conclusions The risk of preterm birth and its subtypes in SCH patients of different ages is not consistent. It is suggested to assess preterm risk in SCH women by different age groups and take individualized pregnancy management and medication guidance.
关键词
亚临床甲状腺功能减退 /
过氧化物酶抗体 /
早产 /
高龄孕妇
Key words
subclinical hypothyroidism /
thyroid peroxidase antibody /
preterm birth /
women of advanced reproductive age
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参考文献
[1] Moster D, Lie RT, Markestad T. Long-term medical and social consequences of preterm birth[J]. N Engl J Med, 2008, 359(3): 262-273.
[2] Rm S, Dw B. Cervical pessary to prevent preterm birth[J]. JAMA, 2017, 318(23): 2299-2300.
[3] Liu L,Johnson HL,Cousens S,et al. Global, regional, and national causes of child mortality: an updated systematic analysisi for 2010 with time trends since 2000[J]. Lancet, 2012, 379(9832): 2151-2161.
[4] 莫莺健, 王长智. 早产相关因素研究进展[J]. 汕头大学医学院学报, 2017, 30(1): 62-64.
[5] Negro R, Mestman JH. Thyroid disease in pregnancy[J].Best Pract Res Clin Endocrinol Metab, 2011, 25: 927-943.
[6] Blazer S, Moreh-Waterman Y, Miller-Lotan R,et al. Maternal hypothyroidismmay affect fetal growth and thyroid function[J]. Obstel Gynecol, 2003, 102(2): 232-241.
[7] 尹玲凤, 丁虹娟. 早产相关因素的临床分析[J]. 中国妇幼健康研究, 2016, 27(10): 1234-1237.
[8] Casey BM, Dashe JS, Wells CE,et al. Subclinical hypothyroidism and pregnancy outcomes[J]. Obstel Gynecol, 2005, 105(2): 239-245.
[9] 王红琴. 妊娠合并甲状腺功能减退的筛查及转归[J]. 中国妇幼保健, 2015, 30(16): 2511-2513.
[10] Green AS, Abalovich M, Alexander E, et al. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum[J]. Thyroid, 2011, 21(10): 1081-1125.
[11] Howson CP, Kinney MV, McDougall L. Born too soon: preterm birth matters[J]. Repord Health, 2013, 10(Suppl 1): S1.
[12] Xu H, Dai Q, Xu Y, et al. Time trends and risk factor associated with premature birth and infants deaths due to prematurity in Hubei Province, China from 2001 to 2012[J]. BMC Pregnancy Childbirth, 2015, 15:329.
[13] Mwaniki MK, Atieno M, Lawn JE, et al. Long-term neurodevelopmental outcomes after intrauterine and neonatal insults: a systematic reveiw[J]. Lancet, 2012, 379(9814): 445-452.
[14] Newnham JP, Dickinson JE, Hart RJ, et al. Strategies to prevent preterm birth[J]. Front Immunol, 2014, 5:584.
[15] Abalovich M, Gutierrez S, Alcaraz G, et al. Overt and subclinical hypothyroidism complicating pregnancy[J]. Thyroid, 2002, 12(1):63-68.
[16] Casey BM, Dashe JS, Wells CE,et al. Subclinical hypothyroidism and pregnnacy outcomes[J]. Obstet Gynecol, 2005, 105(2): 239-245.
[17] Schneuer FJ, Nassar N, Tasevski V, et al. Association and predcitve accuracy of high TSH serum levels in first trimester and advese pregnnacy outcomes[J]. J Clin Endocrinol Metab, 2012, 97(9): 3115-3122.
[18] Tong Z, Xiaowen Z, Baomin C, et al. The effect of subclinical maternal thyroid dysfunction and autommunity on intrauterine growth restriction[J]. Medicine (Baltimore), 2016, 95(19): e3677.
[19] Brits H, Adriaanse M, Rall DM, et al. Causes of prematuirty in the bloemfontein academic complex[J]. S Afr Fam Pract, 2015, 58(3): 223-226.
[20] Oakley L, Penn N, Pipi M, et al. Risk of adverse obstetic and neonatal outcomes by maternal age:quantifying individual and population level risk using routine UK maternity data[J]. PLoS One, 2016, 11(10): e0164462.
[21] Barber KJ, Franklyn JA, McCabe CJ,et al. The in virto effects of triiodothyronine on epidermal growth foctor-induced trophoblast function[J]. J Clin Endocrinol Metab, 2005, 90(3): 1655-1661.
基金
甘肃省自然科学基金项目(17JR5RA026);中疾控妇幼中心合生元母婴营养与健康研究项目(2018FYH007)
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