目的 探讨母亲孕期甲状腺激素(THs)水平波动与新生儿出生体格发育及肛门生殖器距离(AGD)的关联,为促进母婴健康提供依据。方法 基于2016年9月—2018年4月在浙江嘉善建立的出生队列,纳入772对具有孕早期THs浓度、新生儿体格发育和AGD数据的母子对。据WHO儿童生长发育标准计算年龄别体重Z评分(WAZ)、年龄别身长Z评分(LAZ)、年龄别头围Z评分(HCZ)和身长别体重Z评分(WLZ)。采用多元线性回归模型分析母亲THs水平与新生儿出生体格指标的关联,并按性别分层分析其与出生AGD的关联。结果 相较于游离三碘甲状腺原氨酸(FT3)中水平组(4.19~4.98pmol/L),母亲孕期FT3高水平组(>4.98pmol/L)新生儿的WAZ、LAZ、HCZ以及WLZ分别增加0.23(95%CI: 0.07~0.38)、0.06(95%CI: 0.00~0.12)、0.24(95%CI: 0.05~0.42)和0.28(95%CI: 0.05~0.51)。与FT3中水平组比较,FT3低水平组(<4.19pmol/L)与男婴AGDAP更长有关(β=1.59,95%CI: 0.20~2.99,P<0.05),女婴中未见显著关联(P>0.05),甲状腺抗体阴性亚组分析结果与主分析一致。结论 母亲孕早期FT3水平较高与新生儿出生时WAZ、LAZ、HCZ和WLZ较高有关,FT3水平较低与男婴AGDAP较长有关,与女婴AGD无明显关联。本研究为母亲孕早期甲状腺功能与子代出生体格发育和生殖健康的关联提供了更多流行病学证据。
Abstract
Objective To investigate the associations of maternal thyroid hormone (TH) levels during early pregnancy with neonatal anthropometric measures and anogenital distance (AGD), so as to provide reference for maternal and child health. Methods A total of 772 mother-infant pairs from the Jiashan Birth Cohort established between September 2016 and April 2018 were included, with available data on first-trimester TH levels, neonatal anthropometric measures, and AGD. Weight-for-age Z-score (WAZ), length-for-age Z-score (LAZ), head circumference-for-age Z-score (HCZ), and weight-for-length Z-score (WLZ) were calculated according to the WHO Child Growth Standards. Multivariate linear regression models were used to examine the associations between maternal TH levels and neonatal anthropometric indicators, and sex-stratified analysis was conducted for AGD outcomes. Results Compared with the medium free triiodothyronine (FT3) group (4.19 - 4.98 pmol/L), neonates in the high FT3 group (>4.98 pmol/L) had higher WAZ (β=0.23, 95%CI: 0.07 to 0.38), LAZ (β=0.06, 95%CI: 0.00 to 0.12), HCZ (β=0.24, 95%CI: 0.05 to 0.42), and WLZ (β=0.28, 95%CI: 0.05 to 0.51). Low maternal FT3 (<4.19 pmol/L) was associated with a longer AGDAP in male neonates (β=1.59, 95%CI: 0.20 to 2.99,P<0.05), whereas no significant association was observed in female neonates(P>0.05). Results from the thyroid antibody-negative subgroup were generally consistent with the main analysis. Conclusions Higher maternal FT3 levels during early pregnancy were associated with higher neonatal WAZ, LAZ, HCZ, and WLZ, while lower FT3 levels were associated with a longer AGDAP in male neonates. No clear association was observed between maternal TH levels and AGD in female neonates. These findings provide additional epidemiological evidence for the associations of maternal thyroid function during early pregnancy with offspring anthropometric development at birth and early reproductive development indicators.
关键词
甲状腺激素 /
肛门生殖器距离 /
出生体格 /
前瞻性队列研究
Key words
thyroid hormones /
anogenital distance /
neonatal anthropometric measures /
prospective cohort study
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基金
上海市卫生健康委员会卫生行业临床研究专项青年项目(20224Y0176);上海市生物医药技术研究院省部级重点实验室创新能力专项资助(RC2024-05, Q2025-07)
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