retrospective analysis of the effect of gestational hypothyroxinemia on pregnancy outcomes

Objective 　To discuss the influence of gestational hypothyroxinemia to the pregnancy outcomes and fetus development, and find the evidence of hormone replacement therapy. Methods 　The clinical data of 1141 gravida admitted from Nov. 2014 to Oct. 2015 were retrospectively analyzed, including the data of systematic antenatal examination, all the data of pregnancy, the materials of delivery, the last ultrasound examination, production status and the thyroid stimulating hormone (TSH) of the newborn etc., to find the difference of related index. Results 　Of the 1141 gravida with integral data, 200 had past history of thyroid disease, 189 showed below normal of free thyroxine (FT4) and 752 were normal ones. The 189 gravida with normal TSH but lower FT4 were divided into group A (0-5% lower than the normal FT4 value, n=60), group B (5%-10% lower than the normal FT4 value, n=40) and group C (10% and above lower than the normal FT4 value, n=89). The ones with both normal TSH and FT4 value served as control group. Compared to the control group, the higher premature delivery rate, incidence of gestational diabetes mellitus and cesarean delivery rate (P<0.05) were found in group C, and more gravida in group B had a history of hypertension and dyslipidemia during pregnancy (P<0.05). The cesarean delivery rate of group B and C were higher than group A. Meanwhile, the rate of group B was higher than control group (P>0.05). At delivery, the maternal weight, BMI, diastolic pressure, and head circumference of fetus in the last ultrasound examination were higher in group C than in control group (P<0.01), but the gestational weeks of the newborn were shorter in group C (38.55±1.86 weeks) than in control group (39.14±1.57 weeks, P<0.01). The 189 gravida with lower FT4 were divided into two groups according to the thyroid peroxidase antibody (TPOAb) level. The head circumference of fetus in the last ultrasound examination was higher in TPOAb(+) group than in TPOAb(-) group (45.99±62.36cm vs. 33.23±2.08cm, P<0.01). Conclusions The influence of gestational hypothyroxinemia to pregnancy outcomes and fetus development cannot be ignored, especially for the pregnant women with lower FT4 value (10% and above lower than the normal) or with positive TPOAb. It is suggested to take the thyroid function test in the early stage of pregnancy for those pregnant women mentioned above. DOI: 10.11855/j.issn.0577-7402.2017.03.07