The Change Of Plasma Lipids And Glucose Levels In Patients With Hypothyroidism During Pregnancy

Part I. The establish and the application of the normal value of thyroidfunction parameters during the third trimester of pregnancy in the diagnosis ofhypothyroidism.Objective To assess the importance of trimester-specific reference intervals ofthyroid hormones on the interpretation of hypothyroidism during the third trimester ofpregnancy.Methods One thousand seven hundred and twenty-nine pregnant women during37-38gestational weeks who visited shanghai sixth hospital from July2012toDecember2012were enrolled. Serum TSH, FT3, FT4,TgAb and TPOAb weremeasured. Five hundred and sixty-five normal pregnant women were selected forsetting reference intervals according to the U.S. National Academy of ClinicalBiochemistry (NACB) recommended criteria.Results The reference intervals for the third trimester were TSH0.85mIU/L-6.79mIU/L and FT48.45pmol/L-14.68pmol/L. The prevalence of overt hypothyroidism,subclinical hypothyroidism and hypothyroxinemia were0.58%,2.08%and9.02%respectively according to trimester-specific reference intervals. While the prevalenceof overt hypothyroidism, subclinical hypothyroidism and hypothyroxinemia were29.21%,10.41%and40.27%respectively according to ATA reference intervals. Theprevalence of hypothyroidism according to the two different reference intervals wassignificantly different (P <0.01).Among the sixty-nine women positive for TPOAb,subclinical hypothyroidism was found in8.70%and hypothyroxinemia in1.45%.There was no overt hypothyroidism. The prevalence of subclinical hypothyroidism inwomen positive for TPOAb is more than in women negative for TPOAb (X2=12.23,P=0.000). The prevalence of hypothyroxinemia in women negative for TPOAb is more than in women positive for TPOAb（X2=5.02，P=0.025）.Conclusion In order to diagnose, treat and monitor hypothyroidism, it is necessaryto establish the trimester-specific reference intervals of thyroid function indicesduring the third trimester of pregnancy.Part II. Study on the changes of lipid levels and blood glucose in patients withhypothyroidism during pregnancyObjective To investigate the changes of serum lipids and the blood glucose ofhypothyroidism during pregnancy.Methods26cases of patients with hypothyroidism and GDM who visited shanghaisixth hospital from January2013to June2013were collected as observer group1,101patients with hypothyroidism as observer group2,147patients with GDM asobserver group3, and140healthy pregnants as control group. Serum lipids weremeasured and compared.Results HDL-C of observer group1were lower than the control group, and TGwere higher than the control group, P＜0.05. HDL-C of observer group2were lowerthan the control group, and LDL-C of observer group2were higher than observergroup3, P＜0.01. TC of observer group3were lower than the control group, TG werehigher than the control group, P＜0.05. LDL-C of observer group3were lower thanthe control group, P＜0.01. There were significant differences.1h PPG of observer group1were higher than observer group2and the control group,2h PPG of observer group1were higher than observer group2, observer group3,and the control group. FPG,1h PPG and2h PPG of observer group2were lower thanobserver group3. FPG,1h PPG and2h PPG of observer group3were higher than thecontrol group. There were significant differences. Conclusion Abnormal changes of the blood lipids and glucose may be an importantfactor leading to the occurrence of hypothyroidism during pregnancy. The earlydetection and promptly correcting abnormal lipid metabolism is beneficial to controlthe underlying disease, trying to avoid the occurrence of adverse pregnancy outcomes.Part III The influence of hypothyroidism during pregnancy to the outcome ofpregnancy.Objective To analyze the influence of hypothyroidism during pregnancy to theoutcome of pregnancy.Methods One thousand seven hundred and twenty-nine pregnant women during37-38gestational weeks who visited shanghai sixth hospital from July2012toDecember2012were enrolled. They were divided into hypothyroidism group andnormal control group, and the pregnancy outcomes were analyzed.Results The incidence of gestational hypertension of hypothyroidism group werehigher than the non-hypothyroidism group, there were significant differences(P<0.05); the incidence of low birth weight children were higher than thenon-hypothyroidism group, there were significant differences (P<0.05); the incidenceof gestational diabetes were higher than the non-hypothyroidism group, there weresignificant differences (P<0.05).The incidence of obstetric complications ofhypothyroidism group were higher than the non-hypothyroidism group, there weresignificant differences (P<0.05).The anemia incidence of the clinical hypothyroidism group were higher than thenon-hypothyroidism group, there were significant differences (P<0.01); the incidenceof low birth weight children and gestational diabetes were higher than the non-hypothyroidism group, there were significant differences (P<0.05). Thegestational hypertension incidence of the subclinical hypothyroidism group werehigher than the non-hypothyroidism group, there were significant differences(P<0.05); and the low birth weight incidence were higher than thenon-hypothyroidism group, there were significant differences (P<0.01). Thegestational hypertension incidence of the low T4hyperlipidemia group were higherthan the non-hypothyroidism group, there were significant differences (P<0.05); andthe low birth weight incidence were higher than the non-hypothyroidism group, therewere significant differences (P<0.01). And the incidence of cesarean section of thelow T4hyperlipidemia group were higher than the non-hypothyroidism group, therewere significant differences (P<0.05).Conclusion The incidence of adverse pregnancy outcomes was significantlyelevated during pregnancy with hypothyroidism. Screening for hypothyroidismduring early pregnancy has very important clinical significance. Timely and effectivehormone therapy can significantly improve the perinatal outcomes.