Association Of Thyroid Peroxidase Antibody And Thyroglobulin Antibody With Poor Pregnancy Outcomes

Objective:human thyroid autoantibodies (ATA) including thyroid peroxidase antibody (TPOAb), thyroglobulin antibody (TGAb),thyroid-stimulating hormone receptor antibody (TRAb), thyroid microsomal antibodies (TMAb), resistance to sodium/iodide Antibodies symporter (NIS antibody). They may exist alone or concurrently in one person. Positive thyroid autoantibodies are prone to autoimmune thyroid disease, such as toxic diffuse goiter (GD), Hashimoto’s thyroiditis, primary hypothyroidism psychosis. Among them, hypothyroidism may increase adverse outcomes of pregnancy has been recognized, but whether the circumstances of thyroid autoantibodies and normal thyroid function may increase adverse outcomes of pregnancy have not yet reached a consensus on the need for intervention there is a big controversy, which is what this study range. In recent years, attention has been highly concerned about thyroid autoantibodies TPOAb and TGAb, especially on the mother and the fetus may have an adverse pregnancy outcome in the case of pregnancy. This article is to explore the association of positive TPOAb and/or TGAb in early pregnant women and spontaneous abortion, premature birth, gestational hypertension, a medical pointer cesarean section, placental abruption, fetal death and other adverse outcomes of pregnancy Provide a theoretical basis for the first trimester screening required clinical significance of thyroid autoantibodies. Methods:624 pregnant patients in early pregnancy (gestational age≤12 weeks) from 2012 to 2013 obstetrics and gynecology clinic were enrolled. The German cable Spirit LIAISON chemiluminescence analyzer were used to routinely test thyrotropin (TSH), free three triiodothyronine (FT3), free thyroxine (FT4), TPOAb, TGAb.Their pregnancy outcomes were followed up, including spontaneous abortion, premature birth, gestational hypertension, a medical pointer cesarean section (hereinafter referred to as cesarean section), placental abruption, fetal death and other adverse outcomes of pregnancy, the occurrence of adverse outcomes in patients and in patients with normal outcomes were good records and statistical analysis. All results using a normal month of pregnancy-specific reference ranges as diagnostic criteria. TSH> 2.5mIU/L, FT4 normal diagnosis of subclinical hypothyroidism (SCH, hereinafter referred to as subclinical hypothyroidism); 0.1 mlU/L< TSH< 2.5mIU/L, FT3, FT4 normal thyroid function is normal; TPOAb> 16IU/ml and/or TGAb> 100IU/ml as antibodies. Data using SPSS 17.0 statistical software, quantitative data using x±s description of qualitative data using N (%) describe the difference between the quantitative data comparison group t test to compare qualitative data between groups using chi-square rate test to P<0.05 was considered statistically significant, multivariate Logistic regression equation used to explore the different pregnancy outcomes with a reactive state, the state of the relationship between the antibody. Results:(1)Among 624 patients, thyroid function in 292 cases (46.8%) are normal,332 cases (53.2%) are subclinical hypothyroidism. Classification by antibodies, antibody -positive group 266 cases (42.6%), antibody -negative group 358 cases (57.4%).624 patients with a total of 104 cases of adverse outcomes of pregnancy (16.7%), ranking the first two are spontaneous abortion (33 cases) and hypertensive disorders in pregnancy (27 cases). (2) subclinical hypothyroidism group compared with normal thyroid function group, the total incidence of adverse outcomes of pregnancy, spontaneous abortion rate increased (P<0.05). (3) antibody-positive group compared with the antibody -negative group, the total incidence of adverse outcomes, the rate of spontaneous abortion, gestational hypertension disease incidence increased (P<0.05); thyroid function under normal circumstances, the antibody-positive and antibody-negative group group, the total incidence of adverse outcomes also increased (P<0.05); under subclinical hypothyroidism, the antibody positive and antibody-negative group, the total incidence of adverse outcomes increased (P<0.05). (4) normal thyroid function:separate TPOAb positive group and individual TGAb positive group, the total incidence of adverse outcomes was no difference (P>0.05). Separate TPOAb positive and antibody-negative group, the overall incidence of adverse outcomes (P<0.05). Separate TGAb positive and antibody-negative group, the total incidence of adverse outcomes, (P<0.05). (5) Under subclinical hypothyroidism situations:alone TPOAb positive group compared with the single TGAb positive group, the total incidence rate of adverse outcomes was no difference (P> 0.05). Separate TPOAb positive and antibody-negative group, the overall incidence of adverse outcomes (P<0.05). Separate TGAb positive and antibody-negative group, the pregnancy rate of adverse events (P<0.05). (6) compare the prevalence of subclinical hypothyroidism and prevalence of antibody positive difference in pregnancy outcomes between different groups: poor pregnancy outcomes prevalence of subclinical hypothyroidism group of 66.3%, a good pregnancy outcome prevalence of hypothyroidism group was 50.6%, OR= 1.926 (CI 95%:1.239,2.996), namely poor pregnancy outcomes incidence of subclinical hypothyroidism group was 1.9 times the group’s good pregnancy outcomes. Pregnancy outcomes in different antibody positive rate comparison:where poor pregnancy outcomes group antibody positive rate of 72.1%, a good set of antibody positive pregnancy outcome was 36.7%, OR= 4.455 (CI 95%:2.800,7.086), namely poor pregnancy outcomes group antibody positive rate is 4.5 times the group’s good pregnancy outcomes. (7) The adverse outcomes of pregnancy as the dependent variable, age, gestational age, TSH, FT3, FT4 and thyroid autoantibodies situation as independent variables included in binary logistic regression analysis. Finally found subclinical hypothyroidism and thyroid antibodies are independent risk factors for adverse outcomes of pregnancy. Conclusion:Early thyroid women appear (1) Pregnancy autoantibodies and subclinical hypothyroidism, as may increase adverse outcomes of pregnancy. (2) whether in the case of normal thyroid function or subclinical hypothyroidism cases, separate positive and TPOAb positive TGAb same may increase adverse outcomes of pregnancy. (3) early pregnancy subclinical hypothyroidism and thyroid autoantibodies is an independent risk factor for poor pregnancy outcome.