Inventory Survey Of Thyroid Function In The Second Trimester And Correlation Analysis Of It With Pregnancy Outcomes

Objective:To analyze the characteristics of thyroid diseases in pregnant women,and to explore the effect of subclinical hypothyroidism and pure antibody positive on pregnancy outcome in the second trimester of pregnancy.To evaluate the effect of levothyroxine treatment on SCH and pure TPOAb(+)in the treatment of pregnancy complications and pregnancy outcomes.Methods:The data was collected when pregnant women recorded the perinatal health care card from obstetrics and gynecology in the Affiliated Drum Tower Hospital of Nanjing University medical school from January 2015 to February 2016.The rate of pregnant women with hypothyroidism,thyrotoaricosis,thyroid nodule,thyroid cancer and or,normal thyroid function with positive thyroid autoantibodies were got from the data.The pregnancy outcomes among the control group and different groups of SCH patients(SCH + TPOAb positive group,SCH + TPOAb negative group,and pure TPOAb positive group)were compared.The pregnancy outcomes were compared among SCH + TPOAb(+)treatment group critical value group,SCH + TPOAb(+)treatment recommend by guidelines and the control group.And they were also compared among pure TPOAb(+)treatment group and pure TPOAb(+)untreated group and the control group.Results:A total of 3450 of pregnant women were collected,there were 69 cases(2%)about clinical hypothyroidism,38 cases(1.1%)about low T4,389 cases(11.3%)about SCH(which 160 cases(4.6%)about TPOAb(+)group,229 cases(6.6%)about TPOAb(-)group),322 cases(9.3%)about pure TPOAb+,28 cases(0.8%)about hyperthyroidism,5 cases(0.1%)about other(thyroid nodules,inpregnancy thyrotoxicosis etc.),2599 cases(75.3%)about healthy pregnant women.The pregnancy outcomes among SCH+TPOAb(+),SCH+ TPOAb(-),pure TPOAb(+)and control group were compared by chi square test.The results showed that the incidence of gestational hypertension,the incidence of gestational diabetes mellitus,spontaneous abortion,preterm birth,full-term low birth weight,Apgar score<7,and neonatal weight was statistically significant among the four groups(P<0.05).There was no significant difference in the incidence of preeclampsia,preterm premature rupture of membranes,postpartum hemorrhage and fetal distress among the four groups(P>0.05).Post hoc analysis were used by Bonferroni method,the result showed:SCH + TPOAb(+)and TPOAb(+)group were different with control group for gestational hypertension(P<0.0083),SCH + TPOAb(+)group was different with control group and pure TPPAb(+)group for gestational diabetes mellitus(P<0.0083),SCH+TPOAb(+)and TPPAb(+)group were different with control group for spontaneous abortion(P<0.0083),SCH+TPOAb(+)group,SCH+(-TPOAb)group and TPPAb(+)group were different with control group for preterm delivery(P<0.0083),there was significant difference between SCH+ TPOAb(-)group and the control group of the proportion that Apgar score were less than 7(P<0.0083).The incidences of gestational hypertension,diabetes,spontaneous abortion,premature delivery,full-term low birth weight infants,and Apgar score<7 were significantly different among the three groups(SCH + TPOAb(+)critical treatment group,SCH + TPOAb(+)treatment recommend by guidelines and the control group).Post hoc analysis were used by Bonferroni method,the result showed that the incidences of gestational hypertension,diabetes,spontaneous abortion and preterm birth in 2 SCH+TPOAb(+)treatment groups were significantly different from that of the control group(P<0.0167).There was no statistical difference between SCH + TPOAb(+)critical treatment group and SCH + TPOAb(+)treatment recommend by guidelines.There were significant of TSH and FT4 among pure TPOAb(+)with LT-4 treatment group,pure TPOAb(+)without LT-4 treatment and control group at different time points.The level of FT4 in the TPOAb(+)pregnant women receiving LT-4 treatment was significantly higher than that of the TPOAb(+)pregnant women who did not receive treatment.On three groups of adverse pregnancy events and pregnancy outcome analysis:gestational hypertension,spontaneous abortion,premature birth rate between the three groups was statistically significant difference(P<0.05).Conclusion:SCH and/or TPOAb positive can lead to gestational diabetes mellitus,gestational hypertension,premature delivery,spontaneous abortion,full-term low birth weight,and other complications of pregnancy and adverse pregnancy outcomes.L-T4 treatment at the critical point does not improve the prognosis of SCH+TPOAb(+)pregnant women.Medium term LT4 supplementation in pregnant women with normal thyroid function but only TPOAb(+)can reduce the incidence of miscarriage and preterm birth.