The Investigation About The Effect Of Subclinical Hypothyroidism And TPOAb Negative Onpregnancy Outcomes

Objective:To investigate the effect of treatment of pregnancy women with subclinical hypothyroidism(SCH)with diffierent TSH levels and negative thyroid gland peroxidase antibody(TPOAb)on perinatal outcomes.Methods:12540 pregnant women who delivered in the obstetric department of the Affiliated Hospital of Qiingdao University from January 1,2015 to December31,2016 were retrieved using the medical data system.According to the 2011 A merican ATA diagnostic criteria(S1: first-trimester TSH>2.5mIU/L,second-trimester and third-trimester TSH>3.0mIU/L),377 cases of negative TPOAb pregnancy wo men with subclinical hypothyroidism were screened out.According to the different TSH diognastic standard which in 2011(S1)and 2017(S2: TSH>4mIU/L)the A merican Thyroid Association(ATA)guidelines published for pregnancy with subclinical hypothyroidism,all subjects were divided into group A(4mIU/L<TSH<10mIU/L,n=131)and group B(TSH<4mIU/L,first-trimester TSH >2.5mIU/L,second-trimester and third-trimester TSH>3.0mIU/L,n=246).According to whether received Levothyroxine therapy,group A were divided into treatment group(n=70),untreated group(n=61),and group B were divided into treatment group(n=86),untreated group(n=160).At the same time,the pregnant women with TPOAb negative and normal thyroid function were considered as control(n=306).The general conditions,such as age,BMI,pregnancy and gestational age,in group A,group B and control group were analyzed retrospectively.The incidence of gestational hypertension,abortion,premature delivery,anemia during pregnancy,fetal distress,premature rupture of membranes,gestational diabetes mellitus(GDM),placental abruption,fetal malf ormation and low birth weight were compared among all groups.Results:(1)According to S1 and S2 diagnostic criteria,the treatment rate of negative TPOAb pregnant women with subclinical hypothyroidism was 41.39%(156/377)and 51.34%(70/131),respectively,and the difference was statistically significant(P=0.017).(2)In group A,the incidences of gestational hypertension(13.1%,8/61),gestational diabetes mellitus(GDM,16.4%,10/61),anemia during pregnancy(16.4%,10/61),abortion(9.8%,6/61),premature delivery(9.8%,6/61),low birth weight infant(9.8%,6/61)in untreated group were higher than those control group[3.3%(10/306),6.9%(21/306),6.5%(20/306),1.3%(4/306),2.9%(9/306),2.0%(6/306)(P<0.05).The incidences of gestational hypertension(2.9%,2/70),gestational diabetes mellitus(5.7%,4/70),anemia during pregnancy(1.4%,1/70),abortion(1.4%,1/70),premature delivery(1.4%,1/70),low birth weight infant(1.4%,1/70)in tre ated group had no significant difference compared to control(P>0.05).The incidences of placental abruption(3.3%,2/61),premature rupture of membranes(11.5%,7/61),fetal malformation(1.6%,1/61)and fetal distress(4.4%,4/61)in untreated group was higher than control [1.6%(5/306),6.9%(21/306),1.0%(3/306),2.6%(8/306)],but the difference between two groups was not statistically significant(P>0.05).The incid ences of placental abruption(2.8%,2/70),premature rupture of membranes(7.1%,5/70),fetal malformation(0%,0/70),and fetal distress(4.3%,3/70)in treatment group was not significantly different from the control group.(3)In group B,the incidences of gestational hypertension(6.3%,10/160),gestational diabetes mellitus(8.1%,13/160),anemia during pregnancy(8.8%,14/160),abortion(4.4%,7/160),pre mature delivery(3.8%,6/160),fetal distress(3.8%,6/160),placental abruption(2.5%,4/160),premature rupture of membranes(9.4%,15/160),fetal malformation(1.3%,2/160)and low birth weight infantin(4.4%,7/160)in untreated group and in treated group[4.7%(4/86),5.8%(5/86),5.8%(5/86),3.5%(3/86),2.3%(2/86),6.5%(8/86),2.3%(2/86),7.0%(6/86),1.2%(1/86),1.2%(1/86),respectively] compared with the control group,there was no statistical difference(P> 0.05).Conclusion:(1)The treatment rate of subclinical hypothyroidism in pregnant women with negative TPOAb pregnancy in Qingdao is still low.The treatment rate of pregnancy women(TSH>4mIU/L)is higher than pregnancy women(TSH<4mIU/L).The pregnant women who diagnosed as SCH with different TSH level and negative TPOAb in Qingdao have different treatment effect.The adverse preg nancy outcomes of pregnant woman(4.0mIU/L<TSH<10.0mIU/L)who received Levothyroxine Sodium Tablets therapy are significantly improved.(3)The upper limit of serum TSH(4mIU/L)recommended by the American ATA guide in 2017 is more suitable for the diagnosis of subclinical hypothyroidism in Qingdao.