| Objective:To investigate the effect of the L-thyroxine(L-T4)on subclinical hypothyroidism during pregnancy(SCH)with TPOAb-on pregnancy outcomes.And the so on medication plan's correlation with the incidence of gestational diabetes mellitus(GDM).Methods:This research used a retrospective analysis method which selects pregnant women who were hospitalized for delivery in the second affiliated hospital of Soochow University from January 2018 to October 2019(n=6734).The selection of the population and the collection of the data were based on the inclusion and exclusion criteria.According to the 2017 American Thyroid Association(ATA)guidelines and the 2019 domestic "Pregnancy and Postpartum Thyroid Disease Diagnosis Guidelines(2nd Edition)" which set the 4.0 mIU/L as the thyroid-stimulating hormone(TSH)cut-off value in early pregnancy.At the basis of the above standard to diagnose SCH among which there are 304 pregnant women who have negative TPOAb.They were divided into the treated group(n=180)and the untreated group(n=124)according to the L-T4 alternative treatment.The control group:600 pregnant women with normal thyroid function and negative TPOAb.Comparing the incidence of the general clinical data,biochemical data,the GDM incidence and pregnancy outcomes(macrosomia,preterm birth,premature rupture of membranes,placental abruption,fetal distress,low birth weight infant and hypertension).And analyze the correlation of the thyroid function indicators,OGTT values and GDM occurrence.Results:1.There were no statistical significance among the differences in the age,number of pregnancy snd delivery,body mass index before pregnancy,gain weight during pregnancy,diastolic blood pressure,systolic blood pressure,glutamic pyruvic transaminase,glutamic oxaloacetic transaminase,and fasting plasma glucose in first trimester of the three groups(p>0.05).The differences and comparisons of the average gestational age of the SCH untreated group(38.36 ± 1.75 weeks),the reduced group(38.99±1.36 weeks)and the control group(38.91 ± 1.24 weeks)(p<0.05)all have statistical significance.The TC(5.97± 2.47 mmol/L)and TG(1.52±0.69 mmol/L)of the SCH treated group as well as the TC(5.87±0.88 mmol/L)and TG(1.35±0.56 mmol/L)of the SCH untreated group were higher than the TC(5.04 ± 1.45 mmol/L)and TG(1.58±0.83 mmol/L)of the control group,these comparisons all had statistical significance(p<0.05).2.The TSH(5.81 ± 1.19 mIU/L)and FT4(9.40 ± 2.36 pmol/L)of the SCH treated group,as well as the TSH(5.32±0.73 mIU/L)and FT4(9.20±3.67 pmol/L)of the SCH untreated group compared with the TSH(1.21 ± 0.74 mIU/L)and FT4(10.42 ± 2.23 pmol/L)of the control group,these differences all had statistical significance(p<0.05).There were no statistical significance by comparing the three groups according to the level of FT3.3.In the comparisons among the three groups of OGTT-1h and OGTT-2h,there were no statistical differences(p>0.05).Although there were no statistical differences among the three groups of OGTT-0h(p=0.067),when comparing pairs of groups,it was found that the SCH untreated group(4.56±0.43 mmol/L)and the control group(4.37±0.30 mmol/L)was statistically different(p<0.05).4.The incidences of GDM in the SCH group,SCH treated group,the SCH untreated group and the control group were respectively 14.8%,12.8%,17.7%,and 9.3%.It was found that the incidences of GDM in the SCH group and the SCH untreated group were statistically different with the control group(p<0.05).It has no statistical significance between the incidences of GDM in the SCH treated group and the control group(p>0.05).Although the incidence of GDM in the SCH untreated group was higher than that in the SCH treated group,no difference was found between this two groups(p>0.05).5.The Logistic regression of thyroid function and the incidence of GDM:FT4 was negatively correlated with the incidence of GDM(OR value=1.211,95%CI:1.029-1.425),and TSH was positively correlated with the incidence of GDM(OR value=0.807,95%CI:0.692-0.989),all this relationships had statistical significance(p<0.05).6.Correlation analysis of various values of thyroid function and OGTT:TSH is positively correlated with OGTT-0h(p=0.035).OGTT-0h(p=0.007),OGTT-1h(p=0.024),OGTT-2h(p=0.012)were negatively correlated with FT4,and there were no correlations between FT3 and OGTT(p>0.05).7.Compared with the control group,the incidences of premature rupture of membranes,macrosomia,fetal distress,low birth weight infant,placental abruption and hypertension during pregnancy of the SCH treated group were not statistically different.This two groups were statistically different in the incidence of preterm birth,but the difference was not significant.In terms of the overall incidence of adverse outcomes,the incidence of the SCH treated group was 27.7%higher than 19.2%of the control group,which difference has statistical significance.8.In the comparisons between the SCH untreated group and the control group,the incidences of macrosomia,fetal distress,placental abruption and hypertension during pregnancy have no statistical difference(P>0.05).The incidences of premature rupture of membranes,low birth weight infant and preterm birth in the SCH untreated group were respectively 12.1%,3.2%,13.7%,and there were statistical differences between the comparisons with the control group(6.3%,0.8%,4.3%)(p<0.05).In terms of the overall incidence of adverse outcomes,40.3%of the untreated group was significantly higher than 19.2%of the control group and 26.7%of the treated group,which difference was statistically significant(p<0.05).Conclusions:1.Subclinical hypothyroidism during pregnancy affects glucose metabolism which has correlation with the incidence of gestational diabetes mellitus.2.The use of the L-thyroxine can reduce the incidence of GDM,premature rupture of membranes,low birth weight infant and premature delivery in the subclinical hypothyroidism during pregnancy with negative TPOAb.3.FT4 is a protective factor for GDM. |
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