| Background:Subclinical hypothyroidism(SCH)is common in pregnant women.However,clinical opinions on the impact of SCH within the pregnancy on pregnancy outcomes remained discordance.Meanwhile,the effect of levothyroxine replacement on pregnancy with SCH was also controversial.This present study aimed to investigate the relationship between SCH within the pregnancy and adverse pregnancy outcomes,as well as the efficacy of levothyroxine.Methods:A retrospective data of a total of 423 pregnant women who were hospitalized and delivered in the obstetrics department in the Second Affiliated Hospital of Nanchang University from September 2017 to September 2019 were extracted.They were divided into SCH group(n=226)and normal thyroid function group(group C n=197);According to the medication,122 and 104 cases were respectively divided into the treated SCH group(group A n=122)who were prescribed levothyroxine and the untreated SCH group(group B n=104)who were not prescribed levothyroxine.Furthermore,according to the TPOAb detection,those cases in group A were sub-divided into the A1 group(60 cases with positive TPOAb)and the A2 group(62cases with negative TPOAb).The primary endpoint was sum of the adverse pregnancy outcomes including gestational diabetes mellitus,hypertensive disorders of pregnancy,intrahepatic cholestasis of pregnancy,premature delivery,premature rupture of membranes,placental abruption,oligohydramnios,intrauterine distress,low birth weight and fetal macrosomia.The secondary endpoint were the incidence of the adverse pregnancy outcomes in the each of included population.The differences in baseline information,adverse pregnancy outcomes,and neonatal conditions between the three groups A,B,and C and between the A1 and A2 groups were compared.Using binary logistic regression analysis to explore the effect of SCH on the adverse pregnancy outcomes of pregnant women.Results:1.In the baseline: compared with group C,the gestational week of delivery in group A(38.4±2.9 weeks vs 38.9±3.0 weeks,P<0.05)was significantly reduced,and the systolic blood pressure in group B(119.6±13.8 mmHg vs 115.1±10.5 mmHg,P<0.05)was significantly increased,but because the changes in the above two indicators are within the normal range,the differences may not be clinically significant;compared with groups A and C,TSH was significantly higher in group B[(2.13±0.71)mU/L,(2.13±0.78)mU/L vs(6.07±1.63)mU/L),P<0.05];There is no statistically significant difference in baseline between A1 and A2 groups(P>0.05).2.In the primary endpoint: compared with group C,the incidence both in group A(68.0% vs 51.3%)and group B(68.3% vs 51.3%)were significantly increased(P<0.0167);There was no difference in groups A1 and A2(P>0.05).3.In the secondary endpoint: compared with group C,the incidence of cesarean section in groups A was higher(50.0%vs27.9%,P<0.0167),the incidence of gestational diabetes(14.4% vs 4.6%)and fetal distress(13.5% vs 4.1%)in group B was higher(P<0.0167);but there was no difference in the incidence of secondary endpoint between groups A and B and between groups A1 and A2(P> 0.0167).4.Logistic regression analysis showed that the risk on developing gestational diabetes(OR 1.272,95% CI: 1.078-1.501,P=0.004)and fetal distress(OR 1.349,95% CI: 1.136-1.601,P=0.001)increased in group B.Conclusion:In this retrospective study,it was found that subclinical hypothyroidism within the pregnancy increased the risk of adverse pregnancy outcomes in pregnant women.However,the treatment of levothyroxine in preventing adverse pregnancy outcomes might be helpless. |
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