| Objective To analyze the characteristics of preconception thyroid function and thyroid autoantibodies in women with RPL,and to study the relationship between preconception FT3,FT4,TSH,TGAb and TPOAb and the risk of adverse pregnancy outcome and pregnancy complications in women with RPL.To provide theoretical basis for clinical improvement of pregnancy outcome and formulation of pre-pregnancy intervention program.Methods From September 2019 to February 2022,462 patients who were diagnosed as RPL in the Department of Reproductive Medicine of Lanzhou University Second Hospital were selected as the case group,and 125 women of normal childbearing age who underwent fallopian tube anastomosis were selected as the control group.Their general data were collected and thyroid function was tested before pregnancy.The outcomes of next pregnancy in women with RPL were followed up and further divided into adverse pregnancy outcome group(n = 148 cases)and live birth group(n = 314).The patients with live birth were divided into pregnancy complication group(n = 99)and non-pregnancy complication group(n = 146).SPSS software was used to compare the differences in thyroid function and thyroid autoimmunity between RPL patients and normal women,and the characteristics of thyroid function and thyroid autoimmunity in RPL patients under different baseline data levels were analyzed.Finally,binary Logistic regression analysis was performed among each group.To investigate the relationship between preconception thyroid function and thyroid autoantibodies and adverse pregnancy outcomes and pregnancy complications in RPL women.Results(1)The levels of serum FT3 and FT4 in RPL group were significantly higher than those in normal control group(P < 0.05).There was no significant difference in serum TSH level,TGAb and TPOAb positive rate between the two groups.(2)There were significant differences in preconception serum FT3 and TSH levels between patients aged ≥ 30 and < 30 years old in 462 RPL women,and there were significant differences in serum TSH levels between "junior high school and below" group and "senior high school to junior college" group.The serum TSH level of "ethnic Hui" was significantly higher than that of "ethnic Han","ethnic Tibetan and others",the positive rate of TPOAb in "ethnic Tibetan and others" was significantly higher than that in "ethnic Hui",and the positive rate of TPOAb in irregular menstrual rhythm group was significantly higher than that in patients with regular menstrual rhythm.(3)In patients with RPL,the increase of FT3 level was the protective factor of adverse pregnancy outcome(OR < 1),the increase of FT4 level was the risk factor of adverse pregnancy outcome,and the increase of FT4 was mainly the risk factor of spontaneous abortion(OR > 1).TSH level,TGAb and TPOAb had no significant effect on the risk of adverse pregnancy outcome.(4)Positive TGAb and TPOAb are risk factors for pregnancy complications.TGAb is mainly related to the increased risk of GDM and PROM,while TPOAb is mainly related to the increased risk of PROM and preterm delivery.The increase of serum FT3 level was a risk factor for oligohydramnios(OR > 1).There was no significant relationship between the levels of serum FT4 and TSH and the risk of pregnancy complications in patients with RPL.Conclusion The thyroid function of RPL patients is different from that of normal women,their thyroid function is affected by age,ethnicity and education,and thyroid autoantibodies are related to ethnicity and menstrual rhythm.Low FT3 and high FT4 levels in RPL patients are associated with adverse pregnancy outcomes,mainly reflected in the increased risk of spontaneous abortion.Elevated serum FT3 levels are associated with an increased risk of oligohydramnios.Positive TGAb and TPOAb are associated with increased risk of pregnancy complications,in which TGAb is mainly related to the occurrence of GDM and PROM,while TPOAb is mainly related to PROM and preterm delivery. |
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