Correlation Of Missed Abrotion With Vitamin D,Hcy And Thyroid Function In Early Pregnancy

Objective:Missed abortion（MA）is a special type of abortion among gynecology and obstetrics pregnancy related diseases.Its etiology and pathogenesis are complex and diverse,and it is still not fully clear.As the incidence rate of MA increases year by year,the adverse effects on pregnant women and their families are particularly prominent.This study aims to explore the correlation between vitamin D（VD）,homocysteine（Hcy）,and thyroid function in the serum of women with early MA and women who require termination of normal early pregnancy during the same period,in order to fundamentally prevent and treat missed abortion to the greatest extent.Methods:1.From November 2021 to February 2023,200 patients with missed abortion（≤12weeks）who who met the inclusion and exclusion criteria from the Family Planning and Endocrinology of Shanxi Provincial Maternal and Child Health Hospital were collected as the study group.2.200 patients（≤12 weeks）with healthy pregnancy requiring artificial abortion in our hospital during the same period were selected as the control group.3.By collecting clinical data of 25（OH）D₃,Hcy,thyroid stimulating hormone（TSH）,free triiodothyronine（FT₃）,free thyroxine（FT₄）,triiodothyronine（T₃）,thyroxine（T₄）and thyroid peroxidase antibodies（TPOAb）from the two groups,SPSS software was used to analyze the two groups of quantitative data,which did not conform to Normal distribution,and rank sum test was used,Chi-squared test was used for qualitative data,logistic regression analysis,and Spearman correlation analysis were used to conduct inter group difference analysis and correlation research to screen out the influencing factors of missed abortion.Results:1.Single factor analysis showed that:（1）There was no statistically significant difference in general information between the two groups:age,body mass index（BMI）,number of pregnancies,days of pregnancy,and history of cesarean section（P>0.05）.The incidence of miscarriage history in the study group was significantly higher than that in the control group（X²=12.148,P<0.001）.（2）The levels of VD,Hcy,TSH,and TPOAb in the study group were significantly higher than those in the control group（P<0.05）.There was no statistically significant difference in the levels of FT₃,FT₄,and T₄in the thyroid function indicators between the two groups（P>0.05）.（3）The incidence of VD deficiency,hyperhomocysteinemia（HHcy）,TSH elevation,and TPOAb positive in the study group was significantly higher than that in the control group,with statistical significance（P<0.05）.（4）The incidence of thyroid dysfunction in the study group was significantly higher than that in the control group,with a statistically significant difference（X²=88.929,P<0.001）.Comparison between the two groups with abnormal thyroid function:The incidence of clinical hypothyroidism（CH）,subclinical hypothyroidism（SCH）,and TPOAb positive in the study group were statistically different from those with normal thyroid function（P<0.05）.（5）There was no statistical difference between the two groups in the comparison of thyroid dysfunction combined with TPOAb positive（X²=4.133,P>0.05）.2.Logistic regression analysis found that:（1）Compared with the"adequate"25（OH）D3 group,the"deficient"and"inadequate groups had an increased risk of disease（OR=18.258,5.075,P<0.05）,indicating that vitamin D was a protective factor for missed abortion.（2）Patients with a previous history of miscarriage have an increased risk of MA（OR=11.691,95%CI:5.331-25.639）.（3）Hcy≥15μmol/L,people with HHcy have an increased risk of developing the disease（OR=2.425,95%CI:1.096-5.369）,indicating that Hcy is a risk factor for MA.".（4）The risk of MA in the group with TSH"≥4m IU/L"is higher than that in the group with normal TSH,indicating that elevated TSH is a risk factor for MA（OR=15.086,95%CI:1.351-168.501）.Positive TPOAb may increase the risk of MA（OR=9.770,95%CI:3.338-28.593）,indicating that positive TPOAb is a risk factor for MA.Overall thyroid dysfunction increases the risk of MA（OR=9.686,95%CI:2.514-37.317）,especially SCH（OR=9.360,95%CI:1.129-77.615）.3.Spearman correlation analysis showed that there was no correlation between25（OH）D₃,Hcy,TSH,and TPOAb in the study group（P>0.05）.Conclusions:1.Abortion history,VD deficiency,elevated Hcy,elevated TSH,positive TPOAb,CH,and SCH are closely related to early MA.2.Abortion history,Hcy,TSH,and TPOAb positive are risk factors for MA,while VD is a protective factor for MA.3.Various thyroid diseases during pregnancy may lead to MA,especially CH and SCH.4.In clinical work,it is necessary to attach importance to the detection of thyroid function,VD,and Hcy in women of childbearing age during pregnancy preparation and early pregnancy,to diagnose and treat as soon as possible,and to reduce the incidence of MA.