The Treatment Values To Improve Maternal And Fetal Prognosis For Women With Hypothyroidism During Pregnancy

Part Ⅰ:The reference intervals of thyroid function for different gestational age rangeObjective:The objective of study is to establish gestational age-specific reference intervals for serum thyrotropin,free triiodothyronine(FT3),free thyroxine(FT4) in Shanghai.Methods:Singleton pregnant women with negative family and individual history of thyroid disease,negative history of medicine treatment,negative enlargement of thyroid gland,negative thyroid autoantibodies were recruited as reference group.Serum thyrotropin,free triiodothyronine,free thyroxine were determined by 3 kinds of detection reagents:Abbott Architect I2000,Siemensimmulite1000 and Roche E170.Results:The reference intervals of TSH,FT3 and FT4 in the first trimester of pregnancy is 0.04-3.61mIU/L,3.60-5.81pmol/L,12.32-21.66pmol/L respectively for Abbott Architect 12000 and 0.02-3.24 mIU/L,3.58-5.41pmol/L,11.85-21.26pmol/L respectively for Siemensimmulite1000.The reference intervals of TSH,FT3 and FT4 in the second trimester of pregnancy was 0.09-3.93 mlU/L, 3.70-5.95pmol/L,11.19-19.14 pmol/L respectively for Abbott Architect 12000 and 0.09-4.57 mIU/L,3.30-5.22pmol/L,10.68-17.65pmol/L respectively for Siemensimmulite1000. The reference intervals of TSH,FT3 and FT4 in the first trimester of pregnancy was 0.03-4.17mIU/L,3.61-5.87pmol/L,11.57-20.88pmol/L respectively for Roche E170. The reference intervals with gestational age from 8-12+6weeks was 0.19-4.94mIU/L,3.36-5.35pmol/L,10.09-16.88pmol/L respectively for Roche E170. The reference intervals with gestational age from 13-19+6weeks was 0.19-4.94mIU/L,3.36-5.35pmol/L,10.09-16.88pmol/L respectively for Roche E170. While the reference intervals from 20-27+6weeks was 0.7-5.42mIU/L,3.00-4.74 pmol/L,8.39-13.79pmol/L respectively,the ones from 28-40 weeks was 0.63-5.52mIU/L,3.02-4.73pmol/L,8.35-14.14pmol/L respectively for Roche E170. Conclusions:The reference value upper limit for serum thyrotropin increased with progress of pregancy.Part II:The value of levothyroxine treatment in improving pregnancy outcomes in subclinical hypothyroidism women with negative thyroid antibodies.Objective:The objective of study was to evaluate values of levothyroxine treatment in subclinical hypothyroidism women with negative thyroid antibodies on pregnancy outcomes.Methods:Between Aug 2011 and Oct 2013,262 subclinical hypothyroidism womenscreening in the first 20 gestational weeks of pregnancy with negative thyroid antibodieswere recruited.184 women accepted levothyroxine treatment(intervention group),while 179 women choosed no drug treatment(no-intervention group).There were 1 cases with spontaneous abortion and 4 cases with artificial abortion because of fetal anomaly in the no-intervention group. Results:There were no significant differences in pregnancy complications such as gestational diabetes mellitus,hypertensive disorders complicating pregnancy,placental abruption,palcenta previa,premature rupture of membrane,fetal distress, preterm birth,low birth weight,macrosomia. Conclusions:The were no intervention values of Levothyroxine treatment in improving short time pregnancy outcomes in subclinical hypothyroidism women with negative thyroid antibodies.Part Ⅲ:The comparision of perinatal outcomes and offspring’s developmental quotient between pregnancy-intervention group and preconception-intervention group with clinical or subclinical hypothyroidism.Objective:The objective of study was to compare perinatal outcomes and offspring’s developmental quotient between pregnancy-intervention group and preconception-intervention group with clinical or subclinical hypothyroidism.Methods:Between Aug 2011 and Oct 2013,238 women with clinical hypothyroidism delivered.168 women with clinical hypothyroidism and 20 women with subclinical hypothyroidism were detected and treated before conception as preconception-intervention group(study group).831 women with clinical hypothyroidism or subclinical hypothyroidism were detected during pregnancy and 16 women were lost to follow-up.Among these women,49 women with clinical hypothyroidism and 303 women with subclinical hypothyroidism were detected during the first 20 gestational week of pregnancy as as pregnancy-intervention group(control group).30 offsprings of study group and 41 offsprings of control group were evaluated at 6 months with Gesell development schedules.15 offsprings of study group and 27 offsprings of control group were evaluated at 12 months with Gesell development schedules.Results:There were no cases of spontaneous abortion in preconception-intervention group of clinical hypothyroidism and two cases of spontaneous abortion in pregnancy-intervention group of clinical hypothyroidism.The proportion of spontaneous abortion was significantly different between two groups(P<0.05).There were no significant differences in pregnancy complications such as gestational diabetes mellitus,hypertensive disorders complicating pregnancy,placental abruption,preterm birth,low birth weight.There were no significant differences about developmental quotient(DQ) in all the areas of motor, adaptive, language and personal social aspects of Gesell development schedules between two groups at the 6 months follow-up visit and the 12 months follow-up visit.Conclusions:Preconception-intervention clinical hypothyroidism could reduce the risk of spontaneous abortion. The clinical values of preconception-intervention of hypothyroidism to improve offspring’s developmental quotient were not definite and needed to be further studied.