Study On Thyroid Function And Coagulation Indexes In Pregnant Women With Preeclampsia

Objective:Preeclampsia is a common and unique complication of pregnancy,which is harmful to pregnant women and fetus.In this study,we collected not only indicators of thyroid function in the second and third trimester of pregnancy,but also blood coagulation indexes in the third trimester of pregnancy.The purpose was to investigate the differences in these indicators between pregnant women with preeclampsia and normal pregnant women,so as to find out the potential risk factors of preeclampsia and provide a basis for management and early intervention in pregnant women with preeclampsia.Methods:Retrospective screening of pregnant women who received regular obstetrics and gynecology examinations and gave birth in the Women's Hospital School of Medicine Zhejiang University from January 2015 to December 2017.According to the criteria of preeclampsia in the 2015 guidelines for the diagnosis and treatment of hypertension during pregnancy in China,a total of 244 pregnant women with preeclampsia were selected as the observation group,including 123 in the mild preeclampsia group and 121 in the severe preeclampsia group.A total of 124 normal pregnant women without obstetric complications at the same period were selected as the control group.We collected the general clinical data,indicators of thyroid function in the second and third trimester of pregnancy,and blood coagulation indexes in the third trimester of pregnancy of the three groups.Then we compared whether there were differences in indicators between the three groupsResults:1.Comparison of general conditions among the three groups:there was no significant difference in age,gravidity,and parity among the three groups.The pre-pregnancy BMI of the mild preeclampsia group and the severe preeclampsia group was higher than that of the control group(22.37�3.11 VS 22.41�3.14 VS 21.23�2.57kg/m2,all P<0.05).The gestational weeks of delivery in the severe preeclampsia group were lower than those in the mild preeclampsia group and the control group(37.23�2.67 VS 38.89�1.29 VS 39.11�1.28wk,all P<0.05),and the neonatal birth weight in the severe preeclampsia group was significantly lower than those in the mild preeclampsia group and the control group(2856.74�766.88 VS 3323.05�439.36 VS 3378.07�365.61g,all P<0.05).2.Longitudinal comparison of thyroid hormones in the second and third trimesters:TSH levels in the third trimester were significantly higher than that in the second trimester in the control group,mild preeclampsia group and severe preeclampsia(1.96 � 0.96 VS 1.51�0.63mIU/L,2.05�1.15 VS 1.47�0.72mIU/L,2.45�1.31 VS 1.52�0.76mIU/L,all P<0.001),FT4 levels in the third trimester were lower than that in the second trimester(10.84�1.19 VS 11.06�1.12pmol/L,10.84�1.42 VS 11.37�1.53pmol/L,10.66�1.55 VS 11.23�1.27pmol/L,all P<0.05).In the control group,there was no significant difference in the level of FT3 in the second and third trimester of pregnancy(3.84�0.46 VS 3.84�0.46pmol/L,P=0.661);in the mild preeclampsia group and the severe preeclampsia group,the FT3 level was lower in the third trimester than in the second trimester of pregnancy(3.96�0.52 VS 4.39�0.65pmol/L,3.83�0.56 VS 4.33�0.47pmol/L,both P<0.001).3.Comparison of thyroid hormone levels in the second and third trimester of pregnancy among the three groups:in the second trimester of pregnancy,there were no statistically significant differences in TSH and FT4 levels between the three groups,and FT3 levels in the mild pre-eclampsia group and the severe pre-eclampsia group were significantly higher than those in the control group(both P<0.05).In the third trimester,there was no significant difference in FT4 and FT3 levels between the three groups.TSH level in the severe preeclampsia group was significantly higher than that in the mild preeclampsia group and the control group(both P<0.05).4.Comparison of positive rates of thyroid autoantibodies among pregnant women in the three groups:TGAb positive rate,TPOAb positive rate in the second and third trimester were not significantly different between the preeclampsia group and the control group.5.Comparison of blood coagulation indexes in the third trimester among the three groups:APTT showed no significant difference among the three groups.Both the mild preeclampsia group and the severe preeclampsia group had lower PT than the control group(12.16�0.61 VS 12.12�0.57 VS 12.36�0.51s,both P<0.05),and higher TT than the control group(15.06�0.77 VS 15.35�0.77 VS 14.86�0.70s,both P<0.05).In addition,the more serious the condition of PE,the more significant the increase of TT.The FIB of the severe preeclampsia group was significantly lower than that of the mild preeclampsia group and the control group(4.65�0.80 VS 4.92�0.76 VS 4.93�0.80g/L,both P<0.05).6.The results of Binary logistic regression analysis showed that:BMI before pregnancy(OR=1.156,95%CI 1.048-1.276),FT3 in the second trimester(OR=11.18,95%CI 5.913-21.140),TSH in the third trimester(OR=1.304,95%CI 1.005-1.692),TT(OR=1.818,95%CI 1.236-2.673)were independent positive correlation factors for preeclampsia(all P<0.05).PT(OR=0.449,95%CI 0.278-0.725),FIB(OR=0.690,95%CI 0.482-0.986)were independent negative correlation factors for preeclampsia(P<0.05).Conclusion:1.Thyroid hormone levels varied in different pregnancy stages.Both normal pregnant women and pregnant women with pre-eclampsia show increased TSH and decreased FT4 in the third trimester compared with the second trimester.There was no significant change in FT3 value in the second and third trimester of normal pregnant women,but the FT3 in the third trimester was higher than in the second trimester of pregnant women with pre-eclampsia.2.FT3 level in the second trimester was an independent positive correlation factor for preeclampsia.TSH level in the third trimester is an independent positive correlation factor for preeclampsia.The monitoring of thyroid function during pregnancy in preeclampsia patients should be strengthened,and timely guidance and intervention should be given.3.The blood coagulation indexes in the third trimester of preeclampsia patients were different from those in the normal pregnancy group,which were mainly manifested as PT shortened,TT prolonged and FIB decreased.It was suggested to strengthen the monitoring of blood coagulation indexes in preeclampsia patients.4.Elevated BMI before pregnancy is a risk factor for preeclampsia?We can strengthen the education on weight control before pregnancy in the future.