Influence Of Hormone Replacement Therapy With Different TSH Levels In Pregnancy With Subclinical Hypothyroidism On Pregnancy Outcome

Objective By comparing the effects of thyroid hormone replacement therapy with different TSH levels in pregnant women with subclinical hypothyroidism on pregnancy outcomes,explore the appropriate timing of thyroid hormone intervention for pregnant women with subclinical hypothyroidism in this region,and provide a certain degree of diagnosis and treatment for subclinical hypothyroidism.The clinical data provide references for preventing and reducing adverse pregnancy outcomes in the future.Methods Early pregnancy(<14 weeks)pregnant women who had undergone an obstetric examination at the Obstetrics Clinic of the Affiliated Hospital of Inner Mongolia Medical University from December 2019 to December 2020 were selected.Early morning fasting venous blood was collected for six tests of thyroid function.The results showed that FT4 and FT3 were normal and TGAb,TRAb-negative,and TPOAb-positive pregnant women were the research subjects.The subjects were divided into four groups according to different TSH levels and whether they were treated: TSH≤2.5m IU/L was group I,and no thyroid hormone replacement therapy was given;2.5m IU/L<TSH≤4m IU/L is group Ⅱ,divided into untreated group and treated group;TSH>4m IU/L is group Ⅲ,and thyroid hormone replacement therapy is given.The pregnancy outcome of each group was followed up.The pregnancy outcomes of group Ⅰ and group Ⅱ untreated group,group Ⅱ untreated group and treated group,group Ⅱ treated group and group Ⅲ were compared.Results 1.A total of 170 research subjects were included in this study,including 63 cases in group I,44 cases in group Ⅱ untreated group,32 cases in group Ⅱ treatment group,and 31 cases in group Ⅲ.2.Comparing the age and delivery status of group Ⅰ and group Ⅱ untreated group,group Ⅱ untreated group and treatment group,group Ⅱ treatment group and group Ⅲ,there was no significant difference after statistical analysis(P>0.05).3.A total of 20 cases of adverse pregnancy outcomes occurred in group I,and a total of 30 cases of adverse pregnancy outcomes occurred in the untreated group of group Ⅱ.The incidence of adverse pregnancy outcomes between the two groups was compared,and the incidence of miscarriage and preterm delivery in the untreated group of group Ⅱ It was significantly higher than that of group I,and the difference was statistically significant after χ2 test analysis(P<0.05).However,there was no statistical significance in the occurrence of gestational hypertension,gestational diabetes,premature rupture of membranes and placental abruption in the two groups(P>0.05).4.A total of 30 cases of adverse pregnancy outcomes occurred in the untreated group of group Ⅱ,and 11 cases of adverse pregnancy outcomes occurred in the treatment group.Comparing the incidence of adverse pregnancy outcomes between the two groups,the incidence of miscarriage and preterm birth in the untreated group was significantly higher In the treatment group,the difference was statistically significant by χ2 test analysis(P<0.05).However,the occurrence of pregnancy-induced hypertension,gestational diabetes,premature rupture of membranes and placental abruption were not statistically significant in the two groups(P>0.05).5.A total of 11 cases of adverse pregnancy outcomes occurred in the treatment group of group Ⅱ,and a total of 10 cases of adverse pregnancy outcomes occurred in the group Ⅲ.Compare the occurrence of adverse pregnancy outcomes.The pregnant women in the treatment group of group Ⅱ and group Ⅲ had miscarriage,premature delivery,and pregnancy.Hypertension,gestational diabetes,premature rupture of membranes and placental abruption were not statistically significant by χ2 test analysis(P>0.05).Conclusion 1.Early pregnancy thyroid function screening is very necessary,especially including the detection of thyroid-related antibodies,timely detection of thyroid function abnormalities,early monitoring and intervention to achieve the expected therapeutic effect,which can prevent and reduce the occurrence of adverse pregnancy outcomes.2.For women with subclinical hypothyroidism in this region with TPOAb positive and 2.5m IU/L<TSH≤4.0m IU/L,thyroid hormone replacement therapy is recommended as soon as possible to improve thyroid function,which can significantly reduce the incidence of miscarriage and preterm delivery in pregnant women.The occurrence of adverse pregnancy outcomes ensures the safety of mothers and babies.