| Part 1Effects Of Thyroid Disease On Pregnancy OutcomeObjective To analyze the prevalence of thyroid disease during pregnancy and its effect on maternal and fetal pregnancy outcomes;To investigate the clinical effect of levothyroxine in treating subclinical hypothyroidism in pregnancy.Methods A retrospective analysis was conducted on 2,626 cases of single fetal maternal in late pregnancy who gave birth in Jiangsu maternal and child health care center during June 2018 to December 2018,meeting the inclusion and exclusion criteria.According to their thyroid function during pregnancy,these parturient were divided into normal thyroid function group,hypothyroidism group,subclinical hypothyroidism group,hyperthyroidism group,subclinical hyperthyroidism group and hypothyroxemia group.Subclinical hypothyroidism group was divided into treatment and untreated groups based on whether levothyroxine was taken during pregnancy.The clinical data of each group of parturients were recorded,including age,gravidity,parity,thyroid function during pregnancy,delivery gestational age,maternal-fetal complications and pregnancy outcome.The prevalence of thyroid diseases in pregnancy was analyzed;The maternal and fetal pregnancy outcomes were compared between thyroid disease group and normal thyroid function group,and pregnancy outcomes were compared between subclinical hypothyroidism treatment group,untreated group and normal thyroid function group.Results(1)Prevalence of thyroid diseases during pregnancy was 28.4%,including clinical hypothyroidism 1.4%,subclinical hypothyroidism 24.1%,clinical hyperthyroidism 0.84%,subclinical hyperthyroidism 0.99%,and hypothyroxemia0.99%.(2)The incidence of low-weight infants and fetal malformation in the hypothyroidism group was 5.3%,which was statistically significant compared with the normal group(0.8% 0.7%)(P<0.05).(3)The incidence of hypertensive disorder complicating pregnancy,anemia,low-weight infants and fetal growth restriction in subclinical hypothyroidism group was 6.8%,28.6%,2.0% and 2.8%,respectively,which were significantly higher than that in the normal group,and the difference was statistically significant(P<0.05).(4)The incidence of placental abruption and low birth weight infants in the hyperthyroidism group was 9.1%,which was statistically significant compared with that in the normal group(1.5%,0.8%)(P<0.05).(5)The incidence of polyhydramnios and low-weight infants in the subclinical hyperthyroidism group was 11.5% and 7.7%,respectively,and the difference was statistically significant compared with that in the normal group(0.5% and 0.8%)(P<0.05).(6)The incidence of gestational diabetes and polyhydramnios in the low T4 group was 38.8% and 7.7%,respectively,and the difference was statisti-cally significant compared with that in the normal group(19.7% and 0.5%)(P<0.05).(7)There was no significant difference in maternal and fetal pregnancy outcomes between subclinical hypothyroidism treatment group and normal group(P>0.05).However,the incidence of hypertension,anemia,fetal growth restriction,preterm delivery and fetal death in utero in the untreated group was 7.7%,22.7%,3.7%,10.7% and 1%,respectively,which was statistically significant compared with the normal group(P<0.05).Conclusions(1)In thyroid disease during pregnangcy,the prevalance of subclinical hypothyroidism is the highest.(2)Hypothyroidism,subclinical hypothyroidism,hyperthyroidism,subclinical hyperthyroidism and hypothyroxemia during pregnancy can increase the incidence of maternal and fetal adverse pregnancy outcome.(3)Levothyroxine can reduce the incidence of adverse pregnancy outcome in subclinical hypothyroidism.Part 2The Clinical Significance Of Ultrasonic Examination Of Fetal Thyroid GlandObjective The size of fetal thyroid gland was detected by two-dimensional ultrasound and the normal reference range was established;To explore the clinical significance of ultrasonography in detecting fetal thyroid gland.Methods Select healthy pregnant women(control group)and high-risk pregnant women(observation group)who had received prenatal examination in integrated traditional Chinese and western medicine hospital of Jiangsu province from 2015 to2018,meeting inclusion and exclusion criteria.Two-dimensional ultrasound was used to measure the transverse diameter,anteroposterior diameter and length diameters of fetal thyroid in the control group.According to the ellipsoidal formula,the thyroid volume was calculated and the normal reference range of thyroid size of fetus in different gestational weeks was established.The relationship between the transverse diameter,anteroposterior diameter,length diameters and volume size of fetal thyroid and gestational age was analyzed.According to the reference range of thyroid volume established by fetuses in the control group,the observation group was divided into normal volume group,large group and small group,and the thyroid function and growth and development of fetuses after birth were observed.Results(1)Ultrasonic measurements of thyroid gland of 280 normal fetuses at 21-39 weeks of gestation were collected.The transverse diameter,anteroposternal diameter,length diameter and volume of the right lobe of the fetal thyroid gland ranged from3.75±0.93 mm,6.85±1.70 mm,12.28±1.68 mm,173.91±85.46mm3 at 21 weeks of gestation to 6±1.42 mm,14.95±3.16 mm,22.72±3.61 mm,1113.79 ±533.82mm3 at 39 weeks of gestation,fetal thyroid gland increases with gestational age.(2)The median of transverse diameter,anteroposterior diameter,length diameter and volume of the left lobe of fetal thyroid gland were 35.5mm,10 mm,18.35 mm and 540.9mm3,respectively;The median of transverse diameter,anteroposterior diameter,length diameter and volume of the right lobe of fetal thyroid gland were 5.2mm,9.6mm,18.5mm and 521.7mm3,respectively.The left lobe was slightly larger than the right lobe,and there was no significant difference in the size of the left and right lobe(p>0.05).(3)The regression equations between the size of right lobe of fetal thyroid gland and gestational weeks were expressed as follows: y TD=1.827+0.12x(r=0.495,p<0.05),y AD=-0.234+0.366x(r=0.553,p<0.05),y L=2.287+0.547x(r= 0.691,p<0.05), y V=-850.765+49.096x(r=0.63,p<0.05).The regression equation between total thyroid volume and gestational age was expressed as follows: y V=-1814.641+104.96x(r=0.655,p<0.05).(4)In the observation group,both the normal thyroid volume group and the larger group had normal thyroid function,hypothyroidism and transient hypothyroidism after birth,while the smaller group had normal thyroid function and hypothyroidism after birth.(5)In the observation group,there were three neonates with abnormal growth and development,and six neonates with hypothyroidism(three cases of transient hypothyroidism and three cases of hypothyroidism).The incidence of congenital hypothyroidism was 7.06%(6/85),much higher than that of healthy pregnant newborns(0.7‰).Conclusions(1)Two-dimensional ultrasound can measure the size of fetal thyroid and establish a normal reference range;(2)After ultrasound examination of fetal thyroid size,further examination is needed to clarify its function.(3)Maternal thyroid disease increases the risk of thyroid dysfunction in newborns. |
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