期刊
JOURNAL OF ENDOCRINOLOGICAL INVESTIGATION
卷 42, 期 5, 页码 599-607出版社
SPRINGER
DOI: 10.1007/s40618-018-0960-7
关键词
First and second trimester; Levothyroxine (L-T4); Isolated maternal hypothyroxinemia (IMH); Pregnancy outcomes
资金
- National Science and Technology Support Program [2014BAI06B02]
- Chinese National Natural Science Foundation [81170730, 81570709, 81500605]
- Foundation of Key Laboratory in Department of Education of Liaoning Province Government in China [LZ2014035]
- Liaoning Science Public Research Funds [2014001001/GY2014-A-001]
- Key Platform Foundation of Science and Technology for the Universities in Liaoning Province [16010]
- Shenyang Science and Technology Project [17-230-9-02]
ObjectivesTo explore the effect of isolated maternal hypothyroxinemia (IMH) during the first and second trimester of gestation on pregnancy outcomes. To explore whether levothyroxine (L-T4) treatment of women who had IMH identified in the first trimester improves pregnancy outcomes.MethodsWomen in the early pregnancy in the iodine-sufficient area (n=3398) were recruited to this prospective cohort study (ChiCTR-TRC-12002326). Serum thyroid-stimulating hormone (TSH), free thyroxine (FT4), and thyroid peroxidase antibody (TPOAb) were detected. Women with IMH before 12weeks chose to receive L-T4 or remain untreated. The L-T4 dose was adjusted to attain a normal FT4 and TSH level. Pregnancy outcomes were evaluated during follow-up.ResultsIMH in the first trimester was not associated with increased risk of adverse pregnancy outcome compared with controls. The incidence of macrosomia (p=0.022) and gestational hypertension (p=0.018) was significantly higher in IMH identified in the second trimester of gestation compared with controls. IMH identified in the second trimester of gestation was a risk factor for macrosomia [adjusted odds ratio (aOR) 1.942, 95% CI 1.076-3.503, p=0.027] and gestational hypertension (aOR 4.203, 95% CI 1.611-10.968, p<0.01), when body mass index in the early pregnancy was<25kg/m(2).ConclusionsIMH in the first trimester did not increase the risk of adverse outcomes irrespective of whether women received L-T4 treatment. However, IMH identified in the second trimester was associated with increased risk of adverse pregnancy outcome. The results suggest that thyroid function follow-up during the second trimester is necessary, even if thyroid function is normal during the first trimester.
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