Incidence Of Thyroid Disease During Pregnancy And Diagnosis And Treatment Of SCH Patients Under Three Different Diagnostic Criteria And Analysis Of Adverse Events Of Pregnancy

Objective: To investigate the incidence of thyroid diseases in pregnant women in Nanchong area(iodine appropriate area),analyze the diagnosis and treatment of SCH patients under three standards,and explore the relationship between TPOAb and the incidence of thyroid diseases in each period of pregnancy.Methods:1.Selected from Affiliated Hospital of North sichuan Medical College of prenatal care and prenatal,childbirth,and met the inclusion and exclusion criteria of 2348 pregnant women as the research object.2.The incidence and incidence of thyroid diseases and thyroid peroxidase antibody(TPOAb)in three stages of early pregnancy(T1),middle(T2)and late(T3)phase were analyzed.Investigate pregnancy complications and adverse events in SCH patients during pregnancy.Results:1.The incidence of thyroid diseases: T1: Thyrotoxicosis : 0.64% subclinical hyperthyroidism: 1.06%,clinical hypothyroidism(OH): 1.79% subclinical hypothyroidism(SCH): 6.64%,low T4 level: 0.64%;T2: Thyrotoxicosis: 0.24%.Subclinical hyperthyroidism : 0.13%,clinical hypothyroidism(OH):1.24%,subclinical hypothyroidism(SCH): 5.16%,low T4 level: 0.29%;T3: Thyrotoxicosis: 0.36%,subclinical hyperthyroidism: 0.57%,clinical hypothyroidism(OH): 0.93%,subclinical hypothyroidism(SCH): 1.76%,low T4 level: 0.10%.2.Gestational thyroid dysfunction total incidence rate was 20.57%(483/2348),Thyrotoxicosis : 1.15%,subclinical hyperthyroidism :2.09%,OH: 3.66%,SCH: 12.69%,low T4 level: 0.98%.3.Under the three standard,the diagnosis and treatment of SCH patients were as follows: according to the 2011 ATA Guide: 201 cases of TPOAb positive pregnant women in T1 period,35 cases with SCH patients,the incidence rate is 17.41%(35/201),of which 35 cases were treated with SCH,the rate of treatment was 100%(35/35);T1 stage TPOAb negative pregnant women,combined SCH patients with 148 cases,the incidence rate was 6.89%(148/2147),of which 113 patients received SCH treatment,the treatment rate was 76.35%(113/148).There were 319 Cases of TPOAb positive pregnant women in T2 and 51 cases with SCH patients,the prevalence rate was 15.99%(51/319),of which there were 16 cases of new SCH patients,of which 16 were treated with 100%(16/16),2029 in T2 TPOAb negative pregnant women,213 patients with SCH,and 10.50%(213/2029),of which 65 cases were SCH.57 patients received treatment,the cure rate was 87.65%(57/65).There were 363 cases of TPOAb positive pregnant women in T3 and 56 cases with SCH patients,the prevalence rate was 15.43%(56/363),of which there were 5 cases of new SCH patients,of which 5 were treated,the rate of treatment was 100%(5/5),1985 in T3 TPOAb negative pregnant women,242 in SCH patients,and 12.19%(242/1985),and 29 cases were SCH.The treatment rate of 20 patients was 68.97%(20/29).According to the analysis of the occurrence of adverse events of pregnancy in the 2011 ATA Guide: the incidence of adverse events of SCH in SCH patients with TPOAb positive pregnant women was P(c)20%,and the incidence of adverse events in SCH patients was P(d)13.51% in TPOAb negative pregnant women,and the difference was statistically significant.The incidence of adverse pregnancy events in SCH patients was P(c)12.5%,and the incidence of adverse events of SCH in TPOAb negative pregnant women was 12.31%(d),and the difference was statistically significant compared with P(c)>P(d)and P=0.012.The incidence of adverse pregnancy events was 20%.The incidence of adverse events in women with SCH was 20.69%(P)(d),compared with P(c)<P(d)and P2=0.153,and the difference was not statistically significant.According to the 2017 ATA Guide: 201 cases of TPOAb positive pregnant women in phase T1,27 cases with SCH were combined,the incidence was 13.43%(27/201),of which 27 cases were treated with 100%(27/27);2147 cases of T1 stage TPOAb negative pregnant women,122 cases with SCH patients,the incidence rate was 5.68%(122/2147),of which the SCH patients received treatment were accepted.In 103 cases,the rate of treatment was 84.43%(103/122).There were 319 Cases of TPOAb positive pregnant women in T2 and 40 cases with SCH patients,the prevalence rate was 12.54%(40/319),of which there were 13 cases of new SCH patients,of which 13 were treated with 100%(13/13),2029 in T2 TPOAb negative pregnant women,175 patients with SCH,and 8.62%(175/2029),of which 53 cases were SCH.44 patients received treatment,the cure rate was 83.02%(44/53).There were 363 cases of TPOAb positive pregnant women in T3 and 43 cases with SCH patients,the prevalence rate was 11.85%(43/363),of which there were 3 cases of new SCH patients,of which 3 were treated,the rate of treatment was 100%(3/3),1985 in T3 TPOAb negative pregnant women,196 in SCH patients,and 9.87%(196/1985),and 21 cases were SCH.The treatment rate of 20 patients was 95.24%(20/21).According to the analysis of the occurrence of adverse events of pregnancy in the 2017 ATA Guide: the incidence of adverse events of SCH in SCH patients with TPOAb positive pregnant women was P(c)18.52%,and the incidence of adverse events of SCH patients in TPOAb negative pregnant women was 13.93%(d),and the difference was statistically significant.The incidence of adverse events in pregnant women with SCH was P(c)(c),and the incidence of adverse events of SCH in TPOAb negative pregnant women was P(d),and the difference was statistically significant compared with P(c)>P(d)and P=0.003.The incidence of pregnancy ungood events was 33.33%.The incidence of adverse events in pregnant women with SCH was 23.81%(P)(d),and the difference was not statistically significant in P(c)>P(d)and P2=0.479.According to the reference interval of pregnant women in our hospital: 201 cases of TPOAb positive pregnant women in T1 period,18 cases of SCH patients were combined,the incidence was 8.96%(18/201),of which 18 cases were treated with SCH,the rate of treatment was 100%(18/18),2147 TPOAb negative pregnant women in T1 period,106 cases with SCH patients,the incidence was 4.49%(106/2147),of which the receiving treatment was accepted.For SCH patients,the 103 treatment rate was 97.17%(103/106).There were 319 Cases of TPOAb positive pregnant women in T2 and 32 cases with SCH patients,the prevalence rate was 10.03%(32/319),of which there were 14 cases of new SCH patients,of which 14 were treated with 100%(14/14),2029 in T2 TPOAb negative pregnant women,151 patients with SCH,and 7.44%(151/2029),of which 45 cases were SCH.42 patients received treatment,the cure rate was 93.33%(42/45).There were 363 cases of TPOAb positive pregnant women in T3 and 40 cases with SCH patients,the prevalence rate was 11.02%(40/363),of which there were 8 cases of new SCH patients,of which 8 were treated,the rate of treatment was 100%(8/8),1985 in T3 TPOAb negative pregnant women,167 in SCH patients,and 8.41%(167/1985),and 16 cases were SCH.The treatment rate of 14 patients was 87.50%(14/16).4.Correlation analysis of thyroid dysfunction and TPOAb positivity in pregnant women: the positive rate of TPOAb in group A was 22.15%,and the positive rate of TPOAb in group A was 13.7%(compared with P<0.05 in two groups).The positive rate of TPOAb among different types of nail dysfunction is different.Except for hypothyroidism group(29.97%),which is larger than SCH group(18.79%)and P < 0.05,the rest showed no statistical difference according to the different disease types.According to the occurrence of pregnancy adverse events in the reference interval of pregnant women in our hospital,the incidence of adverse events in SCH patients with SCH TPOAb positive pregnant women was 16.67%,P(c)was 16.67%,and P(d)of SCH patients in TPOAb negative pregnant women was P(d),and the difference was statistically significant.The incidence of adverse pregnancy events in SCH patients with POAb positive was 14.29%(c),and the incidence of P(d)was 11.11% for SCH patients in TPOAb negative pregnant women,and the difference was statistically significant.The incidence of adverse events of pregnancy was 12.50%.The incidence of adverse events in TPOAb negative pregnant women with SCH was P(d)18.75%,compared with P(c)<P(d)and P2=0.336,the difference was not statistically significant.Conclusion:1.The incidence of thyroid diseases in pregnant women is high,especially in SCH.SCH pregnant women in our hospital when the combination of TPOAb positive,all voluntary LT4 treatment,when TPOAb negative,the vast majority of patients also choose to receive LT4 treatment,SCH patients have good medical treatment.2.The positive rate of TPOAb was closely related to the occurrence of thyroid diseases in pregnancy,and the positive rate of TPOAb was positively correlated with the prevalence of SCH.3.Under the condition of LT4 treatment,TPOAb positive still will increase the risk of adverse pregnancy events in pregnant women with SCH.4.The incidence of adverse events of pregnancy caused by SCH during different periods of pregnancy is different.5.This study shows that there is no significant difference in the incidence of adverse events at the early stage of pregnancy between the three diagnostic criteria.