| It was well documented that women in pregnancy were trend to suffer from autoimmune thyroid disease such as Graves or Hashimoto thyroiditis with a prevalence of 0.2% and has been shown to affect neonatal thyroid function as well as other outcomes such as spontaneous abortion, intrauterine growth retardation, still birth, premature labor and congenital malformation if they were not appropriately treated. Neonatal thyroid dysfunction without therapy will lead to mental and physical retardation, and some times even result in death.In the last decade, neonates born to mothers with autoimmune thyroid disease were in succession to be found to have primary hypothyroidism, pituitary hypothyroidism, hyperthyroidism or hyperthyrotropinemia, and some were found to have high anti-TSH receptor antibody (TRAb). Previous researches about neonatal thyroid dysfunction were concerned in single factor, very little data were available from early infancy . their mothers and environment based studies on the risk factors for early infantile thyroid dysfunction. While factors such as the state of maternal thyroid function during pregnancy, maternal medical treatment or therapy program during pregnancy and the type of maternal thyroid disease will affect neonatal thyroid function and how widely will they contribute to?ObjectiveIn order to minimize complications and to improve maternal and neonatal outcomes, a cohort of 78 infants born to mothers with autoimmune thyroid disease was investigated to evaluate the impact of maternal thyroid dysfunction during pregnancy and postpartum on infant thyroid function and to identify the possible maternal, neonatal and /or environmental risk factors for causing early infantile thyroid dysfunction by Provincial Neonatal Disease Screening Network which covers nearly thirty seven thousand neonates a year in south east part of China Patients:All the newborns delivered to mothers with autoimmune thyroid disease as defined by criteria from Zhejiang Province (except for Ningbo city) during July 1st of 2001 to June 30th of 2003 were investigated. Seventy eight term, non-asphyxiated neonates met the criteria were recruited into the study. Neonates born to healthy mothers at the same period were set as controls according to Provincial Neonatal Disease Screening Network.The criteria for the diagnosis of Graves' disease or Hashimoto thyroiditis was as follows:Graves disease in the mothers had been diagnosed by clinical and laboratory evidence of hyperthyroidism, increased TPOAb and TPOAb level and a diffuse goiter, excluding other common causes of thyrotoxicosis such as toxic multinodular goiter or toxic adenoma by thyroid ultrasonography or ECT scan or fine-needle biopsy of thyroid tissue.Hashimoto thyroiditis was diagnosed by the presence of increased TPO-Ab and TGAb level, clinical and laboratory evidence of hypothyroidism at the time ofdiagnosis, and decreased echogenicity of the thyroid gland. Some cases with lymphocytic infiltration were confirmed by a fine-needle biopsy of thyroid tissue. Methods:Heel capillary blood was collected on 3-day newborn by obstetrician of local hospital. Samples of blood dried on filter paper were sent to Provincial Neonatal Disease Screening Center to be detected on TSH by Time difference fluorescent analysis (1420 type II, Wallac company, Finland). The neonate was called back immediately if his or her TSH was over 9 mU/L, and the others were called back at 28 to 35 days after birth. The data of mothers and newborns' status were recorded in detail including the type of maternal thyroid disease (Graves disease or Hashimoto thyroiditis), the maternal thyroid function during the pregnancy (three groups were divided: Group A: hyperthyroidism, Group B: hypothyroidism, Group C: euthyroidism based on the level of FT3 FT4 and TSH during pregnancy), the history of medication, the maternal age of pregnancy, the gestational age of baby and neonatal birth weight . The serum concentrations of T3, T4, TSH, FT3, FT4, TPOAb were m... |
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