Clinical Epidemiology Research Of Thyroid Disease During Pregnancy

Objective To Survey the prevalence of Thyroid disease in pregnancy women, andpreliminarliy investigate the impacts of thyriod disease on gestational complications andadverse pregnancy outcomes.Methods Pregnant women who visited obstetric antenatal clinic of Beijing FriendshipHospital affiliated to Capital Medical University from October2010to December2012werechosen for this survey, whose fetal were confirmed a single live births by B-ultrasound, andthey are eligible for inclusion criteria and Exclusion criteria. For all the in grouped pregnantwomen,3ml fasting blood are collected during8-12weeks of pregnancy,24-28weeks, and37weeks-before birth. All available serum samples were analyzed for thyroid hormonemeasurements. to monitoring the dynamic changes of thyroid functions and thyroidperoxidase antibody (TPOAb). According to the recommendations of the National Academyof Clinical Biochemistry (NACB), we calculated the pregnancy specific reference intervalsfor thyroid-stimulating hormone (TSH), and free thyroxine (FT4). By following up andmonitoring of pregnancy the women ’s thyroid function，Screening for gestational thyrioddisease and TPOAb positive to investigation the incidences of thyroid disease，includingclinical hyperthyroidism, subclinical hypothyroidism (SCH), hypothyroxinemia. Women withclinical hypothyroidism and hyperthyroidism were routinely treatmented，and women withSCH were divided intodifferent groups according to their intentions to treatment, for womenwith hypothyroxinemia, no treatment were given. we have been following up to all thepregnant women until childbirth. and Observating complications and adverse pregnancyoutcomes, including premature birth, fetal growth restriction, preeclampsia, gestationalabnormal glucose metabolism and birth weight.Results (1) First Trimester maternal urinary iodine mean:156.43±9.21g/L. Referencerange of thyroid function during pregnancy: T1: TSH:0.03-3.67mU/l, FT4:0.56-1.45ng/dl;T2: TSH:0.60-3.74mU/l, FT4:0.43-0.99ng/dl; T3: TSH:0.58-4.45mU/l, FT4:0.42-0.81ng/dl.(2) Incidence of thyroid disfunction. T1: clinical hypothyroidism:0.74%,SCH:4.44%, Hypothyroxinemia:1.50%, Clinical hyperthyroidism:0.43%, Subclinicalhyperthyroidism:0.63%, TPOAb positive:24.5%; T2: Clinical hyperthyroidism:0.01%,clinical hypothyroidism:0.005%, SCH:4.67%, Hypothyroxinemia:1.85%; T3: SCH:2.40%, Hypothyroxinemia:1.17%, Subclinical hyperthyroidism:0.02%. Incidence of thyroid diseasethrough pregnancy was17.26%. Clinical hyperthyroidism was0.50%, Subclinicalhyperthyroidism was0.83%, clinical hypothyroidism was0.79%, SCH was10.80%,Hypothyroxinemia was4.30%.(3)subclinical hypothyroidism’s incidence of TPOAb positivepregnant women was significantly higher than that of TPOAb negative pregnant women（T1:7.69%/3.38%，P<0.05，T2:6.95%/3.96%，P<0.05；T3:3.52%/1.99%，P<0.05）.(4) theincidence of adverse pregnancy outcomes of SCH treatment and untreated: T1:SCH+TPOAb positive+Drug intervention group:12.00%（3/25） and SCH+TPOAbpositive:44.44%（8/18）,(P<0.05); SCH+TPOAb negative+Drug intervention group:21.43%（3/14）and SCH+TPOAb negative:15.91%（7/44）,(P<0.05); T2and T3:SCH+TPOAb positive+Drug intervention group:21.43%（3/14）and SCH+TPOAb positive:23.68%（9/38）,(P>0.05). SCH+TPOAb negative+Drug intervention group:25%（3/12）and SCH+TPOAb negative:15.91%（7/44）,(P>0.05). SCH+TPOAb negative+Drugintervention group:45.45%（5/11）and SCH+TPOAb negative:23.81（20/84）,(P<0.05).(5)the rate of Low T4hyperlipidemia of pregnant women has on statistically significantdifference compared to normal pregnancy women.(6)For pregnant women with TPOAbpositive prevalence rate of complications and adverse pregnancy outcomes is17.34%, higherthan of normal thyroid function with TPOAb negative15.48%(P <0.05)Conclusions (1) For pregnant women, the level of TSH showed a increased gradualtrend of increase with the number of weeks of pregnancy for TSH, in contrast, FT4showeddecreased gradual trend.(2) In the case of sufficient iodine of the unit or region, Diagnosis ofthyroid disease during pregnancy should be based on the unit or region pregnancy thyroidfunction-specific reference value of the standard.(3)The prevalence of thyroid disease duringpregnancy was17.26%, and that of SCH was10.80%，accounted for the vast majority.(4)Thyroid peroxidase antibodies positive can increase the incidence of SCH. TPOAb positivecombined with SCH can increase the risk of negative pregnancy outcomes.(5) Drugtreatment for subclinical hypothyroidism with TPOAb positive in pregnant women woulddecrease the incidence of adverse pregnancy outcomes and was recommended in early period.(6) the incidence of adverse pregnancy outcomes of TPOAb positive pregnant women ishigher than that of pregnant women with normal thyroid function and TPOAb-negative.