The Effect Of Thyroid Function On The Maternal And Fetal Complications In Late Pregnancy

Objective:To observe the effect of thyroid function on the maternal and fetal complications in late pregnancy.Method:Collecting the full-term pregnancy gravida information of Hunan Provincial Maternal and Child Health Hospital from January2010to November2010. The case group has65subjects who met the generalized diagnosis standards of pregnancy with subclinical hypothyroidism, which was proposed and agreed on the8th National Endocrine Conference in2009, while the control group has260subjects whose thyroid function-FT3, FT4and TSH were within the normal reference range. According to the level of TSH, the control group is divided into four subgroups by quartiles grouping. B1:TSH values in the range between0.1～1.08uIU/ml, B2:TSH values in the range between1.09～1.61uIU/ml; B3:TSH values in the range between1.62～2.36uIU/ml; B4:TSH values in the range between2.37～3.5uIU/ml. The B5(B1+B2+B3):TSH values in the range between0.1～2.36uIU/ml.Observing the age, length of stay, blood pressure, BMI, heart rate, and childbirth gestational age and other clinical indicators at the time of admission, meanwhile monitoring the blood glucose, blood lipids, thyroid function and other biochemical indicators to assess the maternal and fetal complications during childbirth.Results:1. The differences between subclinical hypothyroidism group and control group in the aspects of age, length of stay, blood pressure, BMI, heart rate and gestational age had no statistical significance. 2. The average levels of FBS, CHOL, HDL and LDL in subclinical hypothyroidism group were slightly higher than those of the control group, while the level of TG in the former group was relatively lower, however, the differences between them had no statistical significance.3. FBS level in B2subgroup and B3subgroup decreased obviously compared with B1subgroup, the differences between the three groups were statistically significant (p<0.05); FBS in B4subgroup decreased slightly than that in B1subgroup, but it had no statistical significance. Compared with B4subgroup, FBS level in B2subgroup and B3subgroup decreased obviously as well, and the differences between them were statistically significant (p<0.05). In addition, FBS level between B2and B3had no statistically significant. Pairwise comparisons between B1～B4, there were no statistically significant differences in lipid levels.4. Maternal complications increased obviously in the subclinical hypothyroidism group than in the control group, OR value was1.914(p=0.036).5. Compared with B1subgroup, B2、B3and B4subgroup had higher incidence rate of mother complications and the differences were statistically significant (P<0.05). Moreover, pairwise comparisons between B2～B4, there were no statistically significant differences in maternal complications.6. Fetal complications increased obviously in the subclinical hypothyroidism group than those of control group, OR value is3.195(p=0.036).7. Pairwise comparison among B1、B2、B3and B4subgroup, there were no statistically significant differences in fetal complications.8. The differences between B4and B5in the aspects of age, length of stay, blood pressure, BMI and gestational weeks had no statistical significance. However, compared with B5subgroup, the basal heart rate at the time of admission was relatively fast in B4group and the difference was statistically significant (P<0.05).9. Though the levels of CHOL, HDL, and LDL in B4subgroup were lower than those of B5subgroup, TG was slightly higher than that of B5subgroup, however, there was no statistically significant between them. FBS level in B4subgroup was significantly higher, the difference was statistically significant (p<0.05).10. Maternal complications increased significantly in B4subgroup than those of B5subgroup, OR value was2.272(p=0.013).11. Compared with B5subgroup, the fetal complications in B4subgroup increased slightly, but the difference had no statistically significance.Conclusions:1.subclinical hypothyroidism in late pregnancy is a high-risk factor of pregnancy, which will result in high incidence rate of adverse events related to pregnancy and increase the risk of perinatal complications.2. Subclinical hypothyroidism in late pregnancy has little effect on the blood glucose and lipid metabolism in pregnant woman,besides, there may be no significant correlation to premature delivery.3. The risk of maternal complications in late pregnancy was higher when the level of TSH was above2.36mIU/L.4.the higher TSH value in late pregnancy, the greater risk to Mother complications; Maintain a low level of TSH within the normal reference range in late pregnancy is beneficial for pregnant women, Close monitoring of thyroid function is recommended during pregnancy.