The Related Research In The Influence Of Hypothyroxinemia During Gestation Period On Pregnancy Outcomes And Fetus

[Objective]1.To discuss the influence of hypothyroxinemia during pregnancy to pregnancy outcomes and fetus growing development,and find the evidence of hormone replacement therapy as well as the characteristic of the preganant women who needs L-T4.2.To know more about the thyroid function state of the preganant women and set up the Specific reference range of the thyroid function test indexes.3.To explore the influence of hypothyroxinemia on other test indexes during gestation period,and related factors which has effect on FT4.To understand the timing and key-point of follow-up visit of the thyroid screening and provide the basis for the classification guidance of pregnant women.[Methods]We retrospectively analyzed all the data of 1633 discharged patients from November 2014 to October 2015,Including the data of systematic antenatal examination,all the data of pregnancy,the material of delivery,the supersonic inspection result of the last time,production status and the thyroid stimulating hormone of the newborn etc,to find the difference of related index.And we perspectively collected the data of 1596 pregnant women at outpatient service from February 2016 to january 2017.We standarded the first time thyroid function test,follw-up the results of OGTT,the supersonic inspection result of the last time and the production status.Thyroid related diseases were diagnosed according to the criterion of ATA.We discussed the impact of hypothyroxinemia during preganant period,the difference of pregnancy outcomes and analyzed the factors which impact hypothyroxinemia.To understand the timing and follow-up visit station of the thyroid screening.[Results]In the retrospective study,the 1141 pregnant women with integral data taken into analysis.There were 200 pregnant women had thyroid disease previously,189 of 1141 had free thyroxine below the range of normal value,and 752 normal.The 189 pregnant women with thyroid stimulating hormone in the range of normal value but free thyroxine below the range of normal value 0-5%,5%-10%,and more than 10% were divided to group A,group B and group C,respectively.The ones who's two indexes both in the range of normal value were belong to normal control group.Compared to normal control group,group C had more premature delivery,gestational diabetes mellitus,cesarean delivery(P<0.05).Group B had more women with a history of high blood pressure and more women with dyslipidemia during pregnancy(P<0.05).The cesarean delivery incidence rate of group B and C were higher than group A(P<0.05),(P<0.05,P<0.01).Meanwhile,The rate of group C was higher than the normal control group(P<0.05).Before delivery,group C had a big weight and BMI,and higher level of diastolic blood pressure than the ones of normal control group(P<0.01).The fetus head circumference of thesupersonic inspection of the last time is bigger than the ones of normal control group(P<0.01).But the gestational weeks of the newborn is smaller(38.55±1.86 vs39.14±1.57,P<0.01).941 Pregnant women without history of thyroid disease were divided into two groups according to TPOAb level.The HbA1 c level and globulin ratioof the TPOAb(+)groupweres higher than the TPOAb(-)group.But FT4 level was lower than it.In the perspective study,we calculated the reference ranges of the Thyroid function indexes of the Pregnant women in our hospital.The indexes in the first trimester :FT3 3.95-6.76 Pmol/L;FT4 12.38-22.47Pmol/L;TSH 0.01-5.17 mIU/L;The indexes in the second trimester:FT3 3.72-6.05Pmol/L;FT4 11.22-19.01Pmol/L;TSH 0.05-4.87 mIU/L.The height of fundus of uterus and the level of FT3,FT4,AST,TC,HbA1 c,FBGin the T1 group was much higher than the T2 group.The gestational weeks,age,weight,BMI and the height of fundus of uterus of the pregnant women in the HT group was much bigger than the normal control group.While,the TPOAb,WBC,TC,TG,LDL-Cand HbA1 c levels were much higher than the other group(P<0.05)(P<0.01).But height,diastolic arterial blood pressure,fetal heart,HGB,FT3,FT4,lymphocytes percentage,HCT,A/G and Cr were lower than the normal control group(p<0.05)(p<0.01).In the first trimester,pregnant women in the groupG had a bigger age than which in the groupH(32.71±2.81 years vs 29.51±3.87 years).In the second trimester,gestational weeks,TPOAb,Cr,UA,HbA1 c in the group I were higher thangroup J(p<0.01).HT group had a higher percentage of dystocia,adherent placenta and artificial insemination but lower percentage of GDM than the normal control group.(p<0.05).Pregnant women withTPOAb(+)had a higher incidence of thyroid dysfunction.TSH level ofthe TPOAb(+)group were higher than the TPOAb(-)group(p<0.05);while gestational weeks,ALT and AST levels were lower(p<0.05).The review rate of hyperthyroidism(100%)and normal ratio of which were the highest in the first trimester.But In the second trimester,the review rate ofhypothyroidism(76.19%)was the highest.while the normal ratio of subclinical hypothyroidism were the highest.[Conclusions]1.The incidence of hypothyroxinemia during pregnancy were much higher than Previous studies both in our retrospective study and prospective study.Regardless of TPOAb level,the influence of hypothyroxinemia during pregnancy on pregnancy outcomes and fetus growing development were not allow to ignore.2.Advanced age and overweight maight increase the incidence of hypothyroxinemia during pregnancy.Hypothyroxinemia during pregnancy might have relationship with Impaired glucose regulation.3.TPOAb(+)might be associated withFT4 and TSH level,as well as Glucose Metabolism.4.More attentionshould bepaid topregnancy women in the early phase and the thyroid function tests should be tooktimely.Corresponding treatment should be practiced when needed.