Effect Of Pregnancy With Hypothyroidism And Positive Thyroid Peroxidase Antibody On Preeclampsia

Chapter 1 Analysis of the characteristics of thyroid function in preeclampsiaObjectiveTo explore the relationship between abnormal thyroid peroxidase antibody(TPOAb)and thyroid dysfunction in preeclampsia(PE)pregnant women,and the correlation between thyroid dysfunction and severity of PE.MethodsThe research is a retrospective analysis.210 cases of pregnant women with PE who got obstetric examination and hospital delivery at our hospital from December 2015 to June 2017 were selected and were divided into the mild PE group(129 cases)and the sever PE group(81 cases)according to the severity of PE.Another 210 healthy pregnant women at the same time were selected as control group.The incidence of thyroid dysfunction related disease,the positive rates of thyroid peroxidase antibody(TPOAb),anti-thyroglobulin antibody(TGAb),and the serum levels of thyroid stimulating hormone(TSH),free triiodothyronine(FT3),free thyroxine(FT4)in three groups were compared.Statistical analysisAll data were analyzed by SPSS 20.0 statistical software.The measurement data were presented as(x± s)and were compared by t test.The count data were presented as n(%)and were examined by chi square test.The difference was statistically significant at P<0.05.Results1.Comparison of thyroid disease in pre-eclampsia pregnant womenThe incidence of hypothyroidism in the control group,mild PE group,and severe PE group was 19.52%,34.88%,and 62.96%,respectively.The difference was statistically significant(P<0.05).Comparison between groups showed that compared with the control group,the incidence of hypothyroidism was significantly higher in the mild PE group and the severe PE group;the incidence of hypothyroidism was significantly higher in the severe PE group than in the mild PE group.The above differences were statistically significant(P<0.05).The incidence of hyperthyroidism in the control group,mild PE group,and severe PE group was 0.48%,1.55%,and 4.94%,respectively.The incidence of hypothyroidism was 0.48%,2.33%,and 8.64%,respectively.The differences were statistically significant(P<0.05).The sample sizes of hyperthyroidism or subclinical hyperthyroidism and hypothyroxinemia in three groups were too small to represent the overall condition of the disease type.Therefore,subsequent analysises were focused on clinical hypothyroidism or subclinical hypothyroidism.2.Comparison of positive rates of thyroid autoantibody in pre-eclampsia pregnant womenThe positive rates of TPOAb in the control group,mild PE group,and severe PE group were 12.86%,23.26%,and 56.79%,respectively.The positive rates of TgAb were 11.43%,21.71%,and 54.32%,respectively.The differences were statistically significant(P<0.05).Comparison between groups showed that compared with the control group,the positive rates of TPOAb and TGAb in the mild PE group and the severe PE group were significantly increased;compared with the mild PE group,the positive rates of TPOAb and TGAb in the severe PE group were significantly higher;The differences were statistically significant(P<0.05).3.Comparison of the thyroid hormone levels in pregnant women with preeclampsia and hypothyroidismThe TSH of pregnant women in the control group,mild PE group,and severe PE group was(3.45±0.67)mIU/L,(4.46±0.54)mIU/L,(5.02±0.54)mIU/L,and the FT3 was(4.81 ±0.76)pmol/L,(4.55 ±0.65)pmol/L,(3.64±0.55)pmol/L,and the FT4 was(11.37±2.32)pmol/L,(10.44±3.02)pmol/L,(8,84±3.04)pmol/L,respectively.The differences were statistically significant(P<0.05).Comparison between groups showed that compared with the control group,the TSH in the mild PE group and the severe PE group were significantly increased,and the FT3 and FT4 in the severe PE group were significantly lower;the TSH in the severe PE group was significantly higher than that in the mild PE group.FT3 and FT4 were significantly decreased;the above differences were statistically significant(P<0.05).Conclusion1.Pre-eclampsia is closely related to thyroid dysfunction and thyroid autoimmune disorders.It is common to combine clinical hypothyroidism or subclinical hypothyroidism.2.With the increase of pre-eclampsia,the incidence of hypothyroidism and the positive rate of TPOAb and TgAb increased significantly.3.The level of thyroid hormone disorder is closely related to the severity of pre-eclampsia.The higher the TSH level,the lower the level of FT4 and FT3,and the greater the severity of preeclampsia.Chapter 2 Effect of L-T4 intervention on pre-eclampsia in pregnant women with hypothyroidismObjectiveLevothyroxine(L-T4)was used to treat hypothyroidism during the early pregnancy.To analyze the relationship between the different thyroid function and the pre-eclampsia incidence.MethodsThe research is a retrospective analysis.320 cases of pregnant women with hypothyroidism who got obstetric examination and hospital delivery at our hospital from December 2015 to June 2017 were selected and divided into the improving group(231 cases)and the remaining group(89 cases)based on their thyroid function at the third trimesters.The thyroid function related indicators and blood pressure,the incidence of PE in two groups were compared,and the risk of PE after L-T4 intervention were analyzed.Statistical analysisSame as the first chapter.the risk of PE after L-T4 intervention were analyzed by Multivariate Logistic Regression Analysis.Results1.Comparison of thyroid function related indicators of pregnant women in two groupsIn the first trimester,the levels of TSH,FT3,and FT4 were(3.82±0.85)mIU/L,(4.70 ± 0.69)pmol/L,and(10.46±1.48)pmol/L in the improving group and were(4.37 ±1.20)mIU/L,(4.27 ±0.63)pmol/L,(9.80 ±1.89)pmol/L in the remaining group,respectively.The difference between the two groups was statistically significant(P>0.05).In the third trimester,the levels of TSH,FT3,and FT4 were(2.26 ±0.46)mIU/L,(4.93 ± 0.56)pmol/L,and(11.40±1.64)pmol/L in the improving group and were(4.55±0.61)mIU/L,(4.81 ±0.65)pmol/L,(10.99±2.20)pmol/L in the remaining group,respectively.The positive rates of TPOAb in the two groups were 16.02%and 19.01%,respectively.The difference of TSH and FT4 was statistically significant(P<0.05),but there was no significant difference in the positive rate of FT3 and TPOAb(P>0.05).2.Comparison of blood pressure levels in two groups of pregnant womenIn early pregnancy,the systolic and diastolic blood pressures were(110.03 ±8.27)mmHg and(68.27±4.89)mmHg in the improving group,and were(108.89±9.30)mmHg,(69.71 ±4.27)mmHg in the remaining group,respectively.There was statistically significant difference in diastolic blood pressure(P<0.05)but not in systolic blood pressure(P>0.05).In the third trimester,the systolic and diastolic blood pressures were(119.39 ±6.92)mmHg,(73.09±5.62)mmHg in the improving group,and were(118.31 ±8.10)mmHg,(76.36 ±5.18)mmHg in the remaining group,respectively.There was statistically significant difference in diastolic blood pressure(P<0.05)but not in systolic blood pressure(P>0.05).3.Comparison of pre-eclampsia between two groups of pregnant women during the second trimesterThe incidence of PE was 4.33%,including 2.6%for mild PE and 1.73%for severe PE in the improving group,and was 14.67%,including mild PE 6.74%and severe PE 7.87%in the remaining group.There was a statistically significant difference in the incidence of PE and severe PE between the two groups(P<0.05).4.Analysis of risk of severe preeclampsia by multivariate logistic regressionAfter correcting age,body mass index,parity,the risk of PE were significantly lower than the remaining group(OR=0.469,95%CI:0.062?0.784,P=0.0195).ConclusionAs the thyroid function in pregnant women with hypothyroidism improving,the blood pressure levels are relatively stable,and the incidence of PE is decreased,however,the control effect of thyroid function is poor,which can increase the risk of severe PE.So early screening of pregnancy pregnant women with hypothyroidism should have reasonable management of pregnancy,regular monitoring of thyroid function,adjustment of drug dose,and improvement of thyroid function,which can reduce the risk of severe PE.Chapter 3 Influence of subclinical hypothyroidism and TPOAb positive on the clinical outcome of preeclampsia in pregnant women ObjectiveTo evaluate the influence of subclinical hypothyroidism(SCH)and thyroid autoimmune disorders on PE,pregnancy induced hypertension,gestational diabetes mellitus(GDM),and the incidence of adverse pregnancy outcomes such as miscarriage,premature delivery,fetal distress,premature rupture of membranes,and placental abruption.MethodsThe research is a retrospective analysis.226 cases of pregnant women with SCH,who got obstetric examination and hospital delivery at our hospital from December 2015 to June 2017,were selected and divided into the SCH + TPOAb(+)group(108 cases)and SCH + TPOAb(-)group(118 cases).All pregnant women did not have L-T4 clinical intervention throughout the pregnancy.In addition,304 pregnant women with normal thyroid levels during the same period were collected as the control group,and 44 pregnant women as the TPOAb positive group.The pregnancy complications,pregnancy adverse outcomes such as miscarriage,premature delivery,fetal distress,premature rupture of membranes,and placental abruption and newborn condition in four groups were compared.Statistical analysisSame as the first chapter.Results1.Comparison of pregnancy complications in four groupsThe incidences of SCH,clinical hypothyroidism,pregnancy-induced hypertension,PE,and GDM were 2.63%,1.32%,9.87%,1.32%,and 14.47%in the control group,and 13.64%,9.09%,31.82%,13.64%,22.73%in the simple TPOAb(+)group,respectively.The incidence of clinical hypothyroidism,pregnancy-induced hypertension,PE,and GDM were 47.22%,25%,12.04%,and 25.93%in the SCH +TPOAb(+)group,and 29.66%,11.02%,2.54%,21.19%in the SCH + TPOAb(-)group,respectively.The differences between the four groups were statistically significant(P<0.05).Compared with the control group,clinical hypothyroidism,pregnancy-induced hypertension,PE,GDM in the SCH + TPOAb(+)group and clinical hypothyroidism in the SCH + TPOAb(-)group and SCH,clinical hypothyroidism,pregnancy-induced hypertension,PE,and GDM in the simple TPOAb(+)group were increased significantly.Compared with the SCH + TPOAb(+)group,the incidence of clinical hypothyroidism,pregnancy-induced hypertension,and PE were significantly lower in the SCH + TPOAb(-)group,and the incidence of clinical hypothyroidism was significantly lower in the simple TPOAb(+)group.Compared with the the SCH + TPOAb(-)group,the incidence of clinical hypothyroidism is significantly lower in the simple TPOAb(+)group,while Prevalence of pregnancy-induced hypertension and PE increased significantly.The above differences were statistically significant(P<0.05).2.Comparison of adverse pregnancy outcomes in four groupsThe incidence of spontaneous abortion and premature birth was 4.28%and 4.28%in the control group,and 18.52%,17.59%in the SCH + TPOAb(+)group,and 6.78%,5.93%in the SCH + TPOAb(-)group,and 22.73%,20.45%in the simple TPOAb(+)group,respectively.There was statistical difference in the incidence of spontaneous abortion and premature birth(P<0.05),but not in fetal distress,premature rupture of membranes,placental abruption,cesarean section,and postpartum hemorrhage among the four groups(P>0.05).Compared with the control group,the incidence of spontaneous abortion and preterm birth increased significantly in the SCH + TPOAb(+)group and the simple TPOAb(+)group.Compared with the SCH + TPOAb(+)group,the incidence of spontaneous abortion and preterm birth decreased significantly in the SCH + TPOAb(-)group.Compared with the SCH + TPOAb(-)group,the incidence of spontaneous abortion and preterm birth increased significantly in the simple TPOAb(+)group.The above differences were statistically significant(P<0.05).3.Comparison of four newborn birthsThe incidence of full-term low birth weight infants was 2.96%in the control group,9.26%in the SCH + TPOAb(+)group,3.39%in the SCH + TPOAb(-)group,and 4.55%in the simple TPOAb(+)group,respectively.There was statistical difference in the incidence of full-term low birth weight infants(P<0.05),but not in macrosomia and Apgar score<7 in 1 minute(P>0.05).Compared with the control group,the incidence of term low birth weight infants was significantly higher in the SCH + TPOAb(+)group,and the difference was statistically significant(P<0.05).ConclusionSCH and/or TPOAb positive are correlated with pregnancy complications such as hypothyroidism,PE,pregnancy-induced hypertension,GDM.Pregnant women with SCH and TPOAb positive could increase the incidence of spontaneous abortion,premature birth and low birth weight,which further reflects the rationality of the link between hypothyroidism and PE.Based on this hypothesis,there is a clinical correlation between thyroid function and thyroid autoimmune disorders and PE development.To a certain extent,the present study supports women of childbearing age to perform screening for thyroid function and thyroid autoantibodies in early pregnancy or before pregnancy,reduce the risk of PE,and improve the clinical outcome of mothers and children.