目的:妊娠体重增加(GWG)是一般产科人群和不同亚组妊娠结局的重要因素。甲状腺疾病女性的相应信息有限。我们旨在评估根据医学研究所(IOM)的GWG与甲状腺疾病妇女的妊娠结局之间的关系。
方法:我们对620名孕妇进行了回顾性分析,这些孕妇接受了左甲状腺素治疗(N=545)或因妊娠期甲状腺功能亢进而接受治疗(N=75)。
结果:在接受甲状腺激素治疗的妇女和甲状腺功能亢进的妇女中,根据IOM的GWG与妊娠结局之间存在关联。其中大多数与胎儿结局有关。在接受左甲状腺素治疗的女性中,GWG不足与妊娠期糖尿病(GDM)相关(比值比(OR)2.32,95%置信区间(CI)1.18,4.54),早产(OR2.31,95%CI1.22,4.36),小于胎龄新生儿(OR2.38,95%CI1.09,5.22)和呼吸窘迫(OR6.89,95%CI1.46,32.52)。GWG过多与剖宫产(OR1.66,95%CI1.10,2.51)和巨大儿(OR2.75,95%CI1.38,5.49)相关。胎龄大的新生儿与GWG不足(OR0.25,95%CI0.11,0.58)和GWG过度(OR1.80,95%CI1.11,2.92)相关。在甲状腺功能亢进之后的女性中,GWG过高与胎龄大的新生儿相关(OR5.56,95%CI1.03,29.96).
结论:根据IOM,GWG与接受甲状腺激素治疗的女性和甲状腺功能亢进女性的妊娠结局相关。
OBJECTIVE: Gestational weight gain (GWG) is an important contributor to pregnancy outcomes in the general obstetric population and different subgroups. The corresponding information in women with thyroid conditions is limited. We aimed to evaluate the relationship between GWG according to institute of medicine (IOM) and pregnancy outcomes in women with thyroid disorders.
METHODS: We performed a retrospective analysis of 620 pregnant women either treated with levothyroxine (N = 545) or attended because of hyperthyroidism during pregnancy (N = 75).
RESULTS: The associations between GWG according to IOM and pregnancy outcomes were present both in women treated with thyroid hormone and women followed by hyperthyroidism, most of them related to the fetal outcomes. In women treated with levothyroxine, insufficient GWG was associated with gestational diabetes mellitus (GDM) (odds ratio (OR) 2.32, 95% confidence interval (CI) 1.18, 4.54), preterm birth (OR 2.31, 95% CI 1.22, 4.36), small-for-gestational age newborns (OR 2.38, 95% CI 1.09, 5.22) and respiratory distress (OR 6.89, 95% CI 1.46, 32.52). Excessive GWG was associated with cesarean delivery (OR 1.66, 95% CI 1.10, 2.51) and macrosomia (OR 2.75, 95% CI 1.38, 5.49). Large-for-gestational age newborns were associated with both insufficient GWG (OR 0.25, 95% CI 0.11, 0.58) and excessive GWG (OR 1.80, 95% CI 1.11, 2.92). In women followed by hyperthyroidism, excessive GWG was associated with large-for-gestational age newborns (OR 5.56, 95% CI 1.03, 29.96).
CONCLUSIONS: GWG according to IOM is associated with pregnancy outcomes both in women treated with thyroid hormone and women followed by hyperthyroidism.