背景:由于胎儿在妊娠早期依赖母体甲状腺激素,母体甲状腺功能减退症在胎儿发育中起重要作用。然而,母体甲状腺功能减退与后代代谢性疾病之间的关系尚不清楚.
目的:研究妊娠期母体甲状腺功能减退与代谢结局(肥胖,高血压,2型糖尿病,和血脂异常)在<18岁的儿童中。
方法:我们从开始到2023年5月系统地检索了5个数据库。符合条件的研究包括队列,病例控制,和随机对照试验,涉及怀孕期间有或没有甲状腺功能减退的母亲所生的孩子。使用随机效应模型对至少三项研究报告的结果进行汇总。使用ROBINS-E工具进行观察性研究,并使用Cochrane偏差风险工具进行试验。
结果:搜索确定了3221篇文章,其中包括7项研究(1项试验,6观察)。所有研究都是在北美以外进行的,范围从250到>100万儿童。随访时间6~20年。纳入的研究支持暴露于母体甲状腺功能减退的后代高血压和血糖失调的风险增加(高血压:OR1.08,95%CI0.75,1.57和HR1.81,95%CI1.21,2.69;糖尿病:RR2.7,95%CI0.7,10)。在汇总分析中,母亲甲状腺功能减退与后代肥胖无关(OR1.04,95%CI0.64,1.70).
结论:这项研究发现,妊娠期间母体甲状腺功能减退与子代代谢结局之间存在不一致的证据,尽管与高血压和葡萄糖失调有关是可能的。
BACKGROUND: As the fetus relies on maternal thyroid hormones in early pregnancy, maternal hypothyroidism plays an important role in fetal development. However, the association between maternal hypothyroidism and metabolic disease in
offspring is unclear.
OBJECTIVE: To examine the association between maternal hypothyroidism in pregnancy and metabolic outcomes (obesity, hypertension, type 2 diabetes mellitus, and dyslipidemia) in children < 18 years.
METHODS: We systematically searched 5 databases from inception to May 2023. Eligible studies included cohort, case-control, and randomized controlled trials involving children born to mothers with or without hypothyroidism in pregnancy. Data were pooled across studies using random-effects models for outcomes reported in at least three studies. Quality assessment was performed using the ROBINS-E tool for observational studies and the Cochrane Risk of Bias tool for trials.
RESULTS: The search identified 3221 articles, of which 7 studies were included (1 trial, 6 observational). All studies were conducted outside of North America and ranged in size from 250 to > 1 million children. The follow-up time ranged from 6 to 20 years. Included studies support an increased risk of hypertension and glucose dysregulation in
offspring exposed to maternal hypothyroidism (hypertension: OR 1.08, 95% CI 0.75, 1.57 and HR 1.81, 95% CI 1.21, 2.69; diabetes: RR 2.7, 95% CI 0.7, 10). In the pooled analysis, maternal hypothyroidism was not associated with obesity in
offspring (OR 1.04, 95% CI 0.64, 1.70).
CONCLUSIONS: This study found inconsistent evidence on the association between maternal hypothyroidism in pregnancy and metabolic outcomes in
offspring, though associations with hypertension and glucose dysregulation are possible.