Effect of thyroid stimulating hormone level and thyroid peroxidase antibody status on pregnancy outcome in early pregnancy / 中国医师杂志

ABSTRACT

Objective:To investigate the relationship between thyroid stimulating hormone (TSH) level and thyroid peroxidase antibody (TPOAb) status in the first trimester on pregnancy outcomes.Methods:A total of 2 095 pregnant women with complete clinical data from department of pregnancy endocrinology or department of obstetrics in Dongying People′s Hospital from January 1, 2018 to November 31, 2019.According to the TSH level detected before 12 + 6 weeks of gestation, all pregnant women were divided into normal TSH (0.1 μIU/ml≤TSH< 2.5 μIU/ml), high TSH (2.5 μIU/ml≤TSH≤4.0 μIU/ml), sub-clinical hypothyroidism during gestation (4.0 μIU/ml<TSH<10.0 μIU/ml). According to negative and positive of TPOAb, they were divided into group A [TSH normal + TPOAb (-) group, n=1 523], group B [TSH normal + TPOAb (+ ) group, n=185], group C [high TSH + TPOAb (-) group, n=234], group D [high TSH + TPOAb (+ ) group, n=47], group E [subclinical hypothyroidism + TPOAb (-) group, n=70], and group F [subclinical hypothyroidism + TPOAb (+ ) group, n=36]. Taking group A as the control, the differences of pregnancy complications and pregnancy outcomes between the groups were compared, and the correlation between TSH and TPO antibodies and pregnancy complications and pregnancy outcomes was analyzed by multivariate logistic regression. Results:There was a significant difference in the number of gestational diabetes cases among pregnant women ( P<0.05). Further compared with control group A, group F had the highest percentage (55.6% vs 20.5%). There was a statistical difference in the distribution of preterm delivery among pregnant women in each group ( P<0.05), and the percentage of preterm delivery in group D and group F were increased. There was no statistically significant difference in pregnancy complications and adverse pregnancy outcomes between the other groups and the control group ( P>0.05). Multivariate logistic regression analysis of gestational diabetes mellitus and preterm delivery showed that the risk of gestational diabetes mellitus was significantly increased in group F compared with the control group. Age, gestational status, and TPOAb positivity were risk factors for gestational diabetes. The risk of premature birth in group D, group E and group F was higher than that in the control group [odds ratio ( OR)>1]. Age and TPOAb positivity were risk factors for preterm delivery in pregnant women ( OR>1, P<0.05). Conclusions:TPOAb positive in early pregnancy combined with subclinical hypothyroidism in pregnancy will increase the risk of gestational diabetes, while TPOAb positive in early pregnancy combined with TSH on the high side or subclinical hypothyroidism in pregnancy will increase the risk of premature delivery, so the management of such pregnant women should be strengthened and active treatment should be given if necessary.