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目的 :探讨妊娠期糖尿病(gestational diabetes mellitus,GDM)孕妇孕中期合并单纯低甲状腺素血症对孕晚期相关不良围产结局的影响。方法:选取400例GDM妇女和400例正常妊娠妇女,在妊娠25周左右检测促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)和抗甲状腺过氧化物酶抗体(TPOAb)的浓度,比较GDM妇女和正常妊娠妇女孕中期甲状腺激素各项指标以及甲状腺功能减退发生率,再挑选出GDM合并孕中期单纯低甲状腺素血症的孕妇作为A组;甲状腺功能正常的GDM孕妇为B组;所有纳入组的研究对象均跟踪随访至分娩,统计孕晚期子痫前期、早产、胎儿窘迫、低出生体重儿的发病情况,比较A组和B组的差别。结果:GDM组孕中期TSH水平高于正常孕妇组,FT4水平低于正常孕妇组,且单纯低甲状腺素血症发生率明显高于正常孕妇组(P均<0.05);TPOAb阳性的孕妇孕中期TSH水平明显高于TPOAb阴性的孕妇(P<0.05);A组孕晚期子痫前期和低出生体重儿的发生率明显高于B组(P均<0.05)。结论 :GDM孕妇孕中期易合并单纯低甲状腺素血症,并可使孕晚期发生相关不良围产结局的风险增加,故建议及时治疗。
Objective: To investigate the effect of pregnant women with gestational diabetes mellitus (gestational diabetes mellitus, GDM) in the second trimester of pregnancy on the adverse pregnancy outcomes associated with third trimester pregnancy. Methods: 400 cases of GDM women and 400 normal pregnant women were selected to detect thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxine (FT4) and anti-thyroid peroxide Enzyme antibody (TPOAb) concentrations in GDM women and normal pregnant women compared with thyroid hormone indicators of pregnancy and the incidence of hypothyroidism, and then selected GDM pregnant women with hypo-congenital hypothyroidism as a group A; thyroid function The normal GDM pregnant women were Group B. All the included subjects were followed up until delivery. The incidence of preeclampsia, preterm labor, fetal distress and low birth weight children were counted. The differences between groups A and B were compared. Results: The TSH level in the second trimester of GDM group was higher than that of normal pregnant women, the FT4 level was lower than that of normal pregnant women, and the incidence of hypo-thyroxinemia was significantly higher than that of normal pregnant women (all P <0.05). The TPOAb- TSH levels were significantly higher than those of TPOAb-negative pregnant women (P <0.05). The incidence of preeclampsia and low birth weight infants in group A was significantly higher than that in group B (all P <0.05). Conclusion: GDM pregnant women tend to be complicated by hypo-thyroxinemia in the second trimester of pregnancy, which may increase the risk of unpleasant perinatal complications in the third trimester of pregnancy. Therefore, it is suggested that timely treatment should be given.