Assessing the Outcome of Management of Thyroid Dysfunction in Pregnancy

摘要

INTRODUCTION – Pregnancy comes with hormonal changes, which could lead to complications when not properly managed. The thyroid hormone is one of the hormones that are affected during pregnancy, and it plays a significant role in pregnancy, from conception to delivery. In a bid to identify intended pregnant women and pregnant women with thyroid dysfunction, the Endocrinology Branch of the Chinese Medical Association and Perinatal medicine branch of the Chinese Medical Association set guidelines for diagnosis and treatment of thyroid diseases in pregnancy and postpartum women. The guideline recommends screening for all women who desire to get pregnant soon and pregnant women, which Second Affiliated Hospital of Chongqing Medical University is implementing. PURPOSE - To identify the common thyroid disease found among pregnant women in Chongqing. Evaluate the effectiveness of the management guideline toward improving pregnancy outcomes among women diagnosed with thyroid disease during their pregestational and gestational period, and ascertain the need for additional measures to be taken towards thyroid disease management during pregnancy in certain areas with unfavorable outcomes. METHOD–A retrospective cohort study of 774 pregnant women diagnosed with thyroid dysfunction in the Second Affiliated Hospital of Chongqing Medical University from 2016 -2018 was extracted from the hospital computer patient’s record. Only 724 patients that met the inclusive criteria were analyzed. Participants were grouped into four, according to the time they were diagnosed and managed. The Multiple logistic regression and binary logistic regression statistical analysis were done with SPSS, and we adjusted for potential confounders, including maternal age, parity, and gravida. RESULT – There is an association between maternal age and abortion among pregnant women diagnosed with subclinical hypothyroidism, P-0.018(OR 1.459, 95%CI 1.067-1.997) and significant difference in pregnant women who developed intrauterine growth restriction after being diagno sed with hypothyroidism in the second trimester, P-0.048(OR-0.152, 95%CI 0.024-0.981). There was also a significant difference in gravida, P-0.032(OR 1.368, 95%CI 1.028 1.821) and normal delivery mode, P-0.010(OR 2.521, 95%CI 1.246-5.100).　　CONCLUSION – The study shows a promising result as less complication is observed. However, more attention is needed toward managing subclinical hypothyroidism in pregnancy to curb abortion/miscarriage incidence. Hypothyroidism in second trimester could lead to intrauterine growth restriction. Multigravida increases the risk of complications among pregnant women with thyroid dysfunction.

目录