亚临床甲状腺功能减退合并妊娠期糖尿病孕妇的妊娠结局分析

摘要

目的 研究亚临床甲状腺功能减退(SCH)和妊娠期糖尿病(GDM)的相互影响,及SCH合并GDM孕妇的妊娠结局. 方法 选取2015年5月-2016年9月在北京市海淀区妇幼保健院产科住院分娩的200例GDM合并SCH孕妇作为实验组,同期本院诊断为GDM但不合并甲状腺功能异常者200例作为GDM组,同期本院诊断为SCH不合并血糖异常者200例作为SCH组.比较这三组孕妇产后出血、胎儿窘迫、早产、宫腔感染、巨大儿、大于胎龄儿、小于胎龄儿、新生儿感染、新生儿脐血血气PH值、16 ～ 20周[口服葡萄糖耐量试验(OGTT)前]及30 ～ 34周(OGTT后)甲状腺功能等. 结果 实验组早产及宫腔感染的发生率多于GDM组和SCH组,差异均有统计学意义.实验组应用胰岛素者多于GDM组,差异有统计学意义.三组新生儿感染、巨大儿、小于胎龄儿比较,差异无统计学意义.实验组促甲状腺激素(TSH) OGTT后较OGTT前升高,差异有统计学意义;SCH组TSH OGTT后较OGTT前比较,差异无统计学意义. 结论 GDM合并SCH的孕妇,应用胰岛素、早产及宫腔感染的发生率更高,且TSH可能在孕中晚期增加.%Objective To explore the interrelationship between subclinical hypothyroidism (SCH) and gestational diabetes mellitus (GDM),and analyze the pregnancy outcomes of women with SCH and GDM.Methods Patients were enrolled from Haidian District maternal and Child Health Hospital of Beijing,May 2015 to September 2016.200 women diagnosed with GDM and SCH as experimental group,200 GDM women with normal thyroid function as GDM group,and 200 SCH women with normal glucose as SCH group.Indicators including rate of postpartum hemorrhage,fetal distress,preterm birth,intrauterine infection,macrosomia,large for gestational age infants (LGA),small for gestational age infants (SGA),newborn infection,pH for umbilical cord blood,thyroid gland function in 16 ～ 20 weeks [Before oral glucose tolerance test (OGTT)] and 30 ～ 34 weeks (after OGTT) were compared between the three groups.Results Higher prevalence of preterm birth and intrauterine infection were observed in the experimental group,compared with GDM group and SCH group,with statistical significance.A higher proportion of women used insulin in the experimental group than GDM group,the difference was statistically significant.There were no significant difference in neonatal infection,macrosomia and SGA.The thyroid stimulating hormone (TSH) after OGTT was higher than that before OGTT in experimental group,and the difference was statistically significant.There was no significant difference of TSH among group before and after OGTT in SCH.Conclusion Women with GDM and SCH have higher prevalence of preterrn birth,intrauterine infection,and higher proportion of using insulin.TSH may increase in the second and third trimester.