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目的 探讨妊娠期糖尿病(GDM)患者妊娠中期甲状腺功能与母婴结局的相关性。方法 选取2022年1月—2023年1月在青岛大学附属医院就诊的GDM患者，根据诊断标准分为甲状腺功能亢进(简称甲亢)组(35例，包括临床甲亢和亚临床甲亢)、甲状腺功能减退(简称甲减)组(35例，包括临床甲减和亚临床甲减)、单纯性低甲状腺素血症组(35例)及对照组(70例，甲状腺功能正常)。统计不良母婴结局的发生情况，分析GDM患者妊娠中期甲状腺功能指标与不良母婴结局的相关性。结果 4组产前体质指数(BMI)、餐后1 h血糖、餐后2 h血糖、糖化血红蛋白水平、巨大儿发生率以及不良母婴结局总发生率比较差异均有统计学意义(均P<0.05)。单纯性低甲状腺素血症组和甲亢组巨大儿发生率均明显高于对照组(均P<0.05)，单纯性低甲状腺素血症组不良母婴结局总发生率高于对照组(P<0.05)。logistic回归分析显示:产前BMI(OR=1.331)、餐后1 h血糖(OR=3.746)是巨大儿发生的独立危险因素(均P<0.05);餐后2 h血糖是巨大儿发生的独立保护因素(OR=0.426,P<0.05);甲状腺功能与巨大儿的发生有关，与对照组比较，单纯性低甲状腺素血症组、甲亢组巨大儿发生率均升高(均P<0.05，均OR>1);产前BMI升高是GDM患者发生不良母婴结局的独立危险因素(OR=1.098,P<0.05)。结论 妊娠中期甲状腺功能异常会增加GDM患者不良母婴结局的发生风险。
Abstract：Objective To explore the correlation between thyroid function in the second trimester of pregnancy and maternal and infant outcomes in patients with gestational diabetes mellitus( GDM). Methods The patients with GDM who visited Affiliated Hospital of Qingdao University from January 2022 to January 2023 were selected and divided into hyperthyroidism group( 35 cases,including clinical hyperthyroidism and subclinical hyperthyroidism),hypothyroidism group( 35 cases,including clinical hypothyroidism and subclinical hypothyroidism),simple hypothyroxinemia group( 35 cases),and control group( 70 cases,with normal thyroid function) according to diagnostic criteria. The occurrence of adverse maternal and infant outcomes was statistically analyzed,and the correlations between thyroid function indicators in the second trimester of pregnancy and adverse maternal and infant outcomes in patients with GDM were analyzed. Results There were statistically significant differences in prenatal body mass index( BMI),1-hour postprandial blood glucose,2-hour postprandial blood glucose,and glycated hemoglobin level,the incidence rate of macrosomia,and the total incidence rate of adverse maternal and infant outcomes among the four groups( all P < 0. 05). The incidence rates of macrosomia in simple hypothyroxinemia group and hyperthyroidism group were significantly higher than that in control group( both P< 0. 05),and the total incidence rate of adverse maternal and infant outcomes in simple hypothyroxinemia group was higher than that in control group( P<0. 05). Logistic regression analysis showed that prenatal BMI( OR = 1. 331) and 1-hour postprandial blood glucose( OR = 3. 746) were independent risk factors for macrosomia( both P<0. 05); 2-hour postprandial blood glucose was an independent protective factor for macrosomia( OR = 0. 426,P<0. 05); thyroid function was associated with the occurrence of macrosomia. Compared with control group,the incidence rates of macrosomia in simple hypothyroxinemia group and hyperthyroidism group increased significantly( both P<0. 05,both OR>1); elevated prenatal BMI was an independent risk factor for adverse maternal and infant outcomes in patients with GDM( OR = 1. 098,P<0. 05). Conclusion Abnormal thyroid function in the second trimester of pregnancy increases the risk of adverse maternal and infant outcomes in patients with GDM.
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基本信息:
DOI：10.19829/j.zgfybj.issn.1001-4411.2025.22.001
中图分类号:R714.256
引用信息:
[1]季珊珊,李华伟,潘月帅,等.妊娠期糖尿病患者妊娠中期甲状腺功能与母婴结局的相关性分析[J].中国妇幼保健,2025,40(22):4075-4079.DOI:10.19829/j.zgfybj.issn.1001-4411.2025.22.001.
基金信息:
山东省医药卫生科技项目(202414030736); 山东省青岛市医药卫生科研指导项目(2023-WJZD073,2023-WJZD078); 山东省青岛市医疗卫生优秀人才培养项目(青卫政字[2022]6号)