首页|孕前肥胖程度对妊娠期特异性甲状腺功能异常的影响

孕前肥胖程度对妊娠期特异性甲状腺功能异常的影响

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[目的]探讨孕前不同肥胖程度发生妊娠期特异性甲状腺功能异常的风险.[方法]收集2017年一项上海孕妇队列研究的问卷调查信息、血液和尿液样本,共纳入2 455名单胎孕妇.根据研究对象身高和自报孕前体重计算孕前体重指数(BMI).采用电化学发光法测定血清促甲状腺素(TSH)、总甲状腺素(TT4)、游离甲状腺素(FT4)、总三碘甲状腺原氨酸(TT3)、游离三碘甲状腺原氨酸(FT3)、甲状腺球蛋白抗体(TgAb)和甲状腺过氧化物酶抗体(TPOAb)水平.采用酸消化法测定尿碘水平.比较孕前不同肥胖程度孕妇妊娠期各甲状腺功能指标水平差异,根据本队列建立妊娠期特异性甲状腺激素参考范围,并判断妊娠期特异性甲状腺功能异常情况,使用多元logistic回归评估孕前不同肥胖程度发生妊娠期特异性甲状腺功能异常的风险.[结果]随着肥胖程度增加,母体妊娠期FT3(P<0.001)和TT3(P=0.001)水平逐渐增加,FT4水平逐渐降低(P=0.001).多元logistic回归显示,与孕前正常体重组相比,孕前超重或肥胖的妊娠妇女妊娠期发生单纯低甲状腺血症(OR=3.85,95%CI:2.08～7.14,P<0.001)和高TT3血症(OR=2.78,95%CI:1.45～5.26,P=0.002)的风险显著增高.[结论]孕前超重或肥胖可增加妊娠期甲状腺功能异常风险.
Effect of pre-pregnancy obesity on trimester-specific thyroid dysfunction
[Objective]To explore the risk of different levels of pre-pregnancy obesity on trimester-specific thyroid dysfunction.[Methods]Questionnaire information,blood samples,and urine samples from a 2017 pregnancy cohort study in Shanghai,China were collected.A total of 2 455 pregnant women were included in the analysis.Pre-pregnancy BMI was calculated based on the height and self-reported pre-pregnancy weight.Serum TSH,total thyroxine(TT4),free thyroxine(FT4),total triiodothyronine(TT3),free triiodothyronine(FT3),thyroid globulin antibody(TgAb),and Thyroid peroxidase antibody(TPOAb)were measured using the electrochemiluminescence method.Urine iodine levels were measured using the acid digestion method.Levels of thyroid function indexes of pregnant women with different degrees of obesity during pre-pregnancy were compared,and trimester-specific thyroid dysfunction was evaluated according to the reference range of trimester-specific thyroid hormone established by this cohort.Multivariate logistic regressions analysis was used to assess the correlation between pre-pregnancy obesity and trimester-specific thyroid dysfunction.[Results]As the degree of obesity increased,maternal levels of FT3 and TT3 gradually increased during pregnancy(P<0.001,P=0.001),while FT4 levels gradually decreased(P=0.001).Multivariate logistic regression analysis showed that compared with the normal weight group,pregnant women who were overweight or obesity before pregnancy had a significantly higher risk of hypothyroxinemia(OR=3.85,95%CI:2.08‒7.14,P<0.001)and high TT3(OR=2.78,95%CI:1.45‒5.26,P=0.002)during pregnancy.[Conclusion]Pre-pregnancy overweight or obesity can increase the risk of thyroid dysfunction during pregnancy.

trimesterthyroid dysfunctionpre-pregnancy body mass indexobesity

何欣、廖萍、刘茶珍、齐健、严沁、朱佩云、刘桐、王文静、臧嘉捷

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上海市疾病预防控制中心,上海 200336

妊娠期 甲状腺功能异常 孕前体重指数 肥胖

上海市卫生健康委员会面上项目上海市加强公共卫生体系建设三年行动计划(2023-2025)面上项目上海市加强公共卫生体系建设三年行动计划(2023-2025)重点学科项目上海市加强公共卫生体系建设三年行动计划(2023-2025)重点学科项目

202040215GWVI-8GWVI-11.1-22GWVI-11.1-42

2024

10.19428/j.cnki.sjpm.2024.23118

上海预防医学
上海市预防医学会

上海预防医学

CSTPCD
影响因子：0.615
ISSN：1004-9231
年,卷(期)：2024.36(1)
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