[Analysis of pregnancy-related adverse outcomes in patients with severe hypothyroidism during pregnancy].

Objective: To analyze the pregnancy-related adverse outcomes in patients with severe hypothyroidism during pregnancy. Methods: Using cross-sectional study, a total of 47 pregnant women with severe hypothyroidism in the Peking University First Hospital from January 2007 to December 2020 were retrospectively collected by electronic case system. According to the occurrence of adverse pregnancy events (defined as any pregnancy complication or adverse maternal-fetal/neonatal outcomes), the patients were divided into pregnancy-related adverse outcomes group (n=33) and no pregnancy-related adverse outcomes group (n=15). The demographic data, thyroid function and thyroid autoantibody levels during pregnancy, pregnancy complications and maternal-fetal/neonatal outcomes of the two groups were recorded and analyzed. Results: The age of severe hypothyroidism women was (30.5±4.1) years. The median of gestational week at delivery was 38.6 (36.3, 39.9) weeks, the median of gestational week for diagnosis was 7.0 (6.0, 8.8) weeks, the median of the highest TSH level was 32.7(23.1,60.2)mU/L and the period of reaching the target TSH level for the first time was 6.0(4.0, 10.0)weeks. Most cases (82.5%, 33/40) had thyroid autoimmunity. All women were treated with levothyroxine (L-T4) during pregnancy. A total of 37 cases (77.1%, 37/48) of them obtained the recommended target values. Fourty cases (83.3%, 40/48) gave birth. The birth weight of newborns was (3 041±452) g, the body length was (49.4±2.1) cm, and the head circumference was (33.6±0.7) cm. The period of reaching to target TSH level for the first time in patients without pregnancy-related adverse outcomes was shorter [5.0 (3.0, 9.0) vs 8.0 (4.5, 12.5) weeks) ] (P=0.033), and the times of thyroid function monitoring were more frequent [ (8.2±3.5) vs (6.0±3.6) times] (P=0.049) than the group with pregnancy-related adverse outcomes. Conclusions: The incidence of pregnancy complications and adverse maternal-fetal/neonatal outcomes is high in patients with severe hypothyroidism during pregnancy. Intense follow-up, treatment and restoration of euthyroidism as prompt as possible may improve pregnant outcomes.目的： 分析妊娠期严重甲状腺功能减退（甲减）患者妊娠不良事件情况。 方法： 采用横断面调查，收集2007年1月至2020年12月在北京大学第一医院诊断为严重甲减，并具有妊娠结局的47例（48孕次）患者的临床资料。根据是否发生妊娠不良事件（定义为发生妊娠并发症或母胎/新生儿不良结局任意1项），将患者分为有妊娠不良事件组（n=33）和无妊娠不良事件组（n=15）。分析两组患者一般信息、孕期甲状腺功能、甲状腺自身抗体水平、妊娠并发症及母胎/新生儿结局。 结果： 47例（48孕次）严重甲减患者年龄为（30.5±4.1）岁，分娩孕周［M（Q1，Q3）］为38.6（36.3，39.9）周；诊断孕周为7.0（6.0，8.8）周，孕期促甲状腺激素（TSH）水平为32.7（23.1，60.2）mU/L；TSH首次达标时间为6.0（4.0，10.0）周。82.5%（33/40）患者有甲状腺自身免疫异常。所有患者均给予左甲状腺素（L-T4）治疗，治疗后TSH达标率为77.1%（37/48）。83.3%（40/48）患者成功分娩，新生儿出生体重为（3 041±452）g，身高为（49.4±2.1）cm，头围为（33.6±0.7）cm。与有妊娠不良事件组比较，无妊娠不良事件组患者的孕期TSH首次达标时间更短［（5.0（3.0，9.0）周比8.0（4.5，12.5）周］（P=0.033），甲状腺功能监测次数更多［（8.2±3.5）次比（6.0±3.6）次］（P=0.049）。 结论： 妊娠期严重甲减患者妊娠并发症及母胎/新生儿不良结局发生率较高。积极监测甲状腺功能并给予治疗，可能改善妊娠结局。.