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目的:探讨妊娠期糖尿病(GDM)孕妇甲状腺功能减退对妊娠结局的影响。方法:首先根据75 g糖耐量试验将入选的928例妊娠中期孕妇分为GDM组(255例)和正常组(683例),对比两组甲状腺功能。将同期入院的妊娠晚期GDM孕妇分为单纯GDM组(381例)和GDM合并甲减组(80例),对比两组孕妇的妊娠结局。结果:GDM组中血清FT4水平明显低于正常组(P<0.01);两组血清TSH、FT3、TPOAb阳性率比较,均无统计学差异(P>0.05)。TPOAb阳性妊娠中期妇女的血清TSH水平明显高于TPOAb阴性者(P<0.01)。GDM组低甲状腺素血症率明显高于正常组(P<0.05);GDM组总甲状腺功能减退率明显高于正常组(P<0.05)。GDM合并甲减组子痫前期、剖宫产率明显高于单纯GDM组(P<0.05)。GDM合并甲减组巨大儿发生率明显高于单纯GDM组(P<0.05)。结论:GDM孕妇更易发生甲状腺功能减退,且GDM合并甲减孕妇发生不良妊娠结局的风险较高。
Objective: To investigate the effect of hypothyroidism on the outcome of pregnancy in gestational diabetes mellitus (GDM). Methods: According to the 75 g glucose tolerance test, 928 pregnant women were divided into GDM group (255 cases) and normal group (683 cases), the thyroid function was compared between the two groups. The pregnant women with GDM during the third trimester of pregnancy were divided into simple GDM group (n = 381) and GDM combined hypothyroidism group (n = 80). Pregnancy outcomes were compared between the two groups. Results: The level of serum FT4 in GDM group was significantly lower than that in normal group (P <0.01). There was no significant difference in the positive rates of serum TSH, FT3 and TPOAb between the two groups (P> 0.05). Serum TSH levels in TPOAb-positive mid-pregnancy women were significantly higher than those in TPOAb-negative women (P <0.01). The hypothyroxinemia rate in GDM group was significantly higher than that in normal group (P <0.05). The total hypothyroidism rate in GDM group was significantly higher than that in normal group (P <0.05). GDM with hypothyroidism preeclampsia, cesarean section rate was significantly higher than the simple GDM group (P <0.05). GDM with hypothyroidism macrosomia was significantly higher incidence of GDM group (P <0.05). Conclusion: GDM pregnant women are more prone to hypothyroidism, and GDM with hypothyroidism pregnant women have a higher risk of adverse pregnancy outcomes.