Analysis of perinatal thyroid disease characteristics and risk factors for neonatal thyroid dysfunction

doi:10.11958/20252732

Abstract

Abstract:

Objective To explore the characteristics of perinatal thyroid diseases and analyze the risk factors for neonatal thyroid dysfunction. Methods A total of 1 237 pregnant women who underwent prenatal examination and delivered at Yinchuan Maternal and Child Health Care Hospital, Ningxia Medical University, from March 2022 to March 2025, along with their neonates, were enrolled as study subjects. According to the presence or absence of perinatal thyroid diseases, the participants were divided into the observation group (358 cases) and the control group (879 cases). Clinical data of the pregnant women were collected, and levels of thyroid-stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TgAb) were measured during the first, second and third trimesters as well as postpartum. Neonatal thyroid function was followed up to analyze the characteristics of perinatal thyroid diseases. Multivariate Logistic regression analysis was used to identify independent risk factors for neonatal thyroid dysfunction. Results Among the 1 237 pregnant women, the overall prevalence of perinatal thyroid disorders was 28.9%. The prevalence rates of overt hypothyroidism, subclinical hypothyroidism, thyrotoxicosis, positivity for TPOAb or TgAb, thyroid nodules and postpartum thyroiditis were 5.6% (69 cases), 9.3% (115 cases), 4.9% (61 cases), 12.8% (158 cases), 6.7% (83 cases) and 7.2% (89 cases), respectively. Multivariate Logistic regression analysis showed that elevated first-trimester TSH level (OR=2.387, 95%CI: 1.593-3.572), TPOAb positivity (OR=1.915, 95%CI: 1.232-2.998), non-use of iodine supplementation (OR=2.145, 95%CI: 1.378-3.352) and advanced maternal age (≥35 years, OR=1.792, 95%CI: 1.121-2.885) were independent risk factors for neonatal thyroid dysfunction. Conclusion Elevated first-trimester TSH level, TPOAb positivity, iodine deficiency and advanced maternal age are independent risk factors for neonatal thyroid dysfunction.

Key words: thyroid diseases, peripartum period, epidemiology, infant, newborn, thyroid dysfunction, risk factors

CLC Number:

R725.8，R581.2

Figures/Tables 4

References 22

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组别			n	年龄/岁			BMI/（kg/m²）			孕次			产次（≥2次）			汉族	居住城市		教育程度（大专及以上）
对照组			879	28.7±5.3			27.8±4.6			1.7±0.8			112（12.74）			812（92.4）	613（69.8）		514（58.5）
观察组			358	31.2±6.1			31.8±5.1			2.1±1.1			63（17.60）			330（91.9）	235（65.6）		188（52.5）
t或χ²				5.672^＊			13.477^＊			4.256^＊			4.939^＊			0.127	2.354		3.684
组别	职业（脑力劳动）					吸烟史		饮酒史			甲状腺疾病家族史				建档时BMI/（kg/m²）			妊娠期增重/kg		GDM		HDP
对照组	389（44.2）					27（3.0）		15（1.7）			65（7.3）				24.3±3.4			12.1±3.0		71（8.1）		53（6.0）
观察组	145（40.5）					19（5.3）		11（3.1）			101（28.2）				25.9±3.8			13.8±3.5		65（18.2）		54（15.1）
t或χ²	1.347					3.551		2.356			76.841^＊				4.782^＊			5.126^＊		28.947^＊		31.258^＊
组别		贫血			碘补充剂使用				分娩孕周/周			顺产		新生儿出生体质量/g			1 min Apgar 评分/分				5 min Apgar 评分/分
对照组		117（13.3）			310（35.27）				38.8±1.3			599（67.6）		3 398±405			9.0±0.9				9.8±0.2
观察组		79（22.1）			91（25.42）				37.9±1.8			208（58.1）		3 215±432			8.6±1.3				9.7±0.5
t或χ²		18.924^＊			111.262^＊				6.241^＊			10.256^＊		7.381^＊			3.872^＊				2.147^＊

组别			n	年龄/岁			BMI/（kg/m²）			孕次			产次（≥2次）			汉族	居住城市		教育程度（大专及以上）
对照组			879	28.7±5.3			27.8±4.6			1.7±0.8			112（12.74）			812（92.4）	613（69.8）		514（58.5）
观察组			358	31.2±6.1			31.8±5.1			2.1±1.1			63（17.60）			330（91.9）	235（65.6）		188（52.5）
t或χ²				5.672^＊			13.477^＊			4.256^＊			4.939^＊			0.127	2.354		3.684
组别	职业（脑力劳动）					吸烟史		饮酒史			甲状腺疾病家族史				建档时BMI/（kg/m²）			妊娠期增重/kg		GDM		HDP
对照组	389（44.2）					27（3.0）		15（1.7）			65（7.3）				24.3±3.4			12.1±3.0		71（8.1）		53（6.0）
观察组	145（40.5）					19（5.3）		11（3.1）			101（28.2）				25.9±3.8			13.8±3.5		65（18.2）		54（15.1）
t或χ²	1.347					3.551		2.356			76.841^＊				4.782^＊			5.126^＊		28.947^＊		31.258^＊
组别		贫血			碘补充剂使用				分娩孕周/周			顺产		新生儿出生体质量/g			1 min Apgar 评分/分				5 min Apgar 评分/分
对照组		117（13.3）			310（35.27）				38.8±1.3			599（67.6）		3 398±405			9.0±0.9				9.8±0.2
观察组		79（22.1）			91（25.42）				37.9±1.8			208（58.1）		3 215±432			8.6±1.3				9.7±0.5
t或χ²		18.924^＊			111.262^＊				6.241^＊			10.256^＊		7.381^＊			3.872^＊				2.147^＊

指标	β	SE	Wald χ²	P	OR（95%CI）
妊娠早期TSH	0.871	0.325	7.182	<0.001	2.387（1.593~3.572）
TPOAb	0.650	0.287	5.072	0.005	1.915（1.232~2.998）
碘补充剂使用	0.763	0.312	5.938	<0.001	2.145（1.378~3.352）
年龄	0.583	0.268	4.716	0.016	1.792（1.121~2.885）
常数项	-15.320	2.362	42.069	<0.001	<0.001

指标	β	SE	Wald χ²	P	OR（95%CI）
妊娠早期TSH	0.871	0.325	7.182	<0.001	2.387（1.593~3.572）
TPOAb	0.650	0.287	5.072	0.005	1.915（1.232~2.998）
碘补充剂使用	0.763	0.312	5.938	<0.001	2.145（1.378~3.352）
年龄	0.583	0.268	4.716	0.016	1.792（1.121~2.885）
常数项	-15.320	2.362	42.069	<0.001	<0.001

指标		AUC	95%CI		截断值		敏感度/%
妊娠早期TSH		0.726	0.623~0.814		3.85 mIU/L		75.61
TPOAb阳性		0.743	0.642~0.829		是		68.29
碘补充剂使用		0.773	0.673~0.854		是		78.05
高龄产妇		0.736	0.634~0.822		是		70.73
联合		0.924	0.850~0.969				85.37
指标	特异度/%			阳性预测值/%		阴性预测值/%		约登指数
妊娠早期TSH	62.75			19.12		95.70		0.383
TPOAb阳性	80.39			18.86		87.43		0.487
碘补充剂使用	76.47			24.22		97.31		0.545
高龄产妇	76.47			19.33		97.04		0.472
联合	90.20			36.15		98.96		0.756