Analysis of pregnancy outcome and its influencing factors in patients with hypothyroidism during pregnancy

QIAO Ying; ZHANG Huanli; ZHANG Jing

doi:10.3969/j.issn.1674-3245.2025.06.024

Abstract：Objective To study the impact of hypothyroidism during pregnancy on pregnancy outcomes and construct a model of influencing factors.Methods From December 2019 to December 2023,a retrospective study was conducted on 118 pregnant women with hypothyroidism admitted to Yuncheng Maternal and Child Health Hospital as the case group.In the same period,125 pregnant women with normal thyroid function were selected as healthy control group.Compare the pregnancy outcomes and clinical data of two groups,and use multiple logistic regression analysis to analyze the risk factors of gestational hypothyroidism.Results Compared to the healthy control group,the observation group had a higher proportion of preterm births(χ2=10.523,P<0.05),a higher proportion of miscarriages(χ2adjusted=5.662,P<0.05),a higher proportion of stillbirths(χ2adjusted=4.576,P<0.05),and a lower proportion of vaginal deliveries(χ2=4.919,P<0.05).Compared with the healthy control group,the age of the observation group was higher(t=12.724,P<0.05),the proportion of women in the observation group with a history of spontaneous abortion was higher(χ2=4.852,P<0.05),the proportion of women in the observation group with a family history of hypothyroidism was higher(χ2=9.309,P<0.05),the proportion of women in the observation group with hypertension during pregnancy was higher(χ2=14.528,P<0.05),the proportion of women in the observation group with diabetes during pregnancy was higher(χ2=32.164,P<0.05),and the proportion of women in the observation group with low iodine intake was higher(χ2=6.671,P<0.05),The proportion of pregnant women with thyroid peroxidase antibody(TPOAb)positive in the observation group was higher(χ2=9.294,P<0.05),the serum TSH level in the observation group was higher(t=81.614,P<0.05),and the serum ghrelin level in the observation group was lower(t=127.623,P<0.05),The observation group had higher levels of serum obestatin(t=74.229,P<0.05),lower levels of serum 25 hydroxyvitamin D3[25-(OH)D3](t=43.498,P<0.05),and higher levels of serum insulin resistance(HOMA-IR)(t=42.190,P<0.05).Multivariate logistic regression analysis showed that older age,history of spontaneous abortion,family history of hypothyroidism,pregnancy complicated with hypertension,pregnancy complicated with diabetes,insufficient iodine intake,low level of serum Ghrelin,high level of serum Obestatin,low level of serum 25-(OH)D3 and positive TPOAb were all independent risk factors for hypothyroidism during pregnancy(OR=1.581,1.483,1.684,1.567,1.652,1.484,1.631,1.761,1.422,1.672,P<0.05).Conclusion The probability of adverse pregnancy outcome in hypothyroidism during pregnancy is high.In view of the specific factors affecting hypothyroidism in pregnancy,targeted intervention and treatment can reduce the occurrence of hypothyroidism in pregnancy.