孕早期甲状腺功能正常妇女甲状腺自身免疫与妊娠期糖尿病的相关性研究

doi:10.3969/j.issn.1006-7795.2025.04.007

首都医科大学学报 ›› 2025, Vol. 46 ›› Issue (4): 626-631.doi: 10.3969/j.issn.1006-7795.2025.04.007

• 更年期妇科内分泌与生育力保护 • 上一篇下一篇

孕早期甲状腺功能正常妇女甲状腺自身免疫与妊娠期糖尿病的相关性研究

赵越¹，阮祥燕^1*，邹丽颖²，马郡¹，王月姣¹，田玄玄¹，金婧¹

1.首都医科大学附属北京妇产医院/北京妇幼保健院内分泌科，北京 100026; 2.首都医科大学附属北京妇产医院/北京妇幼保健院围产医学部，北京 100026

收稿日期:2024-12-25 出版日期:2025-08-21 发布日期:2025-08-29
通讯作者: 阮祥燕 E-mail:ruanxiangyan@ccmu.edu.cn
基金资助:
首都医科大学附属北京妇产医院/北京妇幼保健院“优青人才”计划专项经费资助项目（YQRC201807），妇幼健康研究会中医药治疗不孕不育研究项目( 2018AMCHS011)。

Correlation between thyroid autoimmunity and gestational diabetes mellitus in Chinese euthyroid women

Zhao Yue¹，Ruan Xiangyan^1*，Zou Liying²，Ma Jun¹，Wang Yuejiao¹，Tian Xuanxuan¹，Jin Jing¹

1.Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing 100026, China；2.Department of Perinatal Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing 100026, China

Received:2024-12-25 Online:2025-08-21 Published:2025-08-29
Supported by:
This study was supported by Beijing Obstetrics and Gynecology Hospital , Capital Medical University. Beijing Maternal and Child Health Care Hospital “Excellent Youth” Plan Special Funds（YQRC201807），Association for Maternal and Child Health Studies ( 2018AMCHS011).

摘要/Abstract

摘要： 目的探讨妊娠早期甲状腺功能正常女性甲状腺自身免疫（thyroid autoimmunity, TAI）与妊娠期糖尿病（gestational diabetes mellitus, GDM）之间的相关性。方法选取2023年6月至2024年6月于首都医科大学附属北京妇产医院产科门诊规律产检、孕前未确诊甲状腺疾病、孕早期甲状腺功能正常产妇508例，收集患者基线特征、孕早期（孕6~10周）促甲状腺激素（thyrotropin, TSH）、游离甲状腺素（free thyroxine, fT4）、甲状腺过氧化物酶抗体（thyroid peroxidase antibodies, TPOAb）浓度，孕24~28周75 g葡萄糖耐量试验（oral glucose tolerance test, OGTT）结果，根据OGTT结果分为GDM组（n=169）和非GDM组（n=339），对两组TAI阳性发生率、一般情况、甲状腺功能指标等情况进行分析比较。多因素Logistic回归分析GDM的发生因素。结果 GDM组年龄、体质量指数(body mass index, BMI)、孕前肥胖者均显著高于非GDM组，差异有统计学意义（P<0.001）。GDM组年龄超过30岁孕妇比例显著高于非GDM组（59.17% vs 6.79%， χ²=168.667，P<0.001）。孕前肥胖（BMI≥28 kg/m²）产妇在GDM组中占比为24.26%，显著高于非GDM组的8.26%（χ²=24.599，P<0.001）。GDM组中TAI发生率54.44%，非GDM组TAI的发生率为15.93%，两组间差异有统计学意义（χ²=81.659，P<0.001）。Logistic回归分析结果显示年龄超过30岁及孕前肥胖使TAI产妇GDM发生风险增加6.08倍（OR=6.08，95%CI：3.61~10.25，P<0.001）。结论早期甲功正常女性中，随诊年龄增大（尤其超过30岁）、孕前BMI增高（尤其肥胖者）、孕前TAI者，孕期发生GDM的风险显著增加，未来旨在探究甲状腺功能正常的TAI女性发生GDM的预防策略，以期改善不良妊娠结局。

关键词: 甲状腺自身免疫, 甲状腺过氧化物酶抗体, 妊娠期糖尿病, 促甲状腺激素, 游离甲状腺素, 孕早期

Abstract: Objective To explore the correlation between thyroid autoimmunity (TAI) and gestational diabetes mellitus (GDM) in Chinese euthyroid women. Methods A total of 508 euthyroid women were enrolled in the cross-sectional study, who performed their entire clinical/biological workup and oral glucose tolerance test (OGTT) from the department of Gynecology and Endocrinology of the Beijing Obstetrics and Gynecology Hospital, Capital Medical University from June 2023 to June 2024. At median 8 (6-10) weeks of gestation, thyroid-stimulating hormone (TSH), free thyroxine (fT4), and thyroid peroxidase antibodies (TPOAb) were measured, baseline characteristics were recorded, and an OGTT was performed between 24 and 28 weeks of pregnancy. According to the OGTT results, they were divided into GDM group (n=169) and non GDM group (n=339). Thyroid parameters, the demographic and obstetric parameters, and the prevalence of TAI were compared with two groups. The factors associated with GDM were analyzed with multivariate Logistic regression analysis. Results The age, body mass index (BMI), and proportion of obese women before pregnancy in the GDM group were all significantly higher than those in the non-GDM group, with statistically significant differences (P<0.001). The proportion of pregnant women over 30 years old in the GDM group was significantly higher than that in the non-GDM group (59.17% vs 6.79%, χ²=168.667, P<0.001). The proportion of obese mothers (BMI ≥ 28 kg/m²) before pregnancy in the GDM group was 24.26%, which was significantly higher than that in the non-GDM group (8.26%) (χ²=24.599, P<0.001). The incidence of TAI in the GDM group was 54.44%, while it was 15.93% in the non-GDM group. The difference between the two groups was statistically significant (χ²=81.659, P<0.001). The results of Logistic regression analysis showed that maternal age over 30 years and pre-pregnancy obesity increased the risk of GDM occurrence in TAI women by 6.08 times (OR=6.08, 95% CI 3.61-10.25, P<.001). Conclusion Among early pregnancy women with normal thyroid function, as age increases during follow-up (especially over 30 years old), pre-pregnancy BMI increases (especially in obese individuals), and those with pre-pregnancy TAI, the risk of developing GDM during pregnancy significantly increases. It is necessary to explore preventive strategies for GDM in euthyroid TAI women, with a view to improving adverse pregnancy outcomes.

Key words: thyroid autoimmunity, thyroid peroxidase antibodies, gestational diabetes mellitus, thyrotropin, free thyroxine, first trimester

中图分类号:

R711

赵越, 阮祥燕, 邹丽颖, 马郡, 王月姣, 田玄玄, 金婧. 孕早期甲状腺功能正常妇女甲状腺自身免疫与妊娠期糖尿病的相关性研究[J]. 首都医科大学学报, 2025, 46(4): 626-631.

Zhao Yue, Ruan Xiangyan, Zou Liying, Ma Jun, Wang Yuejiao, Tian Xuanxuan, Jin Jing. Correlation between thyroid autoimmunity and gestational diabetes mellitus in Chinese euthyroid women[J]. Journal of Capital Medical University, 2025, 46(4): 626-631.

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孕早期甲状腺功能正常妇女甲状腺自身免疫与妊娠期糖尿病的相关性研究

Correlation between thyroid autoimmunity and gestational diabetes mellitus in Chinese euthyroid women

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