Effect of levothyroxine for pregnancy outcomes due to subclinical hypothyroidism during pregnancy: A meta-analysis

doi:10.3969/j.issn.1004-583X.2021.09.001

Abstract

Abstract:

Objective To evaluate the effect of levothyroxine(LT₄) for pregnancy outcomes in subclinical hypothyroidism(SCH) by meta-analysis. Methods Randomized controlled trials(RCT) of levothyroxine for pregnancy outcomes in SCH were searched from the computer databases according to the related inclusion and exclusion criteria. Following retrieval and quality evaluation, Rev Man 5.3 software was used for statistical analysis. Results A total of 14 literature including 3,596 patients were enrolled. LT₄ reduced the incidence of gestational hypertension, gestational diabetes mellitus, pre-eclampsia, postpartum hemorrhage, premature rupture of membranes, anemia, premature delivery, abortion, neonatal distress, low birth weight infants. Compared with no LT₄ use, the above items in LT₄ group were lower significantly. Conclusion For pregnancy outcomes due to SCH, LT₄ can decrease complications and incidence of adverse neonatal outcomes.

Key words: levothyroxine, pregnancy, subclinical hypothyroidism, meta-analysis

CLC Number:

R581.2

Cai Kexin, Guo Hongju, Yu Shuxia, Chang Lirong. Effect of levothyroxine for pregnancy outcomes due to subclinical hypothyroidism during pregnancy: A meta-analysis[J]. Clinical Focus, 2021, 36(9): 773-777.

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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2021.09.001

https://huicui.hebmu.edu.cn/EN/Y2021/V36/I9/773

Figures/Tables 6

References 31

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作者	国家	组别	受试者 (例)	年龄 (岁)	治疗方法	干预时间	入组时TSH (mU/L)	TPOAb 状态	结局指标	等级
舒展^[8] 2019	中国	T C	67 67	29.7±2.5 29.1±2.0	饮食干预+LT₄ 50 μg/d 饮食干预	干预至分娩为止	5. 52±0. 58 5. 47±0. 64	阴性	①②⑧⑨⑩	C
Nazarpour^[9] 2018	伊朗	T C	183 183	-	LT₄治疗不进行药物干预	整个孕期	>2.5	阴性	⑦	B
刘志明^[10] 2017	中国	T C	43 43	27.42±3.02 27.48±3.04	初始剂量12.5~25 μg/d LT₄,每隔2~4 周增加12.5~25 μg 不接受任何药物治疗	产后 40 d 左右停止用药	>5.06	-	③④⑤⑧	C
刘亚琼^[11] 2017	中国	T C	65 70	- -	LT₄ 25~50 μg/次	-	T1期TSH>2.5;T2、T3期TSH>3.0 不进行药物干预	阳性或阴性	①②④⑤⑦⑨⑩	C
苏颉^[12] 2017	中国	T C	63 63	28.5±1.8 28.1±1.6	LT₄ 50~100 μg/d 六味地黄丸,30粒/次, 2次/d	当TSH恢复正常时停止用药	T1期TSH>2.5; T2、T3期:TSH>3.0	-	①②④⑥⑨⑩	C
管小玲^[13] 2017	中国	T C	35 35	30.1±3.2 30.6±2.7	LT₄ 50~150 μg/d 不采用药物治疗	-	-	阳性	①②④⑤⑦⑨⑩	C
顾成敏^[14] 2017	中国	T V	53 44	29.98±4.17	LT₄ 50~200 μg/d 不给予任何治疗	-	-	阳性或阴性	①②④⑤⑥⑦⑨	C
Ju^[15] 2016	中国	T C	184 273	29.31±3.36 28.88±3.53	LT₄治疗不给予任何治疗	<4周,4~8周且>8周	5.09±1.58 4.92±1.64	阴性	①②④⑤⑦⑨⑩	C
Maraka^[16] 2016	美国	T C	82 284	- -	LT₄治疗	-	T1期TSH>2.5 或T2、T3期TSH >3,但是<10 不给予任何治疗	阳性或阴性	①②③⑤⑦⑩	C
徐冬岩^[17] 2016	中国	T C	30 30	28.12±4.58	LT₄ 50~100 μg/d 不进行任何干预治疗	-	TSH>4.94	阴性	①②⑦⑧	C
张洁芳^[18] 2016	中国	T C	570 570	24.6±3.8	给予LT₄治疗不给予治疗	至妊娠结束	5.17<TSH<10	阴性	①⑥⑦⑧ ⑩	C
成萍^[19] 2016	中国	T C	120 120	29.3±6.7 30.2±5.9	LT₄ 50~100 μg/d 不给予药物治疗	直至TSH降到妊娠特异参考值上限以下	T1期TSH>2.5; T2、T3期:TSH>3.0	-	①②③④⑥⑦⑧	C
李春仙^[20] 2015	中国	T C	81 42	27.1±6.8 27.9±8.3	LT₄ 50 μg/d 不给予药物治疗	-	T1期TSH>2.57;T2期TSH>3.5;T3期TSH>4.9	-	①②⑦⑧⑩	C
Wang^[21] 2012	中国	T C	28 168	-	LT₄治疗不给予药物治疗	直至分娩	TSH>2.5	-	①④⑥⑦⑧⑩	C

作者	国家	组别	受试者 (例)	年龄 (岁)	治疗方法	干预时间	入组时TSH (mU/L)	TPOAb 状态	结局指标	等级
舒展^[8] 2019	中国	T C	67 67	29.7±2.5 29.1±2.0	饮食干预+LT₄ 50 μg/d 饮食干预	干预至分娩为止	5. 52±0. 58 5. 47±0. 64	阴性	①②⑧⑨⑩	C
Nazarpour^[9] 2018	伊朗	T C	183 183	-	LT₄治疗不进行药物干预	整个孕期	>2.5	阴性	⑦	B
刘志明^[10] 2017	中国	T C	43 43	27.42±3.02 27.48±3.04	初始剂量12.5~25 μg/d LT₄,每隔2~4 周增加12.5~25 μg 不接受任何药物治疗	产后 40 d 左右停止用药	>5.06	-	③④⑤⑧	C
刘亚琼^[11] 2017	中国	T C	65 70	- -	LT₄ 25~50 μg/次	-	T1期TSH>2.5;T2、T3期TSH>3.0 不进行药物干预	阳性或阴性	①②④⑤⑦⑨⑩	C
苏颉^[12] 2017	中国	T C	63 63	28.5±1.8 28.1±1.6	LT₄ 50~100 μg/d 六味地黄丸,30粒/次, 2次/d	当TSH恢复正常时停止用药	T1期TSH>2.5; T2、T3期:TSH>3.0	-	①②④⑥⑨⑩	C
管小玲^[13] 2017	中国	T C	35 35	30.1±3.2 30.6±2.7	LT₄ 50~150 μg/d 不采用药物治疗	-	-	阳性	①②④⑤⑦⑨⑩	C
顾成敏^[14] 2017	中国	T V	53 44	29.98±4.17	LT₄ 50~200 μg/d 不给予任何治疗	-	-	阳性或阴性	①②④⑤⑥⑦⑨	C
Ju^[15] 2016	中国	T C	184 273	29.31±3.36 28.88±3.53	LT₄治疗不给予任何治疗	<4周,4~8周且>8周	5.09±1.58 4.92±1.64	阴性	①②④⑤⑦⑨⑩	C
Maraka^[16] 2016	美国	T C	82 284	- -	LT₄治疗	-	T1期TSH>2.5 或T2、T3期TSH >3,但是<10 不给予任何治疗	阳性或阴性	①②③⑤⑦⑩	C
徐冬岩^[17] 2016	中国	T C	30 30	28.12±4.58	LT₄ 50~100 μg/d 不进行任何干预治疗	-	TSH>4.94	阴性	①②⑦⑧	C
张洁芳^[18] 2016	中国	T C	570 570	24.6±3.8	给予LT₄治疗不给予治疗	至妊娠结束	5.17<TSH<10	阴性	①⑥⑦⑧ ⑩	C
成萍^[19] 2016	中国	T C	120 120	29.3±6.7 30.2±5.9	LT₄ 50~100 μg/d 不给予药物治疗	直至TSH降到妊娠特异参考值上限以下	T1期TSH>2.5; T2、T3期:TSH>3.0	-	①②③④⑥⑦⑧	C
李春仙^[20] 2015	中国	T C	81 42	27.1±6.8 27.9±8.3	LT₄ 50 μg/d 不给予药物治疗	-	T1期TSH>2.57;T2期TSH>3.5;T3期TSH>4.9	-	①②⑦⑧⑩	C
Wang^[21] 2012	中国	T C	28 168	-	LT₄治疗不给予药物治疗	直至分娩	TSH>2.5	-	①④⑥⑦⑧⑩	C

因素	纳入文献	OR值	95%CI		I²(%)	Z值	P值
因素	纳入文献	OR值	下限	上限	I²(%)	Z值	P值
妊娠期高血压	8, 11~21	0.55	0.42	0.73	24	4.20	P<0.01
妊娠期糖尿病	8, 11~17, 19, 20	0.63	0.46	0.87	71	2.81	0.005
先兆子痫	10, 16, 19	0.31	0.12	0.84	0	2.32	0.02
产后出血	10~15, 19, 21	0.52	0.29	0.92	0	2.24	0.03
胎膜早破	10, 11, 13~16	0.60	0.43	0.85	53	2.90	0.004
贫血	12, 14, 18, 19, 21	0.32	0.25	0.41	0	9.18	P<0.01
早产	9, 11, 13~21	0.49	0.36	0.65	0	4.90	P<0.01
流产	8, 10, 17~21	0.36	0.26	0.50	0	6.17	P<0.01
新生儿窘迫	8, 11~15	0.56	0.40	0.79	42	3.35	0.0008
低出生体重儿	8, 12~14, 16, 17, 19, 21~22	0.40	0.28	0.57	52	5.07	P<0.01

因素	纳入文献	OR值	95%CI		I²(%)	Z值	P值
因素	纳入文献	OR值	下限	上限	I²(%)	Z值	P值
妊娠期高血压	8, 11~21	0.55	0.42	0.73	24	4.20	P<0.01
妊娠期糖尿病	8, 11~17, 19, 20	0.63	0.46	0.87	71	2.81	0.005
先兆子痫	10, 16, 19	0.31	0.12	0.84	0	2.32	0.02
产后出血	10~15, 19, 21	0.52	0.29	0.92	0	2.24	0.03
胎膜早破	10, 11, 13~16	0.60	0.43	0.85	53	2.90	0.004
贫血	12, 14, 18, 19, 21	0.32	0.25	0.41	0	9.18	P<0.01
早产	9, 11, 13~21	0.49	0.36	0.65	0	4.90	P<0.01
流产	8, 10, 17~21	0.36	0.26	0.50	0	6.17	P<0.01
新生儿窘迫	8, 11~15	0.56	0.40	0.79	42	3.35	0.0008
低出生体重儿	8, 12~14, 16, 17, 19, 21~22	0.40	0.28	0.57	52	5.07	P<0.01