بررسی فراوانی آنتی‌بادی تیروئید پراکسیداز مثبت و عوامل مرتبط با آن طی دوران بارداری در زنان باردار مراجعه کننده به مراکز تحت پوشش دانشگاه شهید بهشتی در سال ۹۵-۱۳۹۲

نوع مقاله: اصیل پژوهشی

نویسندگان

1 استادیار گروه مامایی، دانشکده پزشکی، دانشگاه آزاد اسلامی، واحد ورامین- پیشوا، تهران، ایران.

2 استاد گروه غدد درون‌ریز و متابولیسم، مرکز تحقیقات اندوکرینولوژی تولید مثل، پژوهشکده علوم غدد درون‌ریز و متابولیسم، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران.

3 استاد گروه مامایی و بهداشت باروری، مرکز تحقیقات مامایی و بهداشت باروری، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران.

4 دانشجوی دکترای آمار زیستی، دانشکده بهداشت، دانشگاه علوم پزشکی تهران، تهران، ایران.

5 استاد گروه غدد درون‌ریز و متابولیسم، مرکز تحقیقات غدد درون‌ریز، پژوهشکده علوم غدد درون‌ریز و متابولیسم، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران.

چکیده

مقدمه: آنتی‌بادی تیروئید پراکسیداز (TPOAb)، عامل اصلی خطر اختلال عملکرد تیروئید در دوران بارداری است و می‌تواند نشانگر این اختلالات در دوران بارداری باشد. مطالعه حاضر با هدف ارزیابی فراوانی مثبت بودن TPOAb و عوامل مرتبط با آن در دوران بارداری انجام شد.
روش‌کار: این مطالعه یک تجزیه و تحلیل ثانویه است که بر اساس داده­های موجود در بررسی آینده‌نگر مبتنی بر جمعیت مطالعه تیروئید و بارداری تهران بر روی 2233 نفر از زنان باردار (سه ماهه اول بارداری) مراجعه‌کننده به درمانگاه­های مراقبت‌های دوران بارداری مراکز تحت پوشش دانشگاه شهید بهشتی انجام شد. اندازه‌گیری میزان سرمی TSH، T4، T-uptake و TPOab برای زنان باردار انجام شد. عوامل سن مادر، شاخص توده بدنی، تعداد حاملگی، سن حاملگی، سابقه فردی یا خانوادگی اختلالات تیروئید، گواتر، دیابت نوع یک یا سایر اختلالات خودایمنی، سابقه ناباروری، سابقه سقط جنین، زایمان زودرس یا مرده‌زایی به‌عنوان عوامل خطر احتمالی انتخاب شدند. تجزیه و تحلیل داده­ها با استفاده از نرم‌افزار STATA (نسخه 12) انجام گرفت.
یافته‌ها: در این بررسی 214 نفر (9/7%) TPOAb مثبت بودند. بر اساس مدل رگرسیون لوجستیک، شانس مثبت شدن TPOAb در افرادی که سابقه فردی بیماری تیروئید داشتند، 48/4 برابر (با فاصله اطمینان ۲۶/۲ و ۸۵/۸) بیشتر از افراد فاقد این سابقه بود (05/0p<). ارتباط معنی‌داری بین سایر عوامل مطرح شده (سن مادر، شاخص توده بدنی، تعداد حاملگی، سن حاملگی، مصرف داروی تیروئید، سابقه خانوادگی تیروئید، سابقه ناباروری، سقط و زایمان زودرس) با مثبت شدن TPOAb وجود نداشت (05/0p>).
نتیجه‌گیری: سابقه اختلالات تیروئید با مثبت بودن TPOAb در زنان باردار ارتباط داشته و این عامل می‌تواند به‌عنوان عامل خطری در شناسایی اختلالات اتوایمون تیروئید در نظر گرفته شود.

کلیدواژه‌ها


عنوان مقاله [English]

Frequency of positive thyroid peroxidase antibody and its related factors during pregnancy in pregnant women referring to the centers under coverage of Shahid Beheshti University of Medical Sciences, 2013-2016

نویسندگان [English]

  • Sima Nazarpour 1
  • Fahimeh Ramezani Tehrani 2
  • Masoumeh Simbar 3
  • Maryam Rahmati 4
  • Fereidoun Azizi 5
1 Assistant Professor, Department of Midwifery, Faculty of Medicine, Varamin-Pishva Branch, Islamic Azad University, Tehran, Iran.
2 Professor, Department of Endocrine and Metabolism, Reproductive Endocrinology Research Center، Research Institute for Endocrine Sciencesn, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
3 Professor, Department of Midwifery and Reproductive Health, Midwifery and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
4 Ph.D. Student of Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
5 Professor, Department of Endocrine and Metabolism, Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
چکیده [English]

Introduction: Thyroid peroxidase antibody (TPOAb) is the main risk factor for thyroid dysfunction during pregnancy and can be a marker of these disorders during pregnancy. This study was performed with aim to evaluate the frequency of positive thyroid peroxidase antibody and its related factors during pregnancy.
Methods: This study is a secondary analysis which was performed based on the data available in prospective population based study of The Tehran Thyroid and Pregnancy Study. This study was performed on 2233 pregnant women (at first trimester of pregnancy) who referred to prenatal care centers under coverage of Shahid Beheshti University of Medical Sciences. Serum concentrations of T4، T-uptake، TSH and TPOAb were measured in pregnant women. Mother age، body mass index، parity، gestational age، individual or family history of thyroid dysfunctions، goiter، diabetes type 1 or other autoimmune disorders، history of infertility، abortion، preterm labor، or stillbirth were selected as probable risk factors. Data analysis was performed using STATA software (version 12).
Results: In this study، 214 cases (7.9%) were TPOAb positive. Based on the logistic regression model، the chance of positive TPOAb in women with individual history of thyroid disease was 4.48 times (95% CI: 2.26- 8.85) higher than those without this history (p <0.05). No significant relationship was found between other factors (maternal age, BMI, parity, gestational age, thyroid medication, family history of thyroid dysfunction, history of infertility, history of abortion and history of preterm labor) and positive TPOAb (P>0.05).
Conclusion: The history of thyroid disorders is associated with positive TPOAb in pregnant women and this factor can be considered as a risk factor for the detection of thyroid autoimmune disorders.

کلیدواژه‌ها [English]

  • pregnancy
  • Risk factors
  • Thyroid dysfunction
  • Thyroid Peroxidase Antibody
  1. Carney LA, Quinlan JD, West JM. Thyroid disease in pregnancy. Am Fam Physician 2014; 89(4):273-8.
  2. Vandana, Kumar A, Khatuja R, Mehta S. Thyroid dysfunction during pregnancy and in postpartum period: treatment and latest recommendations. Arch Gynecol Obstet 2014; 289(5):1137-44.
  3. Chen L, Hu R. Thyroid autoimmunity and miscarriage: a meta‐analysis. Clin Endocrinol 2011; 74(4):513-9.
  4. Cignini P, Cafa EV, Giorlandino C, Capriglione S, Spata A, Dugo N. Thyroid physiology and common diseases in pregnancy: review of literature. J Prenat Med 2012; 6(4):64-71.
  5. Prummel MF, Wiersinga WM. Thyroid autoimmunity and miscarriage. Eur J Endocrinol 2004; 150(6):751-5.
  6. Stagnaro-Green A, Abalovich M, Alexander E, Azizi F, Mestman J, Negro R, et al. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid 2011; 21(10):1081-125.
  7. Banerjee S. Thyroid disorders in pregnancy. J Assoc Physicians India 2011; 59:32-4.
  8. Krassas G, Poppe K, Glinoer D. Thyroid function and human reproductive health. Endocr Rev 2010; 31(5):702-55.
  9. Barnett C, Visser T, Williams F, Toor H, Duran S, Presas M, et al. Inadequate iodine intake of 40% of pregnant women from a region in Scotland. J Endocrinol Invest 2002; 25(Suppl 7):90.
  10. Medici M, de Rijke YB, Peeters RP, Visser W, de Muinck Keizer-Schrama SM, Jaddoe VV, et al. Maternal early pregnancy and newborn thyroid hormone parameters: the generation R study. J Clin Endocrinol Metab 2012; 97(2):646-52.
  11. Williams FL, Watson J, Ogston SA, Visser TJ, Hume R, Willatts P. Maternal and umbilical cord levels of T4, FT4, TSH, TPOAb, and TgAb in term infants and neurodevelopmental outcome at 5.5 years. J Clin Endocrinol Metab 2013; 98(2):829-38.
  12. Swelam SE, Bakr HG, Mansour MA. Postpartum thyroid dysfunction: a state of immunological dysregulation. Clin Lab 2011; 57(9-10):731-9.
  13. Bulmus N, Ustuner I, Seda Guvendag Guven E, Kir Sahin F, Senturk S, Baydur Sahin S. Thyroid diseases in pregnancy: the importance of anamnesis. Pak J Med Sci 2013; 29(5):1187-92.
  14. Dehghani Zahedani M, Azinfar A, Mahoori K, Solati S. Analyzing risk factors suggestive of thyroid dysfunction in Iranian pregnant women. Iran J Endocrinol Metab 2010; 4:352-8.
  15. Diehl K. Thyroid dysfunction in pregnancy. J Perinat Neonatal Nurs 1998; 11(4):1-12.
  16. Cunningham FG, leveno KJ, Bloom SL, Hauth JC, Rouse DJ, Spong CY. Williams obstetrics. New York: McGraw Hill; 2010.
  17. Delshad H, Azizi F. Thyroid and pregnancy. J Med Council Islam Republic Iran 2008; 26(3):392-408.
  18. El Baba KA, Azar ST. Thyroid dysfunction in pregnancy. Int J Gen Med 2012; 5:227-30.
  19. Krysiak R, Okopien B, Herman ZS. Hyperthyroidism in pregnancy. Pol Merkur Lekarski 2006; 21(126):579-84.
  20. Chittamuri S, Bongi V, Ayyagari M, Kandregula DK, Kandregula SA. Pregnancy outcomes in subclinical hypothyroidism and thyroid autoimmunity. Thyroid Res Pract 2016; 13(1):1.
  21. Negro R, Formoso G, Mangieri T, Pezzarossa A, Dazzi D, Hassan H. Levothyroxine treatment in euthyroid pregnant women with autoimmune thyroid disease: effects on obstetrical complications. J Clin Endocrinol Metab 2006; 91(7):2587-91.
  22. Nonchev BI, Argatska AV, Pehlivanov BK, Orbetzova MM. Risk factors for postpartum thyroid dysfunction in euthyroid women prior to pregnancy. Folia Med 2017; 59(2):190-6.
  23. Strieder TG, Prummel MF, Tijssen JG, Endert E, Wiersinga WM. Risk factors for and prevalence of thyroid disorders in a cross‐sectional study among healthy female relatives of patients with autoimmune thyroid disease. Clin Endocrinol 2003; 59(3):396-401.
  24. Nazarpour S، Tehrani FR، Simbar M، Tohidi M، Azizi F. Thyroid and pregnancy in Tehran، Iran: objectives and study protocol. International journal of endocrinology and metabolism. 2016;14(1).
  25. Cignini P, Cafà EV, Giorlandino C, Capriglione S, Spata A, Dugo N. Thyroid physiology and common diseases in pregnancy: review of literature. J Prenat Med 2012; 6(4):64-71.
  26. George J, Joshi SR. Drugs and thyroid. J Assoc Physicians India 2007; 55:215-23.
  27. Wenzel KW. Pharmacological interference with in vitro tests of thyroid function. Metabolism 1981; 30(7):717-32.
  28. Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, et al. 2017 Guidelines of the American thyroid association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid 2017; 27(3):315-89.
  29. Dieguez M, Herrero A, Avello N, Suarez P, Delgado E, Menendez E. Prevalence of thyroid dysfunction in women in early pregnancy: does it increase with maternal age? Clin Endocrinol 2016; 84(1):121-6.
  30. Potlukova E, Potluka O, Jiskra J, Limanova Z, Telicka Z, Bartakova J, et al. Is age a risk factor for hypothyroidism in pregnancy? An analysis of 5223 pregnant women. J Clin Endocrinol Metab 2012; 97(6):1945-52.
  31. Aghajanian P, Spencer CA, Wilson ML, Lee RH, Goodwin TM, Mestman JH. Evaluation of risk‐factor‐based screening for thyroid peroxidase antibody positivity in pregnancy. Clin Endocrinol 2016; 84(3):417-22.
  32. Manji N, Carr-Smith J, Boelaert K, Allahabadia A, Armitage M, Chatterjee V, et al. Influences of age, gender, smoking, and family history on autoimmune thyroid disease phenotype. J Clin Endocrinol Metab 2006; 91(12):4873-80.
  33. Korevaar TI, Nieboer D, Bisschop PH, Goddijn M, Medici M, Chaker L, et al. Risk factors and a clinical prediction model for low maternal thyroid function during early pregnancy: two population-based prospective cohort studies. Clin Endocrinol (Oxf) 2016; 85(6):902-9.
  34. Carlé A, Pedersen IB, Knudsen N, Perrild H, Ovesen L, Rasmussen LB, et al. Development of autoimmune overt hypothyroidism is highly associated with live births and induced abortions but only in premenopausal women. J Clin Endocrinol Metab 2014; 99(6):2241-9.
  35. Stagnaro-Green A, Glinoer D. Thyroid autoimmunity and the risk of miscarriage. Best Pract Res Clin Endocrinol Metab 2004; 18(2):167-81.
  36. Moussa A، Kandil H، Shaheen M. Antithyroid autoantibodies in unexplained recurrent abortion. Obgyn. net publications (January 24، 2002). www. obgyn. net/pb/cotm/9905. antithyroid1.(envoyé jusqu’ici); 2002.
  37. Dendrinos S, Papasteriades C, Tarassi K, Christodoulakos G, Prasinos G, Creatsas G. Thyroid autoimmunity in patients with recurrent spontaneous miscarriages. Gynecol Endocrinol 2000; 14(4):270-4.
  38. Liu H, Shan Z, Li C, Mao J, Xie X, Wang W, et al. Maternal subclinical hypothyroidism, thyroid autoimmunity, and the risk of miscarriage: a prospective cohort study. Thyroid 2014; 24(11):1642-9.
  39. Thangaratinam S, Tan A, Knox E, Kilby MD, Franklyn J, Coomarasamy A. Association between thyroid autoantibodies and miscarriage and preterm birth: meta-analysis of evidence. BMJ 2011; 342:d2616.
  40. Poppe K, Glinoer D, Van Steirteghem A, Tournaye H, Devroey P, Schiettecatte J, et al. Thyroid dysfunction and autoimmunity in infertile women. Thyroid 2002; 12(11):997-1001.
  41. Chen X, Jin B, Xia J, Tao X, Huang X, Sun L, et al. Effects of thyroid peroxidase antibody on maternal and neonatal outcomes in pregnant women in an iodine-sufficient area in China. Int J Endocrinol 2016; 2016:6461380.
  42. Ashoor G, Maiz N, Rotas M, Jawdat F, Nicolaides KH. Maternal thyroid function at 11-13 weeks of gestation and spontaneous preterm delivery. Obstet Gynecol 2011; 117(2 Pt 1):293-8.
  43. Hollowell JG, Staehling NW, Flanders WD, Hannon WH, Gunter EW, Spencer CA, et al. Serum TSH, T4, and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab 2002; 87(2):489-99.
  44. Canaris GJ, Manowitz NR, Mayor G, Ridgway EC. The Colorado thyroid disease prevalence study. Arch Intern Med 2000; 160(4):526-34.
  45. Mbah AU, Ejim EC, Onodugo OD, Ezugwu FO, Eze MI, Nkwo PO, et al. Two logistic models for the prediction of hypothyroidism in pregnancy. BMC Res Notes 2011; 4:205.
  46. Rotondi M, Leporati P, La Manna A, Pirali B, Mondello T, Fonte R, et al. Raised serum TSH levels in patients with morbid obesity: is it enough to diagnose subclinical hypothyroidism? Eur J Endocrinol 2009; 160(3):403-8.
  47. Kawasaki E. Type 1 diabetes and autoimmunity. Clin Pediatr Endocrinol 2014; 23(4):99-105.
  48. Mohn A, Di Michele S, Di Luzio R, Tumini S, Chiarelli F. The effect of subclinical hypothyroidism on metabolic control in children and adolescents with Type 1 diabetes mellitus. Diabet Med 2002; 19(1):70-3.
  49. Jovanovic-Peterson L, Peterson CM. De novo clinical hypothyroidism in pregnancies complicated by and type I diabetes, subclinical hypothyroidism, proteinuria: a new syndrome. Am J Obstet Gynecol 1988; 159(2):442-6.
  50. Riley WJ, Maclaren NK, Lezotte DC, Spillar RP, Rosenbloom AL. Thyroid autoimmunity in insulin-dependent diabetes mellitus: the case for routine screening. J Pediatr 1981; 99(3):350-4.
  51. Pishdad GR. Low incidence of type 1 diabetes in Iran. Diabetes Care 2005; 28(4):927-8.
  52. Teng X, Shan Z, Chen Y, Lai Y, Yu J, Shan L, et al. More than adequate iodine intake may increase subclinical hypothyroidism and autoimmune thyroiditis: a cross-sectional study based on two Chinese communities with different iodine intake levels. Eur J Endocrinol 2011; 164(6):943-50.