پیامد بارداری در زنان باردار مبتلا به کم کاری تیروئید (مقاله مروری)

نوع مقاله : مروری

نویسندگان

1 دانشجوی دکترای تخصصی بهداشت باروری، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران.

2 استاد گروه زنان و مامایی، مرکز تحقیقات اندوکرینولوژی تولید مثل، پژوهشکده غدد درون ریز، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران.

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

4 استاد گروه غدد و متابولیسم، پژوهشکده غدد درون ریز، دانشگاه علوم پزشکی شهید بهشتی تهران، تهران، ایران.

چکیده

مقدمه: کم کاری تیروئید، از شایع ترین اختلالات هورمونی دوران بارداری محسوب می شود و برآورد می شود که 3-2 درصد از زنان باردار به این عارضه مبتلا باشند. به علاوه 20-10 درصد از تمام زنان باردار یوتیروئید برای آنتی بادی های تیروئیدی مثبت هستند. برخی مطالعات نشان داده اند که این اختلالات خفیف تیروئید ممکن است در ارتباط با پیامد های بد مادری و جنینی باشد. مطالعه حاضر با هدف افزایش آگاهی و ارائه بررسی در مورد اثر نامطلوب کم کاری تیروئید بر نتایج بارداری انجام شد.
روش کار: این مرور نظام مند و آینده نگر با جستجو در پایگاه های Medline، EMBASE و کتابخانه Cochrane برای یافتن مقالات مرتبط انگلیسی با کلمات کلیدی مناسب انجام شد. در این بررسی از انواع مطالعات از قبیل کارآزمایی بالینی تصادفی شده، کوهورت (آینده نگر و گذشته نگر)، موردی شاهدی و گزارش موردی انجام شده در زمینه اختلالات تیروئیدی در بارداری و پیامد های بد آن ها استفاده شد. از بین 3480 مقالهبه دست آمده از جستجوهای الکترونیکی در شروع کار، 400 مقاله مرتبط وجود داشت که 130 مورد از مطالعات انجام شده در مورد کم کاری تیروئید آشکار، 203 مورد در کم کاری تحت بالینی تیروئید و 67 مورد در زمینه ایمنی تیروئید بود. از این مقالات، 47 مورد در جهت راستای اهداف مطالعه بودند که شامل 22 مورد در کم کاری تیروئید و 26 مورد در ایمنی تیروئید بودند.
یافته ها: کم کاری تیروئید آشکار دارای اثرات سوء متعدد بر نتایج بارداری است ولی در مورد اثرات کوتاه مدت و بلند مدت کم کاری تیروئید تحت بالینی و موارد آنتی بادی تیروئید مثبت، بحث وجود دارد. در مورد عوارض جنینی مادری در زنان باردار با عملکرد طبیعی تیروئید و آنتی بادی TPO مثبت نیز اختلاف نظر وجود دارد.
نتیجه‌گیری: اگرچه اثر بیماری های خود ایمنی تیروئید در بارداری به طور کلی پذیرفته شده است، اما اثرات کم کاری تیروئید تحت بالینی بدون افزایش آنتی بادی بر پیامدهای بارداری مورد بحث است. انجام مطالعات بیشتر برای شناسایی نتایج نامطلوب مادر و نوزاد در کم کاری تحت بالینی تیروئید مادر، ضروری به نظر می رسد.

کلیدواژه‌ها

عنوان مقاله [English]

Pregnancy outcomes in pregnant women with hypothyroidism (A review Article)

نویسندگان [English]

  • Sima Nazarpour 1
  • Fahimeh Ramezani Tehrani 2
  • Masoumeh Simbar 3
  • Freidoon Azizi 4
1 Ph.D student of Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
2 Professor, Department of Obstetrics and Gynecology, Reproductive Endocrinology Research Center, Research Institute of Endocrinology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
3 Associate professor, Department of Reproductive and Midwifery, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
4 Professor, Department of Endocrine and metabolism, Research Institute of Endocrinology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
چکیده [English]

Introduction: Hypothyroidism is considered as the most common thyroid disorder during pregnancy and about 2-3% of pregnant women suffer from this disorder. Furthermore, 10-20% of all pregnant women are positive for TPO antibodies and euthyroidism. Some studies have indicated that these slight thyroid dysfunctions could also be related to poor maternal and fetal outcomes. This study was performed with the aim to increase awareness and provide a review on adverse effect of hypothyroidism  on pregnancy outcomes.
Methods: In this review and prospective study, databases of Medline, Embase and the Cochrane Library were searched with appropriate keywords for relevant English manuscript. In this study, variety of studies including randomized clinical trials, cohort (prospective and retrospective), case-control and case reports that were about thyroid dysfunctions and their adverse outcome in pregnancy were used.
Among 3480 articles foumd from the electronic searches in the beginning of the study, there were 400 related articles that 130 studies were related to overt hypothyroidism, 203 related to subclinical hypothyroidism and 67 related to thyroid safety. Of these articles, 47 cases were in line with the objectives of the study that included 22 studies about hypothyroidism and 26 about thyroid safety.
Results: Overt hypothyroidism has several adverse effects on pregnancy outcomes, but there is debate on short and long term effect of subclinical hypothyroidism, and thyroid antibody positivity. Also, there is no consensus on feto-maternal complication of pregnant women with normal function of thyroid and TPO antibody positive.
Conclusions: Although the impact of autoimmune thyroid disease on pregnancy outcomes is generally accepted, however the effect of subclinical hypothyroidism without increasing TPOAb on pregnancy outcomes is controversial. Further studies on maternal and neonatal outcomes in mother's subclinical thyroid dysfunction are needed.

کلیدواژه‌ها [English]

  • Anti-thyroid antibody
  • Hypothyroidism
  • pregnancy
  • TPO antibody

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مجله زنان، مامایی و نازایی ایران
دوره 17، شماره 126 - شماره پیاپی 126
هفته چهارم آذر ماه 1393
آذر 1393
صفحه 17-26

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