ارتباط هیپوتیروئیدی تحت بالینی در طول بارداری و تولد زودرس: یک مرور سیستماتیک و متاآنالیز مطالعات کوهورت

نوع مقاله : مروری

نویسندگان

1 کارشناس ارشد پرستاری، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی جندی شاپور اهواز، اهواز، ایران.

2 استادیار گروه قلب و عروق، دانشکده پزشکی، دانشگاه علوم پزشکی ایلام، ایلام، ایران.

3 استادیار گروه داخلی، دانشکده پزشکی، دانشگاه علوم پزشکی ایلام، ایلام، ایران.

4 کارشناس رادیولوژی، کمیته تحقیقات دانشجویی، دانشکده پرستاری مامایی و پیراپزشکی شرق گیلان، دانشگاه علوم پزشکی گیلان، رشت، ایران.

5 دانشجوی پزشکی، کمیته تحقیقات دانشجویی، دانشگاه علوم پزشکی ایلام، ایلام، ایران.

چکیده

مقدمه: ارتباط هیپوتیروئید تحت بالینی مادر در دوران بارداری با تولد زودرس هنوز مشخص نیست و نتایج مطالعات قبلی متناقض گزارش شده است. مطالعه حاضر با هدف بررسی ارتباط SCH مادر در طول بارداری و تولد زودرس انجام شد.
روش‌کار: در این مطالعه براساسراهنمای گزارش‌دهی مطالعات مرور سیستماتیک و متاآنالیز (PRISMA) استفاده شد. جستجو متون توسط دو پژوهشگر به صورت مستقل در پایگاه های Scopus، PubMed، Science Direct، Embase، Springer،Web of Science ، CINAH، Wiley Online Library، Cochrane Library ، EBSCO و Google scholar با استفاده از کلیدواژه‌های MESH انگلیسی شامل: Thyroid Disease، Hypothyroidism، Subclinical Hypothyroidism، Preterm Delivery، Preterm Labor، Preterm Birth، Premature Delivery، Premature Labor و Premature Birth انجام شد. محدوده زمانی جستجو، بدون محدودیت تا ژوئن 2017 تعیین شد. از مدل اثرات تصادفی بر اساس آزمون کوکران و شاخص I2 برای برآورد خطر نسبی (RR) و فاصله اطمینان (CI) 95% استفاده شد. داده‌ها توسط نرم‌افزار Comprehensive Meta-Analysis ver. 2 (نرم افزار جامع متاآنالیز) آنالیز شدند.
یافته‌ها: بر اساس نتایج متاآنالیز17 مطالعه با حجم نمونه 3580 مورد و 64885 کنترل، RR برای تولد زودرس در زنان باردار با هیپوتیروئید تحت بالینی در مقایسه با زنان سالم 36/1 (CI 95% :68/1-09/1، 005/0=p) برآورد شد که از نظر آماری معنی‌دار بود. RR در مطالعات آسیایی60/1 (CI 95%: 29/2-12/1، 009/0=p) بود که از نظر آماری معنی‌دار شد اما در مطالعات آمریکایی (576/0=p) و اروپایی (072/0=p) این ارتباط یافت نشد.
نتیجه‌گیری: بروز تولد زودرس در زنان باردار مبتلا به هیپوتیروئید تحت بالینی نسبت به مادران یوتیروئید بالاتر بود و این ارتباط از نظر آماری معنی‌دار به‌دست آمد؛ لذا پزشکان باید مدیریت این بیماران را از نظر بروز پیامدهای بد بارداری از جمله تولد زودرس مدنظر داشته باشند.

کلیدواژه‌ها

عنوان مقاله [English]

The Relationship of Maternal Subclinical Hypothyroidism during Pregnancy and Preterm Birth: A Systematic Review and Meta-Analysis of Cohort Studies

نویسندگان [English]

  • Akram Mansouri 1
  • Siros Norouzi 2
  • Ali Sharifi 3
  • Mohammad Hossein YektaKooshali 4
  • Milad Azami 5
1 M.Sc. in Nursing, Faculty of Nursing and Midwifery, Ahvaz Jundishapour University of Medical Science, Ahvaz, Iran.
2 Assistant Professor, Department of Cardiology, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran.
3 Assistant Professor, Department of Internal Medicine, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran.
4 BC of Radiology, Student Research Committee, Faculty of Nursing, Midwifery and Paramedicine of East Gilan, Gilan University of Medical Sciences, Rasht, Iran.
5 Medical Student, Student Research Committee, Ilam University of Medical Sciences, Ilam, Iran
چکیده [English]

Introduction: The relationship between maternal subclinical hypothyroidism during pregnancy and preterm birth is still not clear and the results of previous studies have been inconsistently reported. This study was performed with aim to assess the relationship between mother's subclinical hypothyroidism during pregnancy and preterm.
Methods: This study was conducted based on preferred reporting items for systematic reviews and meta-analyses (PRISMA) checklist. Review and searching of the literatures were done by two researchers independently in databases such as Scopus, PubMed, ScienceDirect, Embase, Springer, Web of Science, CINAHL, Wiley Online Library, Cochrane Library, EBSCO and Google scholar till June 2017 with standard English MeSH keywords including Thyroid Disease, Hypothyroidism, Subclinical Hypothyroidism, Preterm Delivery, Preterm Labor, Preterm Birth, Premature Delivery, Premature Labor and Premature Birth. Random-effects size based on Cochrane test and I2 were used to pool relative risk (RR) and estimate 95% Confidence Interval (CI). Data were analyzed by Comprehensive Meta-Analysis software ver. 2 software.
Results: Seventeen studies with 3,580 experimental and 64,885 control sample size were included. The RR of preterm birth for pregnant women with subclinical hypothyroidism compared with health group was 1.36 (95% CI: 1.09-1.68, P=0.005) and was statistically significant. RR for this relationship in Asian studies was estimated 1.60 (95% CI: 1.12-2.29, P=0.009) and was statistically significant, but this significant relationship was not found in American (P=0.576) and European (P=0.072) studies.
Conclusion: The incidence of preterm birth for pregnant women with subclinical hypothyroidism was higher compared to euthyroid pregnant women and this relationship was significant. Therefore, physicians should consider the management of these patients in terms of adverse pregnancy outcomes such as preterm birth.

کلیدواژه‌ها [English]

  • Cohort
  • Meta-analysis
  • pregnancy
  • Preterm Birth
  • Subclinical Hypothyroidism

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مجله زنان، مامایی و نازایی ایران
دوره 19، شماره 40
ویژه نامه
اسفند 1395
صفحه 69-78

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