河北医科大学学报 ›› 2023, Vol. 44 ›› Issue (5): 553-556,578.doi: 10.3969/j.issn.1007-3205.2023.05.011

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孕妇糖代谢异常及维生素D缺乏对子代甲状腺功能的影响

  

  1. 1.河北北方学院附属第二医院儿科，河北 张家口 075100；2.河北北方学院附属第二医院检验科，
    河北 张家口 075100；3.河北北方学院附属第二医院消化内镜中心，河北 张家口 075100

  • 出版日期:2023-05-25 发布日期:2023-05-25
  • 作者简介:尉全平（1978-），男，河北张家口人，河北北方学院附属第二医院副主任医师，医学硕士，从事儿童生长发育内分泌诊治研究。
  • 基金资助:
    张家口市市级科技计划财政资助项目（1911022D）

The effect of abnormal glucose metabolism and vitamin d deficiency of pregnant women on the thyroid functions of their offspring

  1. 1.Department of Pediatrics, the Second Affiliated Hospital of Hebei North University, Hebei Province, 
    Zhangjiakou 075100, China; 2.Department of Laboratory Medicine, the Second Affiliated Hospital of 
    Hebei North University, Hebei Province, Zhangjiakou 075100, China； 3.Digestive Endoscopy 
    Center, the Second Affiliated Hospital of Hebei North University, 
    Hebei Province, Zhangjiakou 075100, China

  • Online:2023-05-25 Published:2023-05-25

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摘要： 目的 探究妊娠期糖尿病(gestational diabetes mellitus，GDM)孕妇血糖及25-羟维生素D［25-hydroxyvitamin D，25-(OH)D］水平对子代新生儿甲状腺功能的影响。
方法 分析186例GDM孕妇的临床资料，按血糖控制情况分为GDM控制组102例和GDM未控制组84例，并随机选取同期健康孕妇98例作为对照组，对比3组孕妇的空腹血糖（fasting plasma glucose，FPG）、糖化血红蛋白（glycated hemoglobin，HbA1c）、25-(OH)D水平、甲状腺功能指标及对应新生儿甲状腺功能指标。依据孕妇维生素D水平分为维生素D缺乏组和维生素D不缺乏组，比较2组对应新生儿先天性甲状腺功能减低症（congenital hypothyroidism，CH）的发病率。
结果 GDM未控制组孕妇FPG、HbA1c高于其他2组；GDM未控制组孕妇血25-(OH)D水平最低，GDM控制组次之，对照组最高。GDM未控制组孕妇促甲状腺激素（thyroid stimulating hormone，TSH）最高，GDM控制组次之，对照组最低；GDM 未控制组孕妇游离三碘甲状腺原氨酸（free triiodothyronine，FT3）、游离甲状腺激素（free thyroxin，FT4）低于其他两组。GDM未控制组子代的TSH高于GDM控制组、对照组，且FT3、FT4均低于其他两组。孕妇维生素D缺乏组对应新生儿CH发病率高于维生素D不缺乏组。
结论 孕妇糖代谢异常和维生素D缺乏可引起子代甲状腺功能减低，根据GDM孕妇的血糖及维生素D相关监测指标，采取针对性干预治疗，对预防新生儿甲状腺功能异常、生长发育异常等疾病有重要临床意义。


关键词: 糖尿病, 妊娠, 血糖, 25-羟维生素D

Abstract: Objective To explore the effect of blood glucose and 25-hydroxyvitamin D ［25-(OH)D］ level of pregnant women with gestational diabetes mellitus (GDM) on the thyroid functions of their offspring newborns. 
Methods A total of 186 pregnant women with GDM were divided into GDM intervention group (n=102) and GDM non-intervention group (n=84) according to their blood glucose control. Another 98 healthy pregnant women in the same period were randomly selected as the control group. The levels of fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), 25-(OH)D, thyroid function indexes and corresponding neonatal thyroid function indexes were compared in the three groups. All pregnant women were divided into vitamin D deficiency group and vitamin D non-deficiency group according to their 25-(OH)D levels, and the corresponding incidence rate of neonatal congenital hypothyroidism (CH) was compared between two groups. 
Results The levels of FPG and HbA1c of pregnant women in GDM non-intervention group were higher than those in other two groups. The blood 25-(OH)D level of pregnant women was the lowest in GDM non-intervention group, followed by GDM intervention group, and the highest in control group. The thyroid stimulating hormone (TSH) of pregnant women was the highest in GDM non-intervention group, followed by GDM intervention group, and the lowest in control group. The free triiodothyronine (FT3) and free thyroxin (FT4) in GDM non-intervention group were lower than those of the other two groups. The TSH of the offspring of GDM non-intervention group was higher than those of GDM intervention group and control group. The FT3 and FT4 of the offspring of GDM non-intervention group were lower than those of the other two groups, and the corresponding incidence rate of neonatal CH of vitamin D deficiency group was higher than that of vitamin D non-deficiency group. 
Conclusion Abnormal glucose metabolism and vitamin D deficiency of pregnant women can cause hypothyroidism of their offspring. According to the blood glucose and vitamin D related monitoring indexes of pregnant women with GDM, targeted intervention has great clinical significance in preventing thyroid dysfunction and abnormal development of newborns. 


Key words: diabetes, gestational, blood glucose, 25-hydroxyvitamin D

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