怀孕时期缺铁和甲状腺疾病有关


  【24drs.com】比利时研究者警告指出,超过三分之一孕妇缺铁,使她们的甲状腺疾病风险增加,而造成怀孕并发症(如流产)的可能性增加。
  
  这篇在线发表于7月22日欧洲内分泌学期刊的研究指出,近2,000名孕妇中,35%在第一孕期缺铁,甲状腺自体免疫风险增加超过50%。
  
  以前的研究指出,24%至44%的妇女在怀孕时缺铁,这次是首度提出甲状腺自体免疫盛行率增加的次级影响。
  
  资深作者、比利时布鲁塞尔CHU St-Pierre大学医院内分泌科主任Kris G Poppe博士表示,这是重要的发现,因为相较于一般妇女,孕妇的甲状腺自体免疫增加了流产、早产、低出生体重的风险。
  
  他强调,虽然想要怀孕的妇女应该会增加摄取富含铁质的食物,但有许多人并未计画怀孕。不过,怀孕之后提升血中的铁质数值时犹未晚,在任何情况下,所有妇女都应检视她们自己的铁质储备情况。
  
  Poppe博士表示,但是,往往因为一些经济面的因素,许多社会并未全面性地就此作出建议;这取决于该地区,也取决于孕妇的种族。
  
  整体而言,这些新研究结果显示,即使是都会区,还是有缺铁问题。也提出和缺碘有相似的情况,他表示,我们常认为它已经消失了,但是,当我们调查时,它显然还没有消失。
  
  为了检视第一孕期的甲状腺自体免疫和功能障碍的盛行率,Poppe博士等人进行了一项分析,研究对象是在比利时一所三级转诊中心参与一项进行中之产科参数与生物资料的前瞻性研究的1,900名孕妇。
  
  这些妇女都没有甲状腺疾病史或用甲状腺药物,第一次产前检查时有服用铁补充剂的妇女也排除。
  
  在第一次产前检查时测量铁蛋白、甲状腺过氧化酶抗体(TPO-abs)、甲状腺刺激激素(TSH)、游离甲状腺素(FT4)等数值,也记录了这些妇女的年龄与身体质量指数。
  
  研究团队将缺铁定义为血清铁蛋白数值<15 μg/mL,当TPO-abs数值>60 kIU/L时表示出现甲状腺自体免疫,亚临床甲状腺低能症则定义为TSH数值>2.5 mIU/L。
  
  结果显示,35%的妇女缺铁,平均血清铁蛋白数值10 μg/L,未缺铁妇女之数值则是31 μg/L(P < .001)。年龄≧30岁之妇女的盛行率、缺铁和未缺铁妇女之肥胖盛行率,并无显著差异。
  
  缺铁组的血清TSH值显著高于未缺铁组,数据为1.5 mIU/L vs 1.3 mIU/L (P = .015),缺铁妇女的FT4值显著较低,数据为1.0 ng/dL vs 1.1 ng/dL (P < .001),两组的血清TPO-abs值相当。
  
  研究者发现,缺铁妇女的甲状腺自体免疫盛行率显著高于未缺铁妇女,数据为10% vs 6% (P = .011),亚临床甲状腺低能症盛行率也显著较高,数据为20% vs 16% (P = .049)。
  
  多变项逻辑回归分析指出,缺铁和甲状腺自体免疫显著相关,胜算比值为1.52 (P = .017),不过,校正多种干扰因素之后,与亚临床甲状腺低能症的关联就不显著了。
  
  研究团队表示,显然需要进一步的前瞻性研究确认我们的资料,并试著更详细地解释缺铁、甲状腺自体免疫、甲状腺功能障碍之间的关联,特别是与怀孕结果有关者。
  
  因此,他们正计画进行后续的世代研究,Poppe博士表示,我们必须评估世代的结果,接著探讨缺铁是否对于早产与流产有所影响。他们也将会探讨仅因缺铁、仅因甲状腺自体免疫、或两者皆有之影响的结果,因为其中一种会强化另一种的影响。
  
  资料来源:http://www.24drs.com/
  
  Native link:Iron Deficiency in Pregnancy Linked to Thyroid Disease

Iron Deficiency in Pregnancy Linked to Thyroid Disease

By Liam Davenport
Medscape Medical News

More than one-third of pregnant women are iron deficient, placing them at increased risk of a thyroid disease that increases the likelihood of pregnancy complications such as miscarriage, warn Belgian researchers.

The research, which was published online in the European Journal of Endocrinology on July 22, indicates that 35% of almost 2000 pregnant women had iron deficiency during the first trimester, and that this increased the risk of thyroid autoimmunity by over 50%.

While previous studies have indicated that iron deficiency during pregnancy can affect from 24% to 44% of women, this is the first to show the secondary effect of an increased prevalence of thyroid autoimmunity.

Senior author Kris G Poppe, MD, PhD, head of the Endocrine Clinic, University Hospital CHU St-Pierre, Brussels, Belgium, told Medscape Medical News that this finding is important because thyroid autoimmunity in pregnant women increases the risk of miscarriage, preterm delivery, and low birth weight compared with unaffected women.

Although he emphasized that women who wish to become pregnant should increase their intake of foods rich in iron, he noted that "many don't plan their pregnancy." But "it's not too late" to have serum ferritin levels measured after becoming pregnant, he said, adding that all women should have their iron reserve checked in any case.

"But many societies don't propose that systematically, often for economic reasons, of course," Dr Poppe said. "It depends on the area; it depends also on the ethnicity of the pregnant women."

Taken together, he said that these new findings show that "there is still a problem with iron deficiency, even in urban areas." Noting that there are parallels with iodine deficiency, he said: "We often thought that it had disappeared, but when we do surveys, it's clear that it hasn't disappeared yet."

35% of Pregnant Women Had Iron Deficiency in First Trimester

To examine the prevalence of thyroid autoimmunity and dysfunction during the first trimester of pregnancy, Dr Poppe and colleagues conducted an analysis of 1900 pregnant women taking part in an ongoing prospective study of obstetric parameters and biological data at a tertiary referral center in Belgium.

None of the women had a history thyroid diseases or having used thyroid medications, and women taking iron supplements at the first antenatal visit were also excluded.

Levels of ferritin, thyroid peroxidase antibodies (TPO-abs), thyroid-stimulating hormone (TSH), and free thyroxine (FT4) were measured during the first antenatal visit, and the women's age and body mass index were recorded.

The team defined iron deficiency as a serum ferritin level of <15 μg/mL, while thyroid autoimmunity was said to be present when the TPO-abs level was >60 kIU/L, and subclinical hypothyroidism was defined as a TSH level >2.5 mIU/L.

The results showed that 35% of the women had iron deficiency, with a mean serum ferritin level of 10 μg/L vs 31 μg/L in women without iron deficiency (P < .001). There was no significant difference in the prevalence of women aged ?30 years or in the prevalence of obesity between women with and without iron deficiency.

Serum TSH levels were significantly higher in the iron-deficiency group than in women without iron deficiency, at 1.5 mIU/L vs 1.3 mIU/L (P = .015), and FT4 levels were significantly lower in iron-deficient women, at 1.0 ng/dL vs 1.1 ng/dL (P < .001). Serum TPO-abs levels were comparable between the two groups.

The researchers found that women with iron deficiency had a significantly higher prevalence of thyroid autoimmunity than non–iron-deficient women, at 10% vs 6% (P = .011) and had a significantly higher prevalence of subclinical hypothyroidism, at 20% vs 16% (P = .049).

Multivariate logistic regression analysis indicated that iron deficiency was significantly associated with thyroid autoimmunity, at an odds ratio of 1.52 (P = .017), although it was no longer significantly associated with an increased risk of subclinical hypothyroidism after adjustment for the multiple confounders.

Further Study Needed to Join the Dots

The team says: "It is obvious that further prospective studies are needed to investigate whether our data can be confirmed and to try to explain the association between iron deficiency, thyroid autoimmunity, and thyroid dysfunction in more detail and especially in relation to the pregnancy outcome."

To those ends, they are planning a further analysis of the cohort. Dr Poppe said: "We have to evaluate the outcomes of our cohort and then look at whether the iron deficiency had an impact on preterm delivery [and] miscarriage."

They will also examine whether any impact on outcomes is due to iron deficiency only, the thyroid autoimmune process, or both, as "one could fortify the effect of the other," he indicated.

This research did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Dr Poppe received fees for lectures he gave at Merck symposia in 2011 and 2014. The coauthors report no relevant financial relationships.

    
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