懷孕時期缺鐵和甲狀腺疾病有關


  【24drs.com】比利時研究者警告指出,超過三分之一孕婦缺鐵,使她們的甲狀腺疾病風險增加,而造成懷孕併發症(如流產)的可能性增加。
  
  這篇線上發表於7月22日歐洲內分泌學期刊的研究指出,近2,000名孕婦中,35%在第一孕期缺鐵,甲狀腺自體免疫風險增加超過50%。
  
  以前的研究指出,24%至44%的婦女在懷孕時缺鐵,這次是首度提出甲狀腺自體免疫盛行率增加的次級影響。
  
  資深作者、比利時布魯塞爾CHU St-Pierre大學醫院內分泌科主任Kris G Poppe博士表示,這是重要的發現,因為相較於一般婦女,孕婦的甲狀腺自體免疫增加了流產、早產、低出生體重的風險。
  
  他強調,雖然想要懷孕的婦女應該會增加攝取富含鐵質的食物,但有許多人並未計畫懷孕。不過,懷孕之後提升血中的鐵質數值時猶未晚,在任何情況下,所有婦女都應檢視她們自己的鐵質儲備情況。
  
  Poppe博士表示,但是,往往因為一些經濟面的因素,許多社會並未全面性地就此作出建議;這取決於該地區,也取決於孕婦的種族。
  
  整體而言,這些新研究結果顯示,即使是都會區,還是有缺鐵問題。也提出和缺碘有相似的情況,他表示,我們常認為它已經消失了,但是,當我們調查時,它顯然還沒有消失。
  
  為了檢視第一孕期的甲狀腺自體免疫和功能障礙的盛行率,Poppe博士等人進行了一項分析,研究對象是在比利時一所三級轉診中心參與一項進行中之產科參數與生物資料的前瞻性研究的1,900名孕婦。
  
  這些婦女都沒有甲狀腺疾病史或用甲狀腺藥物,第一次產前檢查時有服用鐵補充劑的婦女也排除。
  
  在第一次產前檢查時測量鐵蛋白、甲狀腺過氧化酶抗體(TPO-abs)、甲狀腺刺激激素(TSH)、游離甲狀腺素(FT4)等數值,也記錄了這些婦女的年齡與身體質量指數。
  
  研究團隊將缺鐵定義為血清鐵蛋白數值<15 μg/mL,當TPO-abs數值>60 kIU/L時表示出現甲狀腺自體免疫,亞臨床甲狀腺低能症則定義為TSH數值>2.5 mIU/L。
  
  結果顯示,35%的婦女缺鐵,平均血清鐵蛋白數值10 μg/L,未缺鐵婦女之數值則是31 μg/L(P < .001)。年齡≧30歲之婦女的盛行率、缺鐵和未缺鐵婦女之肥胖盛行率,並無顯著差異。
  
  缺鐵組的血清TSH值顯著高於未缺鐵組,數據為1.5 mIU/L vs 1.3 mIU/L (P = .015),缺鐵婦女的FT4值顯著較低,數據為1.0 ng/dL vs 1.1 ng/dL (P < .001),兩組的血清TPO-abs值相當。
  
  研究者發現,缺鐵婦女的甲狀腺自體免疫盛行率顯著高於未缺鐵婦女,數據為10% vs 6% (P = .011),亞臨床甲狀腺低能症盛行率也顯著較高,數據為20% vs 16% (P = .049)。
  
  多變項邏輯回歸分析指出,缺鐵和甲狀腺自體免疫顯著相關,勝算比值為1.52 (P = .017),不過,校正多種干擾因素之後,與亞臨床甲狀腺低能症的關聯就不顯著了。
  
  研究團隊表示,顯然需要進一步的前瞻性研究確認我們的資料,並試著更詳細地解釋缺鐵、甲狀腺自體免疫、甲狀腺功能障礙之間的關聯,特別是與懷孕結果有關者。
  
  因此,他們正計畫進行後續的世代研究,Poppe博士表示,我們必須評估世代的結果,接著探討缺鐵是否對於早產與流產有所影響。他們也將會探討僅因缺鐵、僅因甲狀腺自體免疫、或兩者皆有之影響的結果,因為其中一種會強化另一種的影響。
  
  資料來源: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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