欢迎来到艾兰博曼,请 登录 | 立即注册
查看: 1350|回复: 3

【资讯翻译】Levothyroxine for Subclinical Hypothyroidism in Pregnancy

[复制链接]

0

听众

0

收听

917

积分

管理员

Rank: 9Rank: 9Rank: 9

积分
917
发表于 2016-8-10 09:21:27 | 显示全部楼层 |阅读模式
Levothyroxine for Subclinical Hypothyroidism in Pregnancy


Levothyroxine therapy given to pregnant women with subclinical hypothyroidism is associated with a decreased risk of having low-birth-weight babies and of having infants with low Apgar scores.

However, no differences in pregnancy loss or other maternal and neonatal outcomes were found in the new retrospective study, which represents the largest cohort to date reporting pregnancy outcomes of women with subclinical hypothyroidism.

The findings were published in the July issue of Thyroid.

Prevalence figures from the United States suggest that up to 15% of pregnant women have subclinical hypothyroidism. However, evidence on the effects of levothyroxine therapy in this population is mixed. Some observational studies show an association with increased risk of adverse pregnancy outcomes in pregnant women with untreated subclinical hypothyroidism, while other studies show no such association. Of note, a Cochrane review published in 2013 concluded that there were insufficient data to make recommendations for clinical practice with respect to levothyroxine in this population (Cochrane Database Syst Rev. 2013;5:CD007752).

Yet despite this uncertainty and the lack of randomized or interventional trial evidence, the American Thyroid Association (ATA) 2011 guidelines recommended levothyroxine therapy for pregnant women with subclinical hypothyroidism, and in 2012, the US Endocrine Society made a similar recommendation, note the authors of this latest study, led by Spyridoula Maraka, MD, from Mayo Clinic, Rochester, Minnesota.

In order to help address this uncertainty, Dr Maraka and colleagues performed their large single-center study to evaluate the potential benefits of levothyroxine therapy in this population.

Recommendations on Levothyroxine Not Universally Implemented

The study used electronic medical records (EMRs) from 366 pregnant women aged between 18 and 45 years evaluated at the Mayo Clinic. Subclinical hypothyroidism during pregnancy was defined as serum thyroid-stimulating hormone (TSH) of greater than 2.5 mIU/L during the first trimester or greater than 3 mIU/L during the second and third trimesters, but less than 10 mIU/L. Pregnant women were divided into two groups depending on whether they received levothyroxine (n = 82) or not (n = 284).

The outcomes assessed included placental abruption, gestational diabetes, gestational hypertension, preeclampsia, eclampsia, premature rupture of membranes (PROM), preterm delivery, and intrauterine growth restriction (IUGR). Low birth weight and 5-minute Apgar score were also recorded among the infants. Data were evaluated from a time period prior to and after the guideline changes.

The study is the "largest to date reporting on pregnancy outcomes of women with subclinical hypothyroidism who were treated with levothyroxine compared with those who were not," the investigators stress.

This enabled more adverse events to be identified, showing differences between groups in certain outcomes, they write. In addition, the use of EMRs captured detailed clinical data, and complete follow-up of the subjects allowed for a comprehensive outcome assessment.

The authors found an association between levothyroxine therapy and decreased risk of low birth weight (with therapy 1.3% of babies were of low birth weight vs 10% without therapy; P < .001) and of low Apgar score (0% with therapy vs 7% without therapy; P < .001).

However, no statistically significant differences in pregnancy loss (6.1% with therapy vs 8.8% without therapy; P = .12) or other maternal and neonatal outcomes were found.

Despite a twofold increase in the number of pregnant women who received levothyroxine replacement therapy for subclinical hypothyroidism after the release of the updated guidelines (ATA and Endocrine Society), these recommendations have not been universally implemented, the authors note.

"It is believed that this is related in part to the paucity of strong supportive data of such recommendations, as well as the limited penetration guidelines have in various specialty groups," they observe.

Use of Levothyroxine Should Be Discussed With Pregnant Women

Finally, they add that until further evidence becomes available, the results currently support levothyroxine therapy without identifying any evidence of harm. However, they add that the possibility of overtreatment in pregnancy still cannot be excluded.

"Clinicians and pregnant women with subclinical hypothyroidism need to have a frank discussion regarding the potential benefits of levothyroxine therapy while taking into consideration the burden of treatment (ie, daily pills, frequent tests, healthcare visits) and each woman's values and preferences."

They stress, however, that the association found in this study requires confirmation in randomized trials before consideration of widespread use of levothyroxine therapy in pregnant women with subclinical hypothyroidism.

信源地址:http://www.medscape.com/viewarticle/867251

0

听众

0

收听

232

积分

中级会员

Rank: 3Rank: 3

积分
232
发表于 2016-8-10 09:35:47 | 显示全部楼层
这篇我领了~

0

听众

0

收听

232

积分

中级会员

Rank: 3Rank: 3

积分
232
发表于 2016-8-11 09:38:22 | 显示全部楼层
Levothyroxine for Subclinical Hypothyroidism in Pregnancy
妊娠期亚甲减的左旋甲状腺素

亚临床甲状腺功能减退症(亚甲减)孕妇服用左旋甲状腺素与低出生体重婴儿和婴儿低Apgar评分的风险降低相关。

然而,新的回顾性研究发现,在流产或其他孕产妇及新生儿的预后方面没有显著差异。这是迄今为止最大的报告亚甲减女性的妊娠结局的研究。

研究结果发表在七月的《甲状腺》(Thyroid)上。

美国的患病率数据显示,高达15%的孕妇有亚甲减。然而,这一人群接受左旋甲状腺素替代疗法的疗效的相关证据并不一致。一些观察研究表明,未治疗亚甲减的孕妇与不良妊娠结局风险增加相关,而其他研究没有发现这样的相关性。值得注意的是,2013年发表在Cochrane上的一篇综述得出结论,没有足够的数据来建议这一人群接受左旋甲状腺素的临床治疗(Cochrane Database Syst Rev. 2013;5:CD007752)。

然而,尽管存在这种不确定性和随机或介入试验的证据不足,美国甲状腺协会(ATA)2011年的指南仍推荐亚甲减孕妇接受左旋甲状腺素治疗,并且2012年,美国内分泌学会也提出了类似的建议。注意这最新研究的作者,是由明尼苏达州罗切斯特市梅奥医学中心的SpyridoulaMaraka博士领衔的。

为了解决这种不确定性,Maraka博士和他的同事们进行了大型单中心研究,评估这一人群接受左旋甲状腺素治疗的潜在益处。

建议不普遍推行左旋甲状腺素
本研究使用在梅奥医学中心进行评估的18-45岁的366名孕妇的电子医疗记录(EMRs)。妊娠期亚甲减定义为血清促甲状腺激素(TSH)在妊娠早期大于2.5 mIU/L或妊娠中晚期大于3mIU/L并低于10 mIU/L。孕妇根据是(n = 82)否(n = 284)服用左旋甲状腺素分为两组。

评估的结局包括胎盘早剥、妊娠糖尿病、妊娠高血压、先兆子痫、子痫、胎膜早破早产(PROM)、早产和胎儿宫内生长受限(IUGR)。婴儿中也记录了低出生体重和5分钟Apgar评分。在指南变化前后的这段时间进行了数据评估。

研究人员强调说,这项研究是“迄今为止最大的比较接受或未接受左旋甲状腺素治疗的亚甲减孕妇的妊娠结局的研究”。

他们写道,这确定了更多的不良事件,显示出特定结果的各组之间的差异。此外,使用EMRs获得了详细的临床资料,并完成了受试者的随访,允许进行综合结局评价。

作者发现,左旋甲状腺素治疗与低出生体重(接受治疗的低出生体重婴儿率为1.3%vs未接受治疗的10%;P<0.001)和低Apgar评分(接受治疗的0% vs未接受治疗的7%;P <0.001)的风险降低相关。

然而,没有发现流产(接受治疗的6.1%vs未接受治疗的8.8%,P =0.12)或其他孕产妇及新生儿的结局存在统计学上的显著差异。

作者指出,尽管最新指南发布后,接受左旋甲状腺素替代疗法治疗亚甲减的孕妇人数增加了一倍(ATA和内分泌学会),但是这些建议并没有得到普遍实施。

他们说:“我们相信,这与缺乏对该建议强有力的支持数据,以及在不同的特殊人群中有限的指南使用部分相关”。

使用左旋甲状腺素应与孕妇商量
最后,他们补充说,在进一步证据出现前,目前还没有针对亚甲减女性使用左旋甲状腺素治疗有任何确证危害性的证据。但是,他们补充说,在怀孕期间过度治疗的可能性仍不能排除。

“当考虑到治疗的负担(比如每天服药、频繁检测、医疗就诊等),以及每个女性的价值观和喜好,就左旋甲状腺素治疗的潜在益处而言,临床医生以及患有亚甲减的孕妇需要坦率的讨论。”
他们强调,无论如何,在考虑普及对亚甲减孕妇使用左旋甲状腺素治疗前,本研究发现的相关性需要随机试验的确认。

0

听众

0

收听

917

积分

管理员

Rank: 9Rank: 9Rank: 9

积分
917
 楼主| 发表于 2016-8-11 16:13:39 | 显示全部楼层
后台收录
您需要登录后才可以回帖 登录 | 立即注册

本版积分规则

© 2013 艾兰博曼 All Rights Reserved.
( 浙ICP备07020270号-8 )
 
快速回复 返回顶部 返回列表