母亲甲状腺激素水平与妊娠相关焦虑对分娩结果的交互作用

Interaction between maternal thyroid hormone levels and pregnancy-related anxiety on birth outcomes-A birth cohort study

母亲甲状腺激素水平与妊娠相关焦虑对分娩结果的交互作用——一项出生队列研究

Authors: Penggui Wu, Jiajun Ouyang, Wenjin Cai, Lu Chen, Juan Tong, Guopeng Gao, Xiaoyan Wu, Yan Han, Shuangqin Yan, Fangbiao Tao, Kun Huang

Source: Journal of Affective Disorders

PMID: 40499823

DOI: 10.1016/j.jad.2025.119646 

Abstract

Background: Maternal thyroid hormone levels and pregnancy-related anxiety (PRA) influence pregnancy outcomes. However, their potential interactive effects on birth outcomes remain poorly understood.

Methods: This large prospective cohort study was conducted from May 2013 to September 2014 at the Ma'an Shan Maternal and Child Health Center. A total of 1798 mother-infant pairs from the Ma'an Shan Birth Cohort (MABC) participated. PRA assessments and thyroid hormone level tests were performed during the first trimester (1-13 weeks), second trimester (14-27 weeks), and third trimester (after 28 weeks) of gestation.

Results: Second- and third-trimester free thyroxine (FT4) levels were negatively associated with birth weight and reduced large for gestational age (LGA) risk. A high - level FT4 trajectory during pregnancy was also negatively related to birth weight. PRA in the third trimester increased the risk of small for gestational age (SGA) infants, and a high - level PRA trajectory raised LGA risk. Interaction analyses showed that in non-anxious pregnant women during the second and third trimesters, higher FT4 levels significantly reduced LGA risk (OR = 0.90, 95 % CI: 0.83, 0.98; OR = 0.93, 95 % CI: 0.88, 0.99). In women with persistent high anxiety, persistent low FT4 was associated with increased LGA risk (OR = 1.48, 95 % CI: 1.04, 2.10).

Conclusions: Gestational thyroid hormone levels and PRA may interact to influence birth outcomes. Specifically, persistently low thyroid hormone levels combined with chronic high anxiety during pregnancy could increase the risk of LGA infants.

摘要

背景：母体甲状腺激素水平和妊娠相关焦虑（PRA）会影响妊娠结局。然而，二者对出生结局的潜在交互作用仍鲜为人知。

方法：本项大型前瞻性队列研究于 2013 年 5 月至 2014 年 9 月期间，在马鞍山市妇幼保健院开展。研究纳入了马鞍山出生队列（MABC）中的 1798 对母婴。分别在妊娠早期（1-13 周）、中期（14-27 周）和晚期（28 周后）进行妊娠相关焦虑评估及甲状腺激素水平检测。

结果：妊娠中期和晚期的游离甲状腺素（FT4）水平与出生体重呈负相关，并可降低大于胎龄儿（LGA）的发生风险。孕期 FT4 水平持续较高也与出生体重呈负相关。妊娠晚期的妊娠相关焦虑会增加小于胎龄儿（SGA）的发生风险，而孕期焦虑水平持续较高则会增加大于胎龄儿的发生风险。交互分析显示，在妊娠中期和晚期无焦虑的孕妇中，较高的 FT4 水平可显著降低大于胎龄儿的发生风险（OR=0.90，95% CI：0.83，0.98；OR=0.93，95% CI：0.88，0.99）。在持续高焦虑的孕妇中，FT4 水平持续偏低与大于胎龄儿发生风险增加相关（OR=1.48，95% CI：1.04，2.10）。

结论：孕期甲状腺激素水平与妊娠相关焦虑可能存在交互作用，共同影响出生结局。具体而言，孕期甲状腺激素水平持续偏低且合并慢性高焦虑状态，可能会增加大于胎龄儿的发生风险。

关键词：甲状腺激素；妊娠相关焦虑；妊娠结局；出生体重