갑상샘기능항진증을 동반한 임신의 주산기 예후
Perinatal outcome of pregnancy with hyperthyroidism
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목적: 갑상샘기능항진증을 동반한 임신 및 신생아의 주산기 예후를 알아보고, 임신 기간 동안의 항갑상샘호르몬 투약 여부 및 갑상샘기능 유지 여부가 이에 미치는 영향을 평가하기 위해 본 연구를 시행하였다. 연구 방법: 2000년 1월 1일부터 2010년 03월 31일까지 갑상샘기능항진증으로 진단받은 산모들 중 가톨릭대학교 부속병원에서 분만한 163예의 임신을 대상으로 산과, 내과 및 신생아의 병력기록지를 후향적으로 조사하였다. 결과: 갑상샘기능항진증을 동반한 163예의 임신 중 103예가 항갑상샘호르몬 치료를 받았으며, 109예가 임신 중 정상갑상샘기능을 유지하였다. 약제군과 비약제군에서 산모의 합병증 발생은 유의한 차이가 없었으나, 신생아의 갑상샘기능 검사 시 비정상소견은 약제군에서 높게 나타났다 (58% vs 24.5%, P<0.0001). 임신 중 갑상샘기능비정상군은 정상군에 비하여 임신 입원을 요하는 임신오조의 빈도와 신생아의 비정상갑상샘기능의 빈도가 더 높게 나타났다 (21.7% vs 4.6%, P=0.0146; 66.7% vs 39.4%, P=0.0223). 결론: 갑상샘기능항진증 산모에서 임신 중 갑상샘기능이 정상으로 유지되지 않거나, 항갑상샘호르몬 치료를 받는 경우에는 신생아의 갑상샘기능에 영향을 줄 수 있으므로, 임신 중 태아의 갑상샘기능이상을 조기에 발견하여 치료하기 위한 적극적 모니터링이 필요할 수 있다.
Abstract
Objective: To evaluate the maternal and neonatal outcomes of pregnancies complicated with hyperthyroidism, according to the maternal treatment and thyroid function status during pregnancy. Methods: This retrospective study was conducted on women complicated by hyperthyroidism who delivered between January 2000 and March 2010, at Catholic University Medical Center. The baseline characteristics as well as maternal and fetal outcomes were analyzed and compared according to maternal antithyroid medication and thyroid function status. Results: Among 163 pregnant women complicated with hyperthyroidism, 103 women received antithyroid medication and 109 women showed euthyroid status during pregnancy. The mean gestational age and fetal birth weight at delivery were 38.2±2.9 weeks and 2.99±0.64 kg. There was no statistical difference in maternal complications between the medication group (n=103) and the non-medication group (n=59), while neonatal thyroid dysfunction including transient hypothyroidism was significantly higher in the medication group than the non-medication group (58% vs 24.5%, P<0.0001). The incidence of admission due to hyperemesis and neonatal thyroid dysfunction were significantly higher in the thyroid dysfunction group than the euthyroid group (21.7% vs 4.6%, P=0.0146; 66.7% vs 39.4%, P=0.0223, respectively). Conclusion: Maternal antithyroid medication as well as thyroid dysfunction during pregnancy could indicate the careful fetal thyroid monitoring to prevent neonatal thyroid dysfunction.
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