
Pregnancy represents a challenge to the maternal thyroid gland: the various hormonal variations and the increased metabolic demands occurring during ge-station deeply affect thyroid function [1]. The most common cause of gestational hypothyroidism is auto-immune. In a subset of mothers with autoimmune hypothyroidism, thyroid-stimulating hormone (TSH) blocking antibodies can be transferred to the fetus and cause either transient hyperthyrotropinemia or even hypothyroidism in the neonatal period requiring medications in some affected newborns [2]. Thyroid hormones (TH) play an indispensable role in vertebrate embryogenesis, fetal development and maturation. Serum thyroid-stimulating hormone (TSH) remains the primary screening test for thyroid dysfunction. and Evaluation of thyroid hormone replacement therapy in patients with primary hypothyroidism.
During early pregnancy, before the development of a functioning thyroid gland, the fetus is dependent on TH supplied by the mother Maternal hypothyroidism has been associated with poor pregnancy outcome, decreased birth weight and impaired neuropsy-chological development of the offspring [3].
During pregnancy, resistance to thyroid hormone beta (RTH β) serves as a unique model of isolated fetal hyperthyroidism, since the wild-type (WT) fetus is exposed to excessive levels of TH while the mother remains in a clinically eumetabolic state.
Furthermore, the absence of thyroid stimulating antibodies precludes the possibility of autoaimmunity affecting the fetus’ thyroid status [4]. Variations in serum TSH can occur physiologically in pregnancy. During the first trimester, serum TSH usually becomes lower, but rarely decreases to less than 0.1 mU/L, owing to the stimulatory effects of human chorionic gonado-tropin on the thyroid. Serum TSH subsequently returns to normal in the second trimester [5, 6].
Thyroid stimulation starts as early as the first trimester by β-human chorionic gonadotrophin (HCG) hormone, which shares some structural homology with thyroid-stimulating hormone. There is also an estrogen-mediated increase in circulating levels of thyroid-binding globulin (TBG) during pregnancy by 2∼3 times in serum TBG concentrations [7].
Thyroid function tests during first-trimester of pregnancy and particularly the reference interval for thyroid function tests for pregnant women in each region has to be established, to prevent mis-diagnosis and irreversible mental and physical adverse affect for growing fetus [8].
The incidence of varicella is low in pregnant women. The risk of viral pneumonia is not increased, but varicella zoaster virus (VZV)–associated pneumonia is usually more severe in pregnant women. Approximately 90% of women of childbearing age are immune to varicella because this disease is a common childhood illness and the vaccination against VZV has spread in many countries [9].
Rubella easily crosses the placenta of infected pregnant women; in the first trimester, rubella causes miscarriage or fetal death, or congenital rubella syndrome (CRS) could develop. CRS includes auditory, sensorineural, cardiac and ocular abnormalities. In cases in which the primary rubella infection occurs during the first 4 months of pregnancy, a prenatal diagnosis of fetal infection could be proposed. Some infections such as cytomegalovirus (CMV), rubella and toxoplasmosis may result in serious complications in the fetus and the newborn. In a healthy adult, these infections may be asymptomatic or result in mild symptoms. However, depending on gestational age, transplacental infection may cause problems ranging from long-term sequenced to intrauterine or neonatal death.
Investigating changes in exposure to various infectious agents during pregnancy is important in terms of reflecting the health status of the mother and the fetus. Screening for thyroid dysfunction is recom-mended among certain groups of women, who plan a pregnancy. Management of thyroid disease during pregnancy requires special consideration because pregnancy induces major changes in thyroid function, and maternal thyroid disease can have adverse affects on the pregnancy and the fetus. The purpose of this study was to investigate the correlation between thyroid-related factors and infectious factors among prenatal tests of normal pregnant women.
This study was a retrospective study conducted on data from the normal pregnancy women in Bundang CHA women hospital, which is the most recent data that measured. The thyroid related factors and congenital infection factors were determined using standard laboratory techniques on a Cobas?8000 modular analyzer (Roche Diagnostic International AG, Rotkreuz, Switzerland) by particle enhanced immuno-turbidimetric assay). These data were a cross-sectional survey conducted by outpatients in Bundang CHA women hospital. These were performed from June 2016 to December 2016. Among the 2033 subjects who participated in the outpatients. However, since the test items were variously performed from the same patient, there was a missing value in the analysis. This study has been conducted according to the principles expressed in the Declaration of Helsinki (approved and exemp-tion by Institutional Review Board No. 1041479-201705-HR-009 at N. University).
Patients were excluded if they had received abortion, Most of the attendants were missing a test result according to the condition of pregnancy and the request for additional test items for antenatal testing. Results items from normal pregnant women, thyroid-stimulating hormone (TSH), triiodothyronine (T3), free thyroxine (FT4), Varicella zoster virus (VZA) IgM/G, Rubella IgM/G, human immunodeficiency virus (HIV), Hepatitis C virus (HCV) and hepatitis B virus (HBs) Ag/Ab. and general characteristic was pregnancy duration and fetus type (single, twin).
The level of statistical significance was defined as having a
Calculate mistakes and percentages for the results of infected persons VZA, Rubella, HCV, HBs. and Analysis of VZA, rubella, HCV and HBs factors according to the distribution of TSH, T3 and FT4. Correlation between TSH, T3 and FT4 were analyzed by Pearson correlation coefficient.
The frequency of general characteristics of the participants are shown in Table 1. Most of 493 subjects (66.6%) were over the age of 30∼39 years. The VZV IgG (93.3%) and rubella IgG (89.8%) was mostly detected to positive and VZV IgM (96.4%) and rubella IgM (99.4%) was mostly detected to negative. The HIV was detected to negative in all patients. Among them quantitative analysis. mostly negative was 0.1∼0.2 ng/mL amount. The HCV was almostly negative (99.5%). HBs Ag was distribute to positive (2.9%), over 0.3 ng/mL of negative (95.5%). The positive of HBsAb was abudantly detected (76.3%) but negative detected (23.7%). Mostly patients was included in 11∼12 weeks pregnancy and fetus type was single. For thyroid related factors were mostly normal range included (Table 1).
Frequency of general characteristics in the study participants
Characteristic | Variables | N | % |
---|---|---|---|
Age (years) | <19 | 6 | 0.8 |
20∼29 | 107 | 14.5 | |
30∼39 | 493 | 66.6 | |
40∼49 | 112 | 15.1 | |
50∼59 | 22 | 3.0 | |
VZV IgG | Equivocal | 5 | 3.0 |
Negative | 6 | 3.7 | |
Positive | 153 | 93.3 | |
VZV IgM | Equivocal | 4 | 2.4 |
Negative | 159 | 96.4 | |
Positive | 2 | 1.2 | |
Rubella IgG | Equivocal | 33 | 7.0 |
Negative | 15 | 3.2 | |
Positive | 423 | 89.8 | |
Rubella IgM | Equivocal | 1 | 0.2 |
Negative | 467 | 99.4 | |
Positive | 2 | 0.4 | |
HIV (ng/mL) | Negative | 339 | 100.02 |
<0.1 | 10 | 9 | |
0.1∼0.2 | 259 | 76.4 | |
0.2∼0.3 | 62 | 18.3 | |
>0.3 | 8 | 2.4 | |
Positive | 0 | 0 | |
HCV Ab (ng/mL) | Negative | 381 | 99.5 |
<0.1 | 371 | 96.9 | |
0.1∼0.2 | 4 | 1.0 | |
0.2∼0.3 | 1 | 0.3 | |
>0.3 | 5 | 1.3 | |
Positive | 2 | 0.5 | |
HBs Ag (ng/mL) | Negative | 381 | 97.1 |
<0.3 | 6 | 1.6 | |
>0.3 | 365 | 95.5 | |
Positive | 11 | 2.9 | |
HBs Ab (ng/mL) | Negative | 381 | 23.7 |
<2.0 | 70 | 20.0 | |
2∼10 | 13 | 3.7 | |
Positive | 267 | 76.3 | |
Pregnancy weeks | 11 | 92 | 37.6 |
12 | 108 | 44.1 | |
13 | 13 | 5.3 | |
14 | 11 | 4.5 | |
15∼16 | 14 | 5.7 | |
>17 | 7 | 2.9 | |
Fetus type | Single | 229 | 93.5 |
Twin | 16 | 6.5 | |
T3 (0.6∼1.8 ng/mL) | Normal | 140 | 97.9 |
Abnormal | 3 | 2.1 | |
Mean±SD | 1.09±0.28 | ||
TSH (0.35∼5.5 μIU/mL) | Normal | 468 | 98.3 |
Abnormal | 8 | 1.7 | |
Mean±SD | 1.59±1.47 | ||
FT4 (0.89∼1.76 ng/dL) | Normal | 334 | 97.1 |
Abnormal | 10 | 2.9 | |
Mean±SD | 1.19±0.27 |
Abbreviations: VZA, varicella zoster virus; HIV, human immunodeficiency virus; HCV, hepatitis C virus; HBs, hepatitis B virus; TSH, thyroid-stimulating hormone; T3, triiodothyronine; FT4, free thyroxine.
The age-related changes in T3 showed a tendency to decrease with age (
Mean score of thyroid related factors according parameters (N=127)
Variables | Mean±SD | |||
---|---|---|---|---|
T3 | TSH | FT4 | ||
Age (years) | 1.0±0.28 | 1.5±1.47 | 1.1±0.27 | |
<19 | 2.0±1.01 | 1.2±0.07 | ||
20∼29a | 1.1±0.43 | 1.5±1.49 | 1.2±0.33 | a>b |
30∼39 | 1.1±0.31 | 1.4±1.37 | 1.1±0.27 | |
40∼49 | 1.0±0.22 | 1.9±1.76 | 1.1±0.29 | |
50∼59b | 0.9±0.17 | 1.8±1.26 | 1.1±0.27 | |
F ( |
3.915 (0.010) | 2.208 (0.067) | 0.567 (0.687) | |
VZV IgG | 1.3±0.35 | 1.3±1.11 | 1.2±0.26 | |
Equivocal | 0.6±0.27 | 1.2±0.01 | ||
Negative | 1.3±0.54 | 1.1±0.23 | ||
Positive | 1.3±0.35 | 1.3±1.13 | 1.2±0.26 | |
F ( |
1.061 (0.349) | 0.252 (0.778) | ||
VZV IgM | 1.4±0.35 | 1.3±1.11 | 1.2±0.26 | |
Equivocal | 1.1±0.95 | 1.2±0.01 | ||
Negative | 1.4±0.35 | 1.3±1.10 | 1.2±0.01 | |
Positive | 1.8±2.48 | 0.9±0.17 | ||
F ( |
0.264 (0.768) | 0.057 (0.945) | ||
Rubella IgG | 1.1±0.33 | 1.4±1.38 | 1.1±0.22 | |
Equivocal | 1.0±0.29 | 1.1±0.78 | 1.1±0.13 | |
Negative | 1.0±0.01 | 1.3±1.03 | 1.2±0.16 | |
Positive | 1.2±0.33 | 1.5±1.43 | 1.1±0.23 | |
F ( |
0.818 (0.449) | 0.535 (0.587) | 0.521 (0.595) | |
Rubella IgM | 1.1±0.33 | 1.4±1.37 | 1.1±0.22 | |
Equivocal | ||||
Negative | 1.1±0.32 | 1.4±1.38 | 1.1±0.22 | |
Positive | 0.7±0.01 | 1.0±0.14 | 1.1±0.02 | |
F ( |
1.562 (0.219) | 0.223 (0.630) | 0.080 (0.778) | |
HIV | 1.0±0.27 | 1.6±1.55 | 1.1±0.22 | |
Negative | ||||
<0.1 | 0.9±0.13 | 1.4±1.00 | 1.0±0.19 | a<b |
0.1∼0.2a | 1.1±0.26 | 1.7±1.63 | 1.1±0.21 | |
0.2∼0.3b | 1.0±0.32 | 1.4±1.35 | 1.2±0.23 | |
>0.3 | 1.0±0.14 | 2.3±0.94 | 1.0±0.21 | |
Positive | ||||
F ( |
0.795 (0.499) | 1.291 (0.277) | 5.257 (0.002) | |
HCV Ab | 1.0±0.26 | 1.6±1.52 | 1.1±0.23 | |
Negative | ||||
<0.1 | 1.0±0.25 | 1.6±1.52 | 1.1±0.23 | a<b |
0.1∼0.2a | 0.8±0.09 | 1.5±1.53 | 1.3±0.27 | |
0.2∼0.3 | 1.4±0.01 | 2.3±0.01 | 1.2±0.01 | |
>0.3 | 1.5±0.01 | 1.4±1.45 | 1.0±0.18 | |
Positiveb | 1.7±0.01 | 0.1±0.09 | 1.4±0.01 | |
F ( |
3.232 (0.015) | 0.558 (0.693) | 0.802 (0.525) | |
HBs Ag | 1.0±0.27 | 1.7±1.58 | 1.1±0.25 | |
Negative | ||||
<0.3 | 0.9±0.13 | 1.3±1.22 | 1.1±0.04 | |
>0.3 | 1.0±0.28 | 1.7±1.60 | 1.1±0.26 | |
Positive | 1.0±0.18 | 1.1±0.75 | 1.1±0.12 | |
F ( |
0.279 (0.757) | 0.911 (0.403) | 0.277 (0.758) | |
HBs Ab | 1.0±0.26 | 1.7±1.60 | 1.1±0.22 | |
Negative | ||||
<2.0 | 1.0±0.19 | 1.9±2.06 | 1.1±0.18 | |
2∼10 | 0.9±0.12 | 1.4±0.92 | 1.1±0.13 | |
Positive | 1.1±0.27 | 1.7±1.47 | 1.1±0.24 | |
F ( |
0.911 (0.405) | 1.155 (0.316) | 1.155 (0.317) | |
Pregnancy weeks | 1.3±0.32 | 1.2±1.17 | 1.2±0.27 | |
11 | 1.3±0.33 | 1.3±1.03 | 1.2±0.22 | |
12 | 1.2±0.37 | 1.3±1.43 | 1.2±0.35 | |
13 | 1.2±0.01 | 1.1±0.50 | 1.1±0.12 | |
14 | 1.5±0.14 | 1.3±0.79 | 1.0±0.10 | |
15∼16 | 0.7±0.54 | 1.1±0.21 | ||
>17 | 1.4±1.01 | 1.0±0.06 | ||
F ( |
0.393 (0.760) | 0.601 (0.699) | 1.088 (0.415) | |
Fetal | 1.3±0.32 | 1.2±1.17 | 1.2±0.27 | a<b |
Singlea | 1.3±0.32 | 1.3±1.20 | 1.1±0.22 | |
Twinb | 1.4±0.27 | 1.0±0.66 | 1.4±0.71 | |
F ( |
0.690 (0.415) | 0.947 (0.331) | 6.169 (0.014) |
Abbreviation: See Table 1.
The reference values of FT4 were divided into normal group and abnormal group. As a result of cross-analysis between normal and abnormal group based on the reference values of T3 and TSH, The correlation between FT4 and T3 was statistically significant, but TSH was not statistically significant with FT4 (
Mean score of parameters according to FT4 levels status (Mean±SD)
Variables | Free thyroxine | χ2 ( |
|
---|---|---|---|
Normal (N=34) |
Abnormal (N=93) |
||
T3 (ng/mL) | 1.0±0.27 | 1.4±0.60 | |
Normal | N=138 | N=2 | 45.974 (0.001) |
Abnormal | N=1 | N=2 | |
TSH (μIU/mL) | 1.7±0.03 | 1.6±0.06 | |
Normal | N=325 | N=10 | 0.246 (0.620) |
Abnormal | N=8 | - |
Abbreviation: See Table 1.
*
The results of TSH were divided into tertile, and the correlation between each infection factor and general characteristics was investigated. In the age distribution, the highest distribution and TSH value were statistically significant (
Difference of parameters in according to the levels of TSH
Variables | Total | Q∼.30a (N=143) | Q.31∼.70b (N=190) | Q.71∼c (N=143) | χ2 | |
---|---|---|---|---|---|---|
Age | 15.690 | 0.047 | ||||
<19 | 5 | 0 | 2 | 3 | ||
20∼29 | 54 | 16 | 24 | 14 | ||
30∼39 | 300 | 104 | 117 | 79 | ||
40∼49 | 95 | 19 | 37 | 39 | ||
50∼59 | 22 | 4 | 10 | 8 | ||
VZV IgG | 5.281 | 0.260 | ||||
Equivocal | 5 | 4 | 1 | 0 | ||
Negative | 6 | 1 | 3 | 2 | ||
Positive | 142 | 52 | 59 | 31 | ||
VZV IgM | 3.875 | 0.423 | ||||
Equivocal | 3 | 2 | 0 | 1 | ||
Negative | 149 | 55 | 63 | 31 | ||
Positive | 2 | 1 | 0 | 1 | ||
Rubella IgG | 2.022 | 0.732 | ||||
Equivocal | 15 | 5 | 8 | 2 | ||
Negative | 10 | 2 | 6 | 2 | ||
Positive | 184 | 57 | 81 | 46 | ||
Rubella IgM | 2.402 | 0.301 | ||||
Negative | 206 | 64 | 93 | 49 | ||
Positive | 2 | 0 | 2 | 0 | ||
HIV | 12.824 | 0.046 | ||||
Negative | ||||||
<0.1 | 10 | 5 | 2 | 3 | ||
0.1∼0.2a | 247 | 68 | 96 | 83 | ||
0.2∼0.3b | 62 | 18 | 32 | 12 | ||
>0.3 | 8 | 0 | 3 | 5 | ||
Positive | 0 | 0 | 0 | 0 | ||
HCV Ab | 11.764 | 0.162 | ||||
Negative | ||||||
<0.1 | 359 | 96 | 149 | 114 | ||
0.1∼0.2a | 4 | 1 | 2 | 1 | ||
0.2∼0.3 | 1 | 0 | 0 | 1 | ||
>0.3 | 5 | 3 | 0 | 2 | ||
Positiveb | 2 | 2 | 0 | 0 | ||
HBS Ag | 2.349 | 0.672 | ||||
Negative | 6 | 2 | 3 | 1 | ||
<0.3 | 355 | 90 | 140 | 125 | ||
>0.3 | 11 | 4 | 5 | 2 | ||
Positive | ||||||
HBS Ab | 2.699 | 0.609 | ||||
Negative | 68 | 19 | 22 | 27 | ||
<2.0 | 12 | 3 | 6 | 3 | ||
2∼10 | 230 | 62 | 109 | 89 | ||
Positive | ||||||
Pregnancy weeks | 8.903 | 0.541 | ||||
11 | 88 | 31 | 34 | 23 | ||
12 | 101 | 38 | 41 | 22 | ||
13 | 12 | 4 | 7 | 1 | ||
14 | 11 | 3 | 6 | 2 | ||
15∼16 | 12 | 7 | 4 | 1 | ||
>17 | 7 | 3 | 1 | 3 | ||
Fetal | 0.078 | 0.962 | ||||
Singlea | 216 | 80 | 87 | 49 | ||
Twinb | 15 | 6 | 6 | 3 |
Abbreviation: See Table 1.
The correlations of the thyroid-related factors according to tertile of TSH. the T3, TSH and FT4 were found to be correlated. Especially, TSH values were statistically significant according to low group, middle group, and high group, and T3 and FT4 were statistically lower than those of low group. On the other hand, T3 and FT4 showed opposite results with TSH between groups (Table 5).
Thyroid related factors in according to the third grade of TSH levels (Mean±SD)
Variables | Total | Q∼.30a (N=143) | Q.31∼.70b (N=190) | Q.71∼c (N=143) | ||
---|---|---|---|---|---|---|
T3 (ng/mL) | 1.09±0.28 (143) | 1.21±0.35 (36) | 1.06±0.23 (59) | 1.04±0.26 (48) | 4.638 (0.011) | a>c, b>c |
FT4 (ng/dL) | 1.19±0.27 (343) | 1.34±0.40 (143) | 1.16±0.17 (190) | 1.11±0.17 (143) | 21.539 (0.001) | a>c, b<c |
TSH (μIU/mL) | 1.59±1.47 (476) | 0.41±0.24 (92) | 1.25±0.29 (137) | 3.22±1.69 (114) | 326.675 (0.001) | a<b<c |
Abbreviation: See Table 1.
*
Table 6 showed the significant correlation between thyroid factors. The T3 and FT4 factors showed a significant positive correlation. but TSH showed a significant negative correlation with T3, FT4 values.
Correlation of thyroid factors (r(
T3 | TSH | FT4 | |
---|---|---|---|
T3 | 1 | ||
TSH | −0.194 |
1 | |
FT4 | 0.247 |
−0.276 |
1 |
Abbreviation: See Table 1.
**
This study was a retrospective study that investigated the correlation between the prevalence of thyroid factor and prenatal infection in normal pregnant women. Pregnancy-related changes in thyroid phy-si-ology lead to changes in the thyroid function tests. Therefore, parameters of healthy pregnant women differ from those of euthyroid non-pregnant women. The trimester specific range for TSH, as defined in populations with optimal iodine intake, need to be applied while the interpretation of FT4 values necessitates trimester and method-specific ranges given a significant method-dependent variation in the FT4 measurement in pregnancy. Thyroid function in pregnancy and the TSH in pregnancy is physiologically lower than the non-pregnant population [10].
Early diagnosis for thyroid dysfunction of pregnant women and treatment of thyroid dysfunction during pregnancy is important and cost effective to avoid both fetal and maternal complications secondary to thyroid dysfunction [11]. Thyroid function testing during the neonatal period can be fraught with difficulty in interpretation due to the larger variation of normal levels and an overlap between TSH surge and patho-logical levels. These difficulties are compounded by differences in newborn screening methods in different laboratories. Infants with maternal history of thyroid disease may require additional testing beyond the newborn screen. However, providers can consider delaying test until after thyroid levels are more stable [12].
Low thyroid hormone levels during pregnancy have also been associated with impaired fetal neurological development [13]. Trimester-specific ranges for serum TSH as set by each different laboratory should be used in pregnancy. If not available, the following upper limits of normal range are recommended: TSH 2.5 mIU/L for the first trimester, 3.0 mIU/L for the second trimester, and 3.5 mIU/L for the third trimester [5]. Total T4 increases during the first trimester of pregnancy and the reference range is approximately 1.5-fold that of the nonpregnant range throughout the pregnancy [14].
Pregnant mother and infant protection is a priority in the health because these population groups are mostly exposed to the diseases and death. Thyroid dysfunction is one of the common complications of pregnancy and it contributes significantly to the maternal and fetus morbidity and mortality. Neonates born from mothers who developed varicella between D-5 and D+2 of delivery should also receive as soon as possible specific anti-VZV immunoglobulins [15]. Varicella immunization is recommended for all non-immune women as part of pre-pregnancy and postpartum care and Varicella vaccination should not be administered in pregnancy. However, termination of pregnancy should not be advised because of inadvertent vaccination during pregnancy.
The CMV and toxoplasma infections. We assessed IgG and IgM antibodies in pregnant women applying to the hospital in the first trimester and IgG avidity was utilized as a supplemental test to exclude acute infection and prevent unnecessary intervention. Since women had no serological status tested prior to pregnancy, we were not able to assess seroconversion of IgG antibodies. Thus, only women with elevated IgM antibody titers together with high IgG titers were further evaluated with avidity test to diagnose or exclude primary infection [16].
The trend for a correlation between high titers of CMV DNA in breast milk at 6 months and CMV infection at 6 months (
Therefore, it is thought that it is important to evaluate the identification of various infectious persons to the prenatal pregnant women through this study, and it can be understood that the metabolic ability of the mother reflects the health condition of the fetus because it is a factor that directly affects the fetus. Also, monitoring the changes of various thyroid factors according to the exposure status of the infected person presented in this study may play an important role in antenatal screening.
In conclusion, this study may help to understand the pathophysiological mechanisms of infectious agents and sensory pathogens. Pregnancy represents a challenge to the maternal thyroid gland: the various hormonal variations and the increased metabolic demands occurring during gestation deeply affect thyroid function [19, 20]. Adequate thyroid hormone availability is important for an uncomplicated pregnancy and optimal fetal growth and development. Here, we put studies from the past decade on reference ranges for TSH, determinants of thyroid dysfunction, risks of adverse outcomes and options for treatment into perspective. In addition, we provide an overview of the current views on thyroid physiology during pregnancy and discuss strategies appropriate diagnosis, care and management of thyroid dysfunction in the pre-pregnancy, pregnancy and post-pregnancy periods are important to minimize the risk of complications, long-term effects of the mother and fetus.
임신은 갑상선 기능 검사의 중요한 해석을 필요로 하며 임신 중 갑상선 기능 이상과 외부 바이러스성 감염 인자들의 항체의 존재는 태아 및 산모의 건강에 영향을 미치기에 임신에서 갑상선 기능의 선별적 평가가 요구된다. 본 연구에서는 임신기간 동안 정상 산모들의 선택적 산전 감염인자 검사 항목 중에서 갑상선 관련 인자와 바이러스성 감염 인자의 임신시기별 상호 연관성을 알아보고자 하는 후향적 단편 실태조사이다. 분석한 결과를 살펴보면, T3는 나이가 증가함에 따라 감소하고, 특히 HCV가 양성인 그룹에서 양의 유의성을 보였다(
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Lim DK1,2, M.T., graduate student; Park CE3, Professor.