Do Thyroid Diseases during Pregnancy and Lactation Affect the Nutritional Composition of Human Milk?

Abstract Objective: To identify whether the effects of thyroid disease during pregnancy and lactation affect the nutritional composition of human milk. Methods: Systematic review of the scientific literature using the Medical Literature Analysis and Retrieval System Online/MedLine databases to evaluate the association of thyroid diseases during pregnancy and lactation with the nutritional composition of human milk. There was no delimitation by period or by language, and the searches were completed in March 2019. The following descriptors were applied: human milk AND thyroid AND composition, using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) protocol for data search, selection, and extraction. The flowchart proposed for bibliographic search resulted in 12 articles and, of these, four were selected. Results: The articles elected for this review were published between 1976 and 2018. Two studies found significant differences in the nutritional composition of mothers' milk with hypothyroidism or overweight compared with the milk of those without hypothyroidism. Studies have shown that the presence of the disease led to changes in the nutritional composition of human milk, especially a higher concentration of human milk fat. Conclusion: It is extremely important that these women have continuous nutritional follow-up to minimize the impact of these morbidities on the nutritional composition of human milk.摘要 研究目的：明确妊娠及哺乳期甲状腺疾病是否会影响人乳（human milk）的营养成分组成。 研究方法：采用医学文献分析与检索系统在线版（Medical Literature Analysis and Retrieval System Online，简称MedLine）数据库开展系统评价，评估妊娠及哺乳期甲状腺疾病与人乳营养成分组成的关联。本研究未对检索时限及语言进行限制，文献检索工作于2019年3月完成。检索采用主题词组合：人乳 AND 甲状腺 AND 成分，并遵循系统评价与Meta分析优先报告条目（PRISMA）指南进行数据检索、文献筛选与信息提取。经本次文献检索流程筛选后，共获得12篇文献，最终纳入4篇。 研究结果：本次综述纳入的文献发表时间为1976年至2018年。其中2项研究发现，与无甲状腺功能减退症的母亲相比，罹患甲状腺功能减退症或超重的母亲所分泌人乳的营养成分存在显著差异。相关研究表明，甲状腺疾病的存在会使人乳营养成分发生改变，尤以人乳脂肪浓度升高为著。 研究结论：对此类女性开展持续的营养随访，以最大限度减轻此类病症对人乳营养成分组成的不良影响，具有极其重要的意义。