目的·采用meta分析评价根据促甲状腺激素（thyroid stimulating hormone，TSH）水平调整左旋甲状腺素（levothyroxine，L-T4）治疗剂量对甲状腺功能减退孕妇母婴结局的影响。方法·检索中国知网、维普中文科技期刊数据库、万方数据知识服务平台、PubMed、Cochrane Library、Embase数据库，收集建库至2022年4月9日所有关于根据TSH水平调整L-T4剂量治疗甲状腺功能减退孕妇的对照研究文献，并追溯参考文献。2名研究人员独立对所获取的文献进行筛选、数据提取及质量评价，其中质量评价采用Cochrane评价表。结局评价指标包括妊娠高血压、妊娠糖尿病、产后出血、分娩方式、早产、胎儿死亡、新生儿窒息、低出生体质量儿，采用RevMan 5.3软件进行meta分析。结果·在6个数据库共检索到1 268篇文献，最终纳入8篇，其中中文文献4篇、英文文献4篇，整体研究偏倚风险处于中等水平。相对于对照组，根据甲状腺功能减退孕妇TSH水平调整L-T4剂量的试验组孕妇发生妊娠糖尿病风险OR值为0.61（95%CI 0.44~0.86，P=0.004），发生胎儿死亡风险OR值为0.38（95%CI 0.18~0.81，P=0.010），均具有统计学意义。而调整L-T4剂量的治疗方式在阴道分娩［OR=1.82（95%CI 0.75~4.40，P=0.180）］、妊娠高血压［OR=0.77（95%CI 0.53~1.12，P=0.170）］、产后出血［OR=1.20（95%CI 0.50~2.92，P=0.680）］、早产［OR=0.72（95%CI 0.48~1.06，P=0.100）］、低出生体质量儿［OR=1.00（95%CI 0.65~1.54，P=0.999）］和新生儿窒息［OR=0.50（95%CI 0.20~1.27，P=0.150）］发生风险方面与对照组差异无统计学意义。结论·根据TSH水平调整L-T4治疗剂量，可能有助于降低甲状腺功能减退孕妇的妊娠糖尿病和胎儿死亡风险。

Objective ·To evaluate the effects of levothyroxine (L-T4) dose adjustment according to the level of thyroid stimulating hormone (TSH) on maternal and infant outcomes in the pregnant women with hypothyroidism by meta-analysis. Methods ·China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), Wanfang Data Knowledge Service Platform, PubMed, Cochrane Library and Embase were retrieved to collect all the controlled studies on the treatment of pregnant women with hypothyroidism by adjusting the dose of L-T4 according to TSH level from the establishment of the databases to April 9, 2022. The references were also traced. Literature screening, data extraction, and quality evaluation were performed independently by two researchers. Cochrane evaluation was used to evaluate the quality of the included literature. Outcome indicators included gestational hypertension, gestational diabetes, postpartum hemorrhage, delivery mode, preterm birth, fetal death, neonatal asphyxia, and low birth weight infants. RevMan 5.3 was used for meta-analysis. Result ·A total of 1 268 articles were retrieved from 6 databases, and 8 were included in the study, including 4 Chinese articles and 4 English articles. The overall risk of study bias was at a moderate level. Compared with the control group, the OR of gestational diabetes risk was 0.61 (95%CI 0.44?0.86, P=0.004) and the OR of fetal death risk was 0.38 (95%CI 0.18?0.81, P=0.010) in the experimental group with L-T4 dose adjusted according to the TSH level of the pregnant women with hypothyroidism, which were both statistically significant. However, the treatment method of adjusting L-T4 dose did not affect the risks of vaginal delivery [OR=1.82 (95%CI 0.75?4.40, P=0.180)], gestational hypertension [OR=0.77 (95%CI 0.53?1.12, P=0.170)], postpartum hemorrhage [OR=1.20 (95%CI 0.50?2.92, P=0.680)], preterm birth [OR=0.72 (95%CI 0.48?1.06, P=0.100)], low birth weight infants [OR=1.00 (95%CI 0.65?1.54, P=0.999)], or neonatal asphyxia [OR=0.50 (95%CI 0.20?1.27, P=0.150)] significantly. Conclusion ·Adjusting the L-T4 therapeutic dose according to the TSH level may help reduce the risks of gestational diabetes and fetal death in the pregnant women with hypothyroidism.