目的 基于甲状腺功能、甲状腺自身抗体分析妊娠期孕妇碘营养异常的影响因素，并分析妊娠期孕妇碘营养异常与妊娠结局的关系。 方法 前瞻性选取2021年1月至2023年6月于青海省人民医院行常规产前检查的妊娠期孕妇838例作为研究对象，所选孕妇均跟踪随访至分娩结束，失访7例，最终纳入831例，其中孕早期孕妇276例、孕中期孕妇384例、孕晚期孕妇171例。收集孕妇资料，检测尿碘浓度（UIC）、尿肌酐（UCr）及甲状腺功能指标和甲状腺自身抗体水平，根据孕妇碘营养状况分为碘充足组、碘异常组（包括碘缺乏、碘超足量和碘过量组）。分析妊娠期孕妇碘营养状况，比较不同孕期孕妇碘营养状况，对比不同碘营养状况孕妇甲状腺功能指标、甲状腺疾病患病率及单纯甲状腺过氧化物酶抗体（TPOAb）、甲状腺球蛋白抗体（TGAb）、促甲状腺激素受体抗体（TRAb）阳性率，并比较不同碘营养状况孕妇不良妊娠结局情况，予以多因素logistic回归分析妊娠期孕妇碘异常的危险因素，并构建预测模型探索其预测价值。 结果 纳入的831例妊娠期孕妇碘充足373例（44.89%），碘异常458例（55.11%）（其中碘缺乏、碘超足量、碘过量各为282、144、32例）。不同孕期孕妇碘营养状况比较，差异无统计学意义（P > 0.05）。碘异常组血清促甲状腺激素（TSH）水平、单纯TPOAb、TGAb、TRAb阳性率、甲状腺功能异常发生率及不良妊娠结局总发生率均高于碘充足组（P < 0.05）；碘缺乏组、碘超足量组和碘过量组血清TSH水平、甲状腺功能异常发生率及不良妊娠结局总发生率均高于碘充足组（P < 0.05）。血清TSH水平及TPOAb、TGAb、TRAb阳性均是妊娠期孕妇碘异常的影响因素（P < 0.05）。构建的预测模型预测妊娠期孕妇碘异常的曲线下面积（AUC）值为0.876，敏感度为72.27%，特异度为89.01%。 结论 妊娠期孕妇碘营养异常率较高，大多处于碘缺乏状态，且妊娠期孕妇碘营养异常与甲状腺功能、甲状腺自身免疫及妊娠结局有关，但与孕期无明显相关性，同时根据危险因素构建的预测模型能够较好的预测妊娠期孕妇碘营养异常。

Objective To analyze the factors influencing iodine nutritional status in pregnant women during pregnancy， based on thyroid function and thyroid autoantibody levels， and to explore the association between iodine nutritional abnormalities and pregnancy outcomes. Methods A total of 838 pregnant women who underwent routine prenatal checkups at Qinghai Provincial People's Hospital between January 2021 and June 2023 were prospectively enrolled in this study. All participants were followed until delivery. Seven cases were lost to follow-up， resulting in a final sample size of 831 participants. Among them， 276 were in the first trimester， 384 in the second trimester， and 171 in the third trimester. Data on urinary iodine concentration （UIC）， urinary creatinine （UCr）， thyroid function indicators， and thyroid autoantibodies were collected. Based on their iodine nutritional status， the participants were categorized into either the iodine-sufficient group or the iodine-abnormal group （including iodine-deficient， iodine-hyper-sufficient， and iodine-excessive subgroups）. This study analyzed the iodine nutritional status of pregnant women during different gestational periods， compared thyroid function indices， prevalence of thyroid diseases， and the positivity rates of thyroid peroxidase antibody （TPOAb）， thyroglobulin antibody （TGAb）， and thyroid-stimulating hormone receptor antibody （TRAb） among different iodine status groups. Additionally， adverse pregnancy outcomes were compared across groups. Multivariate logistic regression analysis was conducted to identify risk factors associated with iodine abnormalities during pregnancy， and a predictive model was developed to assess its potential predictive value. Results Among the 831 pregnant women included in the study， 373 cases （44.89%） exhibited iodine sufficiency， while 458 cases （55.11%） presented with iodine abnormalities， including 282 cases of iodine deficiency， 144 cases of iodine hypersufficiency， and 32 cases of iodine excess. No statistically significant differences were observed in the iodine nutritional status across different trimesters （P > 0.05）. The serum level of thyroid-stimulating hormone （TSH） was significantly higher in the iodine abnormal group compared to the iodine sufficient group （P < 0.05）. Additionally， the iodine abnormal group demonstrated higher positivity rates of TPOAb alone， TGAb， and TRAb， as well as increased incidence of thyroid dysfunction and total adverse pregnancy outcomes compared to the iodine sufficient group （all P < 0.05）. These adverse indicators were also significantly elevated in the iodine-deficient， iodine super-sufficient， and iodine overdose subgroups compared to the iodine sufficient group （P < 0.05）. Elevated serum TSH levels and the presence of TPOAb， TGAb， and TRAb were identified as risk factors for iodine abnormalities during pregnancy （P < 0.05）. The predictive model constructed for identifying iodine abnormalities in pregnant women demonstrated an area under the curve （AUC） of 0.876， with a sensitivity of 72.27% and a specificity of 89.01%. Conclusions The prevalence of iodine nutritional abnormalities among pregnant women during pregnancy was high， with most cases presenting iodine deficiency. These abnormalities were associated with thyroid function， thyroid autoimmunity， and pregnancy outcomes， but showed no significant correlation with gestational age. Furthermore， the prediction model developed based on identified risk factors demonstrated effective performance in predicting iodine nutritional abnormalities during pregnancy.