Comparison of Thyroid Function Tests in Pregnant Women with and without Gestational Diabetes

Abstract

Aim: The aim of this study was to determine whether there were abnormalities in thyroid hormone levels and anti-thyroid peroxidase antibodies in pregnant women with and without gestational diabetes mellitus. Material and Methods: We analyzed the medical records of 107 pregnant women. Clinical data related to maternal age, gestational week, body mass index, thyroid function tests, and anti-thyroid peroxidase antibodies, fasting blood glucose tests and HbA1c levels were obtained. The Pearson chi-square test, the Mann-Whitney U test, independent samples t-test, the Spearman correlation coefficient and Logistic regression model were performed. Results: Gestational diabetes mellitus group was significantly older (p=0.001). Body mass index was statistically different between the two groups (p=0.002). There were statistically significant differences in fasting blood glucose and HbA1c between the two groups (p<0.001 and p=0.004, respectively). The frequency of anti-thyroid peroxidase antibodies was higher in pregnant women with gestational diabetes mellitus, but the result was not statistically significant (p=0.716). Euthyroidism (57.9%) was more prevalent in all patients. While cases of subclinical hypothyroidism were statistically significantly different between gestational diabetes mellitus and non-gestational diabetes mellitus groups (p<0.001), euthyroidism and isolated hypothyroxinemia had no significant differences (p=0.093 and p=0.220, respectively). Our results suggest that pregnant women with subclinical hypothyroidism are 5.5 times more likely to be gestational diabetes mellitus. Conclusion: Subclinical hypothyroidism during pregnancy was detected more frequently in women with gestational diabetes mellitus than in women without gestational diabetes mellitus. Taken together, women with GDM should be performed thyroid tests and anti TPO routinely.

Keywords

• Gestational diabetes mellitus
• Hypothyroidism
• Anti-thyroid peroxidase antibodies

Project Number

yok

Gestasyonel Diyabetli ve Gestasyonel Diyabet Olmayan Gebelerde Tiroid Fonksiyon Testlerinin Karşılaştırılması

Abstract

Amaç: Bu çalışmanın amacı, gestasyonel diyabeti olan ve olmayan gebelerde tiroid hormon düzeylerinde ve anti-tiroid peroksidaz antikorlarında farklılık olup olmadığını belirlemektir. Gereç ve Yöntemler: 107 gebe kadının tıbbi kayıtlarını incelendi. Anne yaşı, gebelik haftası, vücut kütle indeksi, tiroid fonksiyon testleri ve antitiroid peroksidaz antikorları, açlık kan şekeri testleri ve HbA1c düzeyleri ile ilgili klinik veriler elde edildi. Pearson ki-kare testi, Mann-Whitney U testi ve bağımsız örnekler t testi, Spearman korelasyon katsayısı ve lojistik regresyon modeli uygulandı Bulgular: Gestasyonel diyabet grubu anlamlı olarak daha yaşlıydı (p=0,001). Vücut kütle indeksi iki grup arasında istatistiksel olarak farklıydı (p=0,002). İki grup arasında açlık kan şekeri ve HbA1c açısından istatistiksel olarak anlamlı farklılıklar vardı (sırasıyla p<0,001 ve p=0,004). Gestasyonel diyabetli gebelerde anti-tiroid peroksidaz antikorları sıklığı daha yüksekti, ancak istatistiksel olarak anlamlı farklılık yoktu (p=0,716). Ötiroidizm (%57,9) tüm hastalarda daha yaygındı. Subklinik hipotiroidi olguları GDM’li olan ve olmayan gruplar arasında istatistiksel olarak anlamlı farklılık gösterirken (p<0,001), ötiroidizm ve izole hipotiroksinemi arasında anlamlı fark bulunmadı (sırasıyla p=0,093 ve p=0,220). Sonuçlarımız subklinik hipotiroidizmi olan gebelerin gestasyonel diyabet olma olasılığının 5,5 kat daha fazla olduğunu göstermektedir. Sonuç: Gestasyonel diyabetli kadınlarda gebelikteki subklinik hipotiroidizm gestasyonel diyabetli olmayan kadınlardan daha sık saptanmıştır. Gestasyonel diyabetli kadınlara rutin olarak tiroid testleri yapılmalı ve anti-tiroid peroksidaz antikorlarına bakılmalıdır

Keywords

• gestasyonel diyabet
• hipotiroidizm
• anti tiroid peroksidaz antikorları

Supporting Institution

yok

Project Number

yok

Thanks

Ahmet Topaçoğlu'na dil kontrolü için teşekkür ederiz

References

1. 1. Wei Y et al. International Association of Diabetes and Pregnancy Study Group criteria is suitable for gestational diabetes mellitus diagnosis: further evidence from China. Chin Med J (Engl). 2014;127(20):3553-3556.
2. 2. Li X et al. Association between thyroid function and risk of gestational diabetes mellitus in assisted pregnancies: A retrospective cohort study. Diabetes Res Clin Pract. 2021;171:108590.
3. 3. Ethridge JK et al. Perinatal outcomes associated with the diagnosis of gestational diabetes made by the international association of the diabetes and pregnancy study groups criteria. Obstet Gynecol. 2014;124(3):571-578.
4. 4. Alwan N et al. Treatments for gestational diabetes. Cochrane Database Syst Rev. 2009(3):CD003395.
5. 5. Konar H et al. Association of Thyroid Dysfunction and Autoimmunity in Pregnant Women with Diabetes Mellitus. J Obstet Gynaecol India. 2018;68(4):283-288.
6. 6. Negro R; Mestman JH. Thyroid disease in pregnancy. Best Pract Res Clin Endocrinol Metab. 2011;25(6):927-943. 7. Diéguez M et al. Prevalence of thyroid dysfunction in women in early pregnancy: does it increase with maternal age? Clin Endocrinol (Oxf). 2016;84(1):121-126.
7. 8. Lambadiari V et al. Thyroid hormones are positively associated with insulin resistance early in the development of type 2 diabetes. Endocrine. 2011;39(1):28-32.
8. 9. Jia M et al. Meta-analysis of the association between maternal subclinical hypothyroidism and gestational diabetes mellitus. Int J Gynaecol Obstet. 2019;144(3):239-247.

9. 10. Maleki N; Tavosi Z. Evaluation of thyroid dysfunction and autoimmunity in gestational diabetes mellitus and its relationship with postpartum thyroiditis. Diabet Med. 2015;32(2):206-12.
10. 11. Tudela CM et al. Relationship of subclinical thyroid disease to the incidence of gestational diabetes. Obstet Gynecol. 2012;119(5):983-988.
11. 12. Huang K et al. Isolated effect of maternal thyroid-stimulating hormone, free thyroxine and antithyroid peroxidase antibodies in early pregnancy on gestational diabetes mellitus: a birth cohort study in China. Endocr J. 2019;66(3):223-231.
12. 13. Olivieri A et al. High frequency of antithyroid autoantibodies in pregnant women at increased risk of gestational diabetes mellitus. Eur J Endocrinol. 2000;143(6):741-747.
13. 14. Yang S et al. Low Thyroid Hormone in Early Pregnancy Is Associated With an Increased Risk of Gestational Diabetes Mellitus. J Clin Endocrinol Metab. 2016;101(11):4237-4243.
14. 15. Fatima SS et al. Screening of subclinical hypothyroidism during gestational diabetes in Pakistani population. J Matern Fetal Neonatal Med. 2016;29(13):2166-2170.
15. 16. Karakosta P et al. Thyroid dysfunction and autoantibodies in early pregnancy are associated with increased risk of gestational diabetes and adverse birth outcomes. J Clin Endocrinol Metab. 2012;97(12):4464-4472.
16. 17. Yang Y et al. Thyroid antibodies and gestational diabetes mellitus: a meta-analysis. Fertil Steril. 2015;104(3):665-671.e3.
17. 18. Association AD. 2. Classification and Diagnosis of Diabetes:. Diabetes Care. 2020;43(Suppl 1):S14-S31.
18. 19. Hod M et al. The International Federation of Gynecology and Obstetrics (FIGO) Initiative on gestational diabetes mellitus: A pragmatic guide for diagnosis, management, and care. Int J Gynaecol Obstet. 2015;131 Suppl 3:S173-211.
19. 20. Metzger BE et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010;33(3):676-682.
20. 21. Marwaha RK et al. Establishment of reference range for thyroid hormones in normal pregnant Indian women. BJOG. 2008;115(5):602-606.
21. 22. De Groot L et al. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2012;97(8):2543-2565.
22. 23. Alexander EK et al. 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid. 2017;27(3):315-389.
23. 24. Catalano PM. Trying to understand gestational diabetes. Diabet Med. 2014;31(3):273-81.
24. 25. Montaner P et al. Is thyroid autoimmunity associated with gestational diabetes mellitus? Metabolism. 2008;57(4):522-525.
25. 26. Safian S et al. Thyroid Dysfunction in Pregnant Women with Gestational Diabetes Mellitus. Curr Diabetes Rev. 2020;16(8):895-899.
26. 27. Toulis KA et al. Maternal subclinical hypothyroidsm and gestational diabetes mellitus: a meta-analysis. Endocr Pract. 2014;20(7):703-714.
27. 28. Shahid MM et al. Association of gestational diabetes mellitus and thyroid status during pregnancy: a cross-sectional study in a tertiary health care center of Bangladesh. Gynecol Endocrinol. 2020:1-7.
28. 29. Hornnes PJ et al. Glucose tolerance and incidence of pancreatic islet cell antibodies in pregnancy in women with thyroid autoantibodies. Horm Metab Res. 1991;23(3):122-125.
29. 30. Vandana et al. Thyroid dysfunction during pregnancy and in postpartum period: treatment and latest recommendations. Arch Gynecol Obstet. 2014;289(5):1137-1144.
30. 31. Das DK et al. Thyroid hormone regulation of beta-adrenergic receptors and catecholamine sensitive adenylate cyclase in foetal heart. Acta Endocrinol (Copenh). 1984;106(4):569-576.