The relationship between the two endocrine pathologies: subclinical gestational hypothyroidism and gestational diabetes mellitus

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Abstract

BACKGROUND: Over the past decade, gestational diabetes mellitus has become of increasing medical and social importance. It happens due to its increased prevalence and due to its negative impact on pregnancy and long-term metabolic disorders in the mother and fetus.

AIM: The aim of this study was to assess the relationship between subclinical gestational hypothyroidism and gestational diabetes mellitus, the two most common endocrine pathologies in pregnancy.

MATERIALS AND METHODS: We studied 200 medical records of pregnant women. The main group included 133 patients with subclinical gestational hypothyroidism, and the control group consisted of 67 women without endocrine pathology. The diagnosis of gestational diabetes mellitus was made based on the Ministry of Health of the Russian Federation clinical guidelines criteria. The diagnosis of subclinical hypothyroidism was made based on the thyroid-stimulating hormone level above 2.5 μIU/ml in combination with an increased titer of antithyroid antibodies or above 4.0 μIU/ml in the absence of any thyroid disorder. Statistical analysis was carried out using the StatTech v.2.1.0 program (Stattech Ltd, Russia).

RESULTS: The prevalence of hypothyroidism was higher among women with family history of diabetes mellitus. The chances of developing gestational diabetes mellitus increased by 9.706 times in the presence of hypothyroidism, by 1.077 times with an increase in age by one full year at the time of seeing the doctor, and by 1.023 times with an increase in weight before pregnancy by one kilogram. The thyroid-stimulating hormone level of more than 2.7 μIU/ml predicted the development of gestational diabetes mellitus with a sensitivity of 71.4% and a specificity of 63.1%.

CONCLUSIONS: Subclinical gestational hypothyroidism and gestational diabetes mellitus are interrelated endocrine disorders with common pathophysiological predictors. Among women with a normal body mass index, subclinical gestational hypothyroidism is a more significant risk factor for gestational diabetes mellitus than an increase in age or body weight. A certain threshold level of thyroid-stimulating hormone (more than 2.7 μIU/ml) in the first trimester increases the chances of developing gestational diabetes mellitus and should be considered as a signal for timely prevention and detection of gestational diabetes mellitus.

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About the authors

Vera A. Uchamprina

N.E. Bauman City Clinical Hospital No. 29

Email: vera2k@mail.ru
ORCID iD: 0000-0001-5341-4731

MD, Cand. Sci. (Med.)

Russian Federation, Moscow

Ekaterina I. Bobrova

Medical Unit No. 95, Central Medical Unit No. 119 of Russian Federal Biomedical Agency

Email: kekskoffe@yandex.ru
ORCID iD: 0000-0002-0558-2578

MD, Cand. Sci. (Med.)

Russian Federation, Moscow

Nadezhda M. Startseva

Peoples’ Friendship University of Russia

Author for correspondence.
Email: n.startseva@yahoo.com
ORCID iD: 0000-0001-5795-2393
SPIN-code: 3415-3773

MD, Dr. Sci. (Med.), Professor

Russian Federation, Moscow

Andrey S. Anikeev

Peoples’ Friendship University of Russia

Email: keshafike@gmail.com
ORCID iD: 0000-0002-4585-4646
SPIN-code: 3020-0434
Russian Federation, Moscow

Mariya I. Sviridova

N.E. Bauman City Clinical Hospital No. 29

Email: marysadoc@rambler.ru
ORCID iD: 0000-0001-8942-3111

MD, Cand. Sci. (Med.)

Russian Federation, Moscow

References

  1. Jia M, Wu Y, Lin B, et al. Meta-analysis of the association between maternal subclinical hypothyroidism and gestational diabetes mellitus. Int J Gynaecol Obstet. 2019;144(3):239–247. doi: 10.1002/ijgo.12751
  2. Gong LL, Liu H, Liu LH. Relationship between hypothyroidism and the incidence of gestational diabetes: a meta-analysis. Taiwan J Obstet Gynecol. 2016;55(2):171–175. doi: 10.1016/j.tjog.2016.02.004
  3. Urvanova EYu. Chastota patologii shchitovidnoi zhelezy u beremennykh s gestatsionnym sakharnym diabetom. In: Aktual’nye voprosy nauki i obrazovaniya: teoreticheskie i prakticheskie aspekty. Materialy Mezhdunarodnoi (zaochnoi) nauchno-prakticheskoi konferentsii. Ed. by A.I. Vostretsov. Kishinev; 2020. P. 148–151. (In Russ). [cited 2022 Jul 14]. Available from: https://old.ngmu.ru/upload/publication/26584.pdf.
  4. Startseva NM, Sviridova MI, Uchamprina VA, et al. Gestational diabetes mellitus and hypothyroidism: disease comorbidity. Obstetrics and Gynecology: News, Opinions, Training. 2021;9(3):11–16. (In Russ). doi: 10.33029/2303-9698-2021-9-3-11-16
  5. Olina AA, Sadykova GK. Functional state of the thyroid gland during pregnancy: a modern view of the problem. Medical Science and Education of the Urals. 2018;19(2):178–181. (In Russ).
  6. Handisurya A, Pacini G, Tura A, et al. Effects of thyroxine replacement therapy on glucose metabolism in subjects with subclinical and overt hypothyroidism. Clin Endocrinol. 2008;69(6):963–969. doi: 10.1111/j.1365-2265.2008.03280.x
  7. Troshina ЕА, Senyushkina ЕS. Metabolic systemic effects triiodothyronine. The Russian Archives of Internal Medicine. 2020;10(4):262–271. (In Russ). doi: 10.20514/2226-6704-2020-10-4-262-271
  8. Lee SY, Cabral HJ, Aschengrau A, et al. Associations between maternal thyroid function in pregnancy and obstetric and perinatal outcomes. J Clin Endocrinol Metab. 2020;105(5): e2015–e2023. doi: 10.1210/clinem/dgz275
  9. Popova PV, Shilova ES, Tkachuk AS, et al. First trimester thyroid function in pregnant women residing in Saint Petersburg: reference values and risk of gestational diabetes. Diabetes Mellitus. 2018;21(1):34–41. (In Russ). doi: 10.14341/DM9283
  10. Endokrinologiya: natsional’noe rukovodstvo. 2nd ed. Ed. by I.I. Dedov, G.A. Mel’nichenko. Moscow: GEOTAR-Media; 2021. (In Russ).
  11. Blatt AJ, Nakamoto JM, Kaufman HW. National status of testing for hypothyroidism during pregnancy and postpartum. J Clin Endocrinol Metab. 2012;97(3):777–784. doi: 10.1210/jc.2011-2038
  12. Russian Association of Endocrinologists. Gipotireoz: klinicheskie rekomendacii. 2021. (In Russ.). [cited 2022 Jul 15]. Available from: https://legalacts.ru/doc/klinicheskie-rekomendatsii-gipotireoz-utv-minzdravom-rossii/.
  13. Mohammed HSM, AbdElmageed RM. The relationship between type 2 diabetes mellitus and related thyroid diseases. Cureus. 2021;13(12). doi: 10.7759/cureus.20697
  14. Russian Association of Endocrinologists, Rossiiskoe obshchestvo akusherov-ginekologov. Gestatsionnyi sakharnyi diabet. Diagnostika, lechenie, akusherskaya taktika, poslerodovoe nablyudenie: klinicheskie rekomendatsii. 2020. (In Russ). [cited 2022 Jul 15]. Available from: https://rae-org.ru/system/files/documents/pdf/kr_gsd_2020.pdf.
  15. Papysheva OV, Startseva NM, Savenkova IV. The health of infants born to mothers with gestational diabetes mellitus. Doctor.Ru. 2019;7(162):12–18. (In Russ). doi: 10.31550/1727-2378-2019-162-7-12-18
  16. Moen GH, Sommer C, Prasad RB, et al. Mechanisms in endocrinology: epigenetic modifications and gestational diabetes: a systematic review of published literature. Eur J Endocrinol. 2017;176(5):247–267. doi: 10.1530/EJE-16-1017
  17. Domanski G, Lange AE, Ittermann T, et al. Evaluation of neonatal and maternal morbidity in mothers with gestational diabetes: a population-based study. BMC Pregnancy Childbirth. 2018;18(1). doi: 10.1186/s12884-018-2005-9
  18. International Diabetes Federation. IDF diabetes atlas. 10th ed. 2021. [cited 15 Jun 2022]. Available from: https://www.diabetesatlas.org
  19. Zeki R, Oats JJN, Wang AY, et al. Cesarean section and diabetes during pregnancy: an NSW population study using the Robson classify cation. J Obstet Gynaecol Res. 2018;44(5):890–898. doi: 10.1111/jog.13605
  20. Gupta G, Sharma P, Kumar P, et al. Study on subclinical hypothyroidism and its association with various inflammatory markers. J Clin Diagn Res. 2015;9(11). doi: 10.7860/JCDR/2015/14640.6806
  21. Haddow JE, Craig WY, Neveux LM, et al. First and second trimester risk of aneuploidy (faster) research consortium. Free thyroxine during early pregnancy and risk for gestational diabetes. PLoS One. 2016;11(2):e0149065. doi: 10.1371/journal.pone.0149065
  22. Meregaglia M, Dainelli L, Banks H, et al. The short-term economic burden of gestational diabetes mellitus in Italy. BMC Pregnancy Childbirth. 2018;18(1). doi: 10.1186/s12884-018-1689-1
  23. Chaker L, Ligthart S, Korevaar TIM, et al. Thyroid function and risk of type 2 diabetes: a population-based prospective cohort study. BMC Med. 2016; 14(150). doi: 10.1186/s12916-016-0693-4
  24. Grasberger H, Van Sande J, Hag-Dahood Mahameed A, et al. A familial thyrotropin (TSH) receptor mutation provides in vivo evidence that the inositol phosphates/Ca2+ cascade mediates TSH action on thyroid hormone synthesis. J Clin Endocrinol Metab. 2007;92(7):2816–2820. doi: 10.1210/jc.2007-0366
  25. Di Guardo F, Currò JM, Valenti G, et al. Non-pharmacological management of gestational diabetes: The role of myo-inositol. J Complement Integr Med. 2019;17(2). doi: 10.1515/jcim-2019-0111
  26. Tahir F, Majid Z. Inositol supplementation in the prevention of gestational diabetes mellitus. Cureus. 2019;11(9). doi: 10.7759/cureus.5671

Supplementary files

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2. Fig. 1. Analysis of thyroid-stimulating hormone dynamics in the group of patients with subclinical gestational hypothyroidism during therapy

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3. Fig. 2. Odds ratio (OR) estimates with the 95% confidence interval (CI) for the studied predictors of gestational diabetes mellitus

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4. Fig. 3. ROC-curve characterizing the dependence of gestational diabetes mellitus likelihood on the logistic function P

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5. Fig. 4. Analysis of the sensitivity and specificity of the model depending on the logistic function P threshold values

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СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
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СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
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