An immunological and genetic study of patients with gestational diabetes mellitus

Lapolla, Annunziata; Betterle, Corrado; Sanzari, M.; Zanchetta, R.; Pfeifer, Eric A.; Businaro, A; Fagiolo, U; Plebani, Mario; Marini, Stefania; Photiou, E.; Fedele, Domenico

doi:10.1007/bf00569424

Cited by 28 publications

(25 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, despite the high prevalence of ThyAb in the 181 women at risk of GDM, no increased ThyAb frequency (10.5%) was found in the subgroup of pregnant women developing GDM. These results confirm the finding of Lapolla et al (9) of a low prevalence of ThyAb in a group of patients with GDM who were tested for several organ-specific autoantibodies during the third trimester of pregnancy. Our findings suggest that it is not impaired glucose tolerance itself but rather a family history of diabetes mellitus that represents a risk factor for the presence of ThyAb in pregnancy.…”

Section: Discussionsupporting

confidence: 91%

See 1 more Smart Citation

High frequency of antithyroid autoantibodies in pregnant women at increased risk of gestational diabetes mellitus

Olivieri

Valensise

Magnani

et al. 2000

European Journal of Endocrinology

View full text Add to dashboard Cite

Background: Thyroid autoantibodies (ThyAb) and subclinical hypothyroidism occur more frequently in pregnant women with insulin-dependent diabetes mellitus than in healthy pregnant women. Few studies have investigated the presence of ThyAb in women with gestational diabetes mellitus (GDM), and no significant association between diabetes in pregnancy and thyroid function has been reported. Objective: To assess the thyroid biochemical profile and estimate the prevalence of ThyAb in a group of pregnant women at increased risk of GDM due to family and personal risk factors, and to investigate the relationship between a positive family history of diabetes or thyroid diseases and the eventual presence of ThyAb during pregnancy. Methods: Oral glucose tolerance, serum ThyAb and thyroid function were evaluated in 181 pregnant women with increased risk for GDM (study group). Seventeen healthy pregnant women without risk factors for GDM and with a normal glucose tolerance were recruited as controls. Results: The women who developed GDM showed a mean free thyroxine concentration significantly lower than that observed in the healthy pregnant women and in those with impaired gestational glucose tolerance and normal glucose tolerance. Twenty-nine of the 181 women in the study group (16%) were ThyAb positive. However, the risk of being ThyAb positive during pregnancy was three times greater in the women with positive family history of both diabetes mellitus and thyroid disease than in those with no family history of these conditions. Conclusions: This study showed that women with increased risk of GDM, mostly those with family history of diabetes mellitus and thyroid disease, also have an increased risk of being ThyAb positive during pregnancy. It also highlighted the importance of evaluating thyroid function in pregnant women with impaired glucose tolerance, in view of their increased risk of subclinical hypothyroidism.

show abstract

Section: Discussionsupporting

confidence: 91%

“…As regards gestational diabetes mellitus (GDM), various non-organ-specific autoantibodies have been found to be associated with the condition (7). However, few studies have investigated the presence of ThyAb in women with GDM, and no significant association between diabetes in pregnancy and thyroid function has been reported (8,9).…”

Section: Introductionmentioning

confidence: 99%

High frequency of antithyroid autoantibodies in pregnant women at increased risk of gestational diabetes mellitus

Olivieri

Valensise

Magnani

et al. 2000

European Journal of Endocrinology

View full text Add to dashboard Cite

show abstract

“…Antibody positivity was, furthermore, associated with a low BMI. The frequency of ICAs found in this study lies within the prevalence range of 1.6-12.4% previously reported by others (6,7,(24)(25)(26)(27)30), using standardized immunofluorescence techniques. As for GADAs, the prevalence in the GDM-A subgroup (5.4%) was similar, compared with a Caucasian GDM-A population from Spain (6%) (28), but higher, compared with two GDM-A populations from Denmark (2.2%) (29) and Northern Italy (0%) (27).…”

Section: Discussionsupporting

confidence: 61%

“…In contrast, the risk was low for positivity of GADAs plus IA2As in the absence of ICAs (22%). Previous studies that found an association of ICA or GADA positivity during pregnancy with subsequent development of type 1 diabetes reported risks for type 1 diabetes, ranging widely from 10 to 60% 5-12 months postpartum (6,7,17,25,26), the variability of which may be explained by the very low number of women (<5) followed postpartum in all (6,7,17,26) but one (25) of these studies.…”

Section: Discussionmentioning

confidence: 92%

Prediction of Type 1 Diabetes Postpartum in Patients With Gestational Diabetes Mellitus by Combined Islet Cell Autoantibody Screening: A Prospective Multicenter Study

et al. 1997

View full text Add to dashboard Cite

Women with gestational diabetes mellitus (GDM) have a considerable risk of developing diabetes later in life. To determine the predictive value of autoantibody markers in gestational diabetic pregnancy for the development of type 1 diabetes postpartum, we tested 437 patients with GDM (289 women treated with diet only [GDM-A] and 148 requiring insulin treatment during pregnancy [GDM-B]) for antibodies to islet cells (ICAs), GAD (GADAs), and tyrosine phosphatase ICA512/IA-2 (IA2As). We prospectively followed them with repeated oral glucose tolerance tests and antibody determinations for up to 7 years postpartum (mean, 1.6 years; range, 0-7.2 years). The cumulative risk of diabetes up to 5 years postpartum was 17% (95% CI 12-22%). The risk of type 1 diabetes was 3% (2-5%) by 9 months and 7% (4-9%) 2 years after delivery. At delivery, 8.5% of all patients were ICA+, 9.5% were GADA+, 6.2% were IA2A+, and 18.1% were positive for at least one antibody (12.6% for GDM-A vs. 30.4% for GDM-B, P < 0.0001). During follow-up, GADAs persisted in 75%, ICAs in 35%, and IA2As in 30% of the subjects positive for the respective marker at delivery. By 2 years postpartum, 29% (19-39%) of patients positive for at least one antibody developed type 1 diabetes, compared with 2% (1-4%) of antibody-negative patients (P < 0.0001). Thereby, the risk for type 1 diabetes 2 years postpartum increased with the number of antibodies present at delivery from 17% (6-28%) for one antibody, to 61% (30-91%) for two antibodies, and to 84% (55-100%) for 3 antibodies. Risk of progression to type 1 diabetes postpartum was also associated with the status of parity. Women with one or more pregnancies before the index pregnancy had a higher risk for type 1 diabetes 2 years after delivery (14.7% [4.9.-24.5%]) than women having their first (i.e., index) pregnancy (5% [2.9-7.1%]) (P < 0.006). A comparison of different prediction strategies showed that single antibody screening with GADA yielded the highest sensitivity of 63% (45-75%), compared with ICA (48% [31-65%]) and IA2A (34% [13-47%]). Combined screening with two autoantibodies increased sensitivity to 74% (58-90%) and 75% (60-92%) when using GADA plus ICA or GADA plus IA2A, respectively. Screening with all three markers improved sensitivity further to 82% (67-100%). Beta-cell autoantibodies determined at delivery in women with GDM are highly predictive for the development of type 1 diabetes postpartum. Autoantibody screening in pregnant women with GDM from populations at high risk for type 1 diabetes should therefore be considered to allow early diagnosis and appropriate therapy.

show abstract

“…Two other studies have shown similar results [6,14]. Olivieri and colleagues [6] found that women who were at higher risk for GDM and with a positive family history of DM had a higher frequency of ATA, and not the women with GDM.…”

Section: Discussionmentioning

confidence: 59%

Thyroid function abnormalities and antithyroid antibody prevalence in pregnant women at high risk for gestational diabetes mellitus

Agarwal

Dhatt

Punnose

et al. 2006

Gynecological Endocrinology

View full text Add to dashboard Cite

Both gestational diabetes mellitus (GDM) and thyroid dysfunction in pregnancy compromise maternal and fetal health. The aim of the present study was to determine the prevalence of abnormal thyroid function and antithyroid antibodies during early pregnancy in a population at high risk for GDM. Serum free triiodothyronine (FT3), free thyroxine (FT4) and thyroid-stimulating hormone (TSH) were measured in 301 pregnant women who underwent routine 'universal screening' for GDM. The antithyroid peroxidase antibody (antiTPOAb) was also quantified in 255 of these women. GDM was confirmed by a 75-g oral glucose tolerance test using World Health Organization criteria. No statistically significant difference was found between the 80 (26.6%) women with GDM and the 221 (73.4%) women without GDM for any of the thyroid function tests. In the cohort tested for antiTPOAb, the 51 (20.0%) women who were positive for antiTPOAb had higher mean TSH (1.57 +/- 2.49 mIU/l; p < 0.001) than the women negative for antiTPOAb. Seventeen (5.6%) women had low FT4 while 12 (4.0%) women had high TSH; 28 (9.3%) women had low serum TSH, among whom three (1.0%) also had high FT4. The significantly higher prevalence of hypothyroxinemia and antiTPOAb titers than generally reported warrants routine screening for thyroid abnormalities. This screening, which can be effectively and easily incorporated into screening practices already in place for GDM, would result in improved obstetric care.

show abstract

An immunological and genetic study of patients with gestational diabetes mellitus

Cited by 28 publications

References 30 publications

High frequency of antithyroid autoantibodies in pregnant women at increased risk of gestational diabetes mellitus

High frequency of antithyroid autoantibodies in pregnant women at increased risk of gestational diabetes mellitus

Prediction of Type 1 Diabetes Postpartum in Patients With Gestational Diabetes Mellitus by Combined Islet Cell Autoantibody Screening: A Prospective Multicenter Study

Thyroid function abnormalities and antithyroid antibody prevalence in pregnant women at high risk for gestational diabetes mellitus

Contact Info

Product

Resources

About