Low Thyroid Hormone in Early Pregnancy Is Associated With an Increased Risk of Gestational Diabetes Mellitus

Sm, Yang; Shi, Fanhuai; Leung, Peter C.K.; Huang, He; Fan, Jianxia

doi:10.1210/jc.2016-1506

Cited by 96 publications

(87 citation statements)

References 40 publications

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“…Similar findings have been described by Tudela et al . and more recently by Yang et al., who showed this association between GDM and FT4. Whether this finding indicates that elevated TSH levels may contribute to increased insulin resistance and thereby to the development of GDM has yet to be determined.…”

Section: Discussionsupporting

confidence: 92%

Low thyroid‐stimulating hormone and its persistence beyond the first trimester of pregnancy

Fraenkel

Shafat

Cahn³

et al. 2018

Intl J Gynecology & Obste

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Section: Discussionsupporting

confidence: 92%

Low thyroid‐stimulating hormone and its persistence beyond the first trimester of pregnancy

Fraenkel

Shafat

Cahn³

et al. 2018

Intl J Gynecology & Obste

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“…GDM and Type 2 diabetes have risk factors and pathogenesis in common, so it is reasonable to propose that women with either elevated or lower thyroid hormones levels would be prone to develop GDM. Similarly, there is still a lack of consistency in the relationship between TSH levels and GDM risk . Our results are in line with the study by Chaker et al ., which showed that higher TSH and lower free T 4 were related to an increased Type 2 diabetes risk among 8452 participants in the Rotterdam Study .…”

Section: Discussionmentioning

confidence: 91%

Higher thyroid‐stimulating hormone levels in the first trimester are associated with gestational diabetes in a Chinese population

Leng

Wang

et al. 2019

Diabet. Med.

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Aim To evaluate the relationship between maternal thyroid‐stimulating hormone levels during the first trimester and gestational diabetes risk. Methods In Tianjin, China, 7258 women underwent a thyroid‐stimulating hormone screening test within 12 gestational weeks and then had a glucose challenge test at 24–28 weeks of gestational age. The women with a glucose challenge test ≥7.8 mmol/l underwent a 75 g oral glucose tolerance test. Gestational diabetes was diagnosed following International Association of Diabetes and Pregnancy Study Group criteria. Restricted cubic spline analysis was performed to explore full‐range risk associations of thyroid‐stimulating hormone levels with gestational diabetes. Logistic regression was performed to obtain odds ratios and 95% confidence intervals. Results In all, 594 women (8.2%) had gestational diabetes. Among women with thyroid‐stimulating hormone ≤3.2 mIU/l, a positive association between thyroid‐stimulating hormone levels and gestational diabetes risk was found (adjusted OR: 1.13, 95% CI: 1.00–1.27). There was no relationship between thyroid‐stimulating hormone levels and gestational diabetes risk in univariable and multivariable analyses among women with thyroid‐stimulating hormone >3.2 mIU/l. In subgroup analyses, among women with thyroid‐stimulating hormone ≤3.2 mIU/l and BMI ≥25 kg/m2, the adjusted odds ratio for thyroid‐stimulating hormone levels with gestational diabetes was enhanced to 1.25 (95% CI: 1.02–1.53). Conclusions In pregnant Chinese women, thyroid‐stimulating hormone levels even within normal range in the first trimester were positively related to gestational diabetes risk, especially for pre‐pregnancy overweight/obese women.

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“…In‐vitro and in‐vivo experiments have shown that insulin resistance in SCH may be caused by a decrease in peripheral insulin response resulting from excessive glucose–fatty acid cycling, which impairs the ability of insulin to increase blood flow rate to insulin‐sensitive tissues . Although a large‐sample retrospective study conducted by Yang et al . implied no predictive ability of maternal TSH and TPO‐Ab on GDM risk, it is theoretically reasonable that insulin resistance produced by pregnancy‐specific pathological changes and SCH predispose an increased risk of GDM.…”

Section: Discussionmentioning

confidence: 99%

Meta‐analysis of the association between maternal subclinical hypothyroidism and gestational diabetes mellitus

Jia

Lin

et al. 2019

Intl J Gynecology & Obste

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Background Subclinical hypothyroidism (SCH) and gestational diabetes mellitus (GDM) are common endocrine disorders that occur during pregnancy. Objective To determine whether the risk of GDM differs between pregnant women with normal thyroid function and those with SCH. Search strategy MEDLINE, EMBASE, the Cochrane Library, and Web of Science were searched for studies published in English from inception to March 1, 2017, using combinations of the search terms “thyroid dysfunction”, “thyroid diseases”, “subclinical hypothyroidism”, “hypothyroxinemia”, “thyrotropin”, “gestational diabetes”, “hyperglycemia in pregnancy”, and “adverse pregnancy outcomes”. Selection criteria We selected cohort studies that included pregnant women with SCH; in which the outcome of interest was, or included, the incidence of GDM; and that had data available for both the SCH and GDM groups. Studies were excluded if assisted reproductive technologies were used to achieve pregnancy; reviews, abstracts, and case reports were also excluded. Data collection and analysis Eleven studies were included in the analysis. Summary odds ratios (ORs) for the risk of GDM were calculated. Main results SCH with positive antithyroid autoantibodies markedly increased GDM risk (OR 3.22, 95% confidence interval 1.72–6.03, I2=55%). Conclusion SCH with positive antithyroid autoantibodies in pregnancy is associated with an increased risk of GDM.

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Low Thyroid Hormone in Early Pregnancy Is Associated With an Increased Risk of Gestational Diabetes Mellitus

Abstract: Low thyroid hormone levels in early pregnancy are a risk factor for GDM incidence.

Cited by 96 publications

References 40 publications

Low thyroid‐stimulating hormone and its persistence beyond the first trimester of pregnancy

Low thyroid‐stimulating hormone and its persistence beyond the first trimester of pregnancy

Higher thyroid‐stimulating hormone levels in the first trimester are associated with gestational diabetes in a Chinese population

Meta‐analysis of the association between maternal subclinical hypothyroidism and gestational diabetes mellitus

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