Study on the occurrence of gestational diabetes mellitus in first trimester hypothyroid and euthyroid pregnant women
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20254279Keywords:
Anemia, Caesarean section, Gestational diabetes mellitus, Hypothyroidism, Neonatal outcome, Pre-eclampsia, Preterm deliveryAbstract
Background: Hypothyroidism and gestational diabetes mellitus are two common endocrine complications in pregnancy. Individually, contributing to adverse outcomes. With the increase in the prevalence of subclinical hypothyroidism, the risk of the occurrence of gestational diabetes mellitus among pregnant women has increased. Thus, the purpose of this study is to determine the association between hypothyroidism and the subsequent onset of gestational diabetes. Introducing universal thyroid screening in the early stages of pregnancy, along with timely intervention, may help reduce the impact of both conditions on expectant mothers, thereby promoting healthier pregnancies and overall maternal well-being. This study aimed to determine the proportion of pregnant women with gestational diabetes mellitus among first-trimester (0- 12 weeks) hypothyroid and euthyroid pregnant women.
Methods: This is a Prospective study conducted in the Department of OBG, ESIC-PGIMSR Bangalore between April 2023 to October 2024. Pregnant women who registered at the Antenatal OPD during their first visit, including both euthyroid and hypothyroid individuals, were followed up, and the prevalence of gestational diabetes mellitus among them, with maternal and fetal outcomes, has been evaluated.
Results: In our study, the prevalence of GDM in patients with hypothyroidism is found to be 80%, with adverse maternal and fetal outcomes. Thus, the association of GDM with hypothyroidism has an increased risk of preterm delivery (22.5%), severe preeclampsia (10%), gestational hypertension (7.5%), anaemia (30%), placental abruption (5%), and an increased number of caesarean sections (72.5%), with an increased neonatal morbidity.
Conclusions: Early universal screening and timely intervention for hypothyroidism in the first trimester can reduce the subsequent occurrence of gestational diabetes mellitus in later trimesters of pregnancy, with a reduction in the adverse maternal and fetal outcomes.
References
Yadav V, Dabar D, Goel AD, Bairwa M, Sood A, Prasad P, et al. Prevalence of hypothyroidism in pregnant women in India: a meta‐analysis of observational studies. J Thyr Res. 2021;2021(1):5515831.
Divakar H, Singh R, Narayanan P, GVD KB, Hegde A. Dual endocrinopathy-the nexus between hyperglycaemia (gestational diabetes) and hypothyroidism among pregnant women in India. J. Evidence Based Med. Health. 2017;4(61):3658-61.
Prasad BD, Nabanita D, Swagata B. Relationship of gestational diabetes mellitus with hypothyroidism in pregnancy. Sch J App Med Sci. 2015;3(7D):2719-23.
Petca A, Dimcea DA, Dumitrașcu MC, Șandru F, Mehedințu C, Petca RC. Management of hyperthyroidism during pregnancy: a systematic literature review. J Clin Medi. 2023;12(5):1811.
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):171-5.
Al-bayati A, Al-Khateeb S.The effects of thyroid hormones and their abnormalities on intestinal and hepatic glucose metabolism. Sch Int J Biochem. 2021;4:26-36.
Karakosta P, Alegakis D, Georgiou V, Roumeliotaki T, Fthenou E, Vassilaki M, et al. Thyroid dysfunction and autoantibodies in early pregnancy are associated with increased risk of gestational diabetes and adverse birth outcomes. J Clin Endocrinol Metabol. 2012;97(12):4464-72.
Maraka S, Ospina NM, O'Keeffe DT, Espinosa De Ycaza AE, Gionfriddo MR, Erwin PJ, et al. Subclinical hypothyroidism in pregnancy: a systematic review and meta-analysis. Thyroid. 2016;26(4):580-90.
Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, 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):315-89.
Gayam S, Madhurima P, Paul S, Tallavajhula M. The validity of single step test (DIPSI) for screening for GDM in all trimesters of pregnancy. Obs Rev J obstet Gynecol. 2015;1(2):34-38.
Balaji V, Seshiah VJ. Management of diabetes in pregnancy. J Assoc Physic India. 2011;59(1):33-6.
Wang J, Gong XH, Peng T, Wu JN. Association of thyroid function during pregnancy with the risk of pre-eclampsia and gestational diabetes mellitus. Endocr Pract. 2021;27(8):819-25.
Yang S, Shi FT, Leung PC, Huang HF, Fan J. Low thyroid hormone in early pregnancy is associated with an increased risk of gestational diabetes mellitus. J Clin Endocrinol Metabol. 2016;101(11):4237-43.
Fatima SS, Rehman R, Butt Z, Asif Tauni M, Fatima Munim T, Chaudhry B, et al. Screening of subclinical hypothyroidism during gestational diabetes in Pakistani population. J Mater-Fetal Neonat Medi. 2016;29(13):2166-70.
Tirosh D, Benshalom-Tirosh N, Novack L, Press F, Beer-Weisel R, Wiznitzer A, et al. Hypothyroidism and diabetes mellitus–a risky dual gestational endocrinopathy. Peer J. 2013;1:e52.
Parveen H, Durrani AM, Ali SM, Noor N. Association of hypothyroidism in pregnant women with hyperglycaemia. Int J Heal Sci Res. 2019;9(9):325-9.
Amudha P, Manochithra B. Implications of combined endocrinopathy of diabetes mellitus and hypothyroidism on pregnancy. Int J Reprod Contracep Obstetr Gynecol. 2017;6(1):267.
Sahu MT, Das V, Mittal S, Agarwal A, Sahu M. Overt and subclinical thyroid dysfunction among Indian pregnant women and its effect on maternal and fetal outcome. Arch Gynecol Obstetr. 2010;281(2):215-20.