Comparing the fetal and maternal outcomes of dual endocrinopathy with that of isolated gestational diabetes mellitus and hypothyroidism in Indian pregnant women
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20260188Keywords:
Gestational diabetes mellitus, Dual endocrinopathy, Hypothyroidism, Pregnancy outcomeAbstract
Background: Both diabetes mellitus and hypothyroidism are known to cause adverse effects for mother and fetus, however, their combined effect has not been adequately studied in the Indian context. This study aimed to fill that gap.
Methods: A prospective cohort study was conducted with three groups. Group 1 consisted of mothers diagnosed with gestational diabetes mellitus only (n=61), group 2 consisted of hypothyroidism only (n=55) and group 3 consisted of pregnant patients diagnosed with both gestational diabetes mellitus and hypothyroidism (n=35). These three groups were followed up from the time of diagnosis, for up to one week following delivery. The maternal outcomes assessed include premature rupture of membranes, preterm labour and preeclampsia. Fetal outcomes include APGAR scores at 1 minute and 5 minutes, NICU admission and birth weight.
Results: Amongst the three groups, mothers with gestational diabetes mellitus had the highest birth weights of babies (2.99±0.61 kg), followed by dual endocrinopathy group (2.44±0.76 kg) , and lastly, by hypothyroidism group (2.22±0.71 kg). Other outcomes did not have any significant association with type of endocrinopathy.
Conclusions: Pregnant patients diagnosed with hypothyroidism alone have chances of having babies who are small for gestational age whereas the other two groups are likely to have large for gestational age babies. Further studies are required to confirm this finding.
Metrics
References
Tirosh D, Benshalom-Tirosh N, Novack L, Press F, Beer-Weisel R, Wiznitzer A. Hypothyroidism and diabetes mellitus-a risky dual gestational endocrinopathy. Peer J. 2013;1:e52. DOI: https://doi.org/10.7717/peerj.52
Konar H. DC Dutta’s textbook of obstetrics: Including perinatology and contraception. 10th ed. New Delhi, India: Jaypee Brothers Medical; 2023.
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 Thyroid Res. 2021;2021:5515831. DOI: https://doi.org/10.1155/2021/5515831
Barišić T, Mandić V, Vasilj A, Tiric D. Higher levels of thyrotropin in pregnancy and adverse pregnancy outcomes. J Matern Fet Neonat Med. 2019;32(17):2883-8. DOI: https://doi.org/10.1080/14767058.2018.1451509
Groof Z, Garashi G, Husain H, Owayed S, AlBader S, Mouhsen HA, et al. Prevalence, risk factors, and fetomaternal outcomes of gestational diabetes mellitus in Kuwait: a cross‐sectional study. J Diabetes Res. 2019;2019(1):9136250. DOI: https://doi.org/10.1155/2019/9136250
Gupta N, Sharma S, Jamwal S. Prevalence of dual endocrinopathy (hypothyroidism and gestational diabetes mellitus) in patients of preeclampsia. Int J Reprod Contracept Obstet Gynecol. 2019;8:4700-4. DOI: https://doi.org/10.18203/2320-1770.ijrcog20195304
Seshiah V, Das AK, Balaji V, Joshi SR, Parikh MN, Gupta S. Gestational diabetes mellitus-guidelines. JAPI. 2006;54(622).
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. DOI: https://doi.org/10.1089/thy.2016.0457
Paul VK. Ghai essential pediatrics. 9th ed. New Delhi, India: CBS Publishers & Distributors; 2019.
Beta J, Khan N, Fiolna M, Khalil A, Ramadan G, Akolekar R. Maternal and neonatal complications of fetal macrosomia: cohort study. Ultrasound Obstet Gynecol. 2019;54(3):319-25. DOI: https://doi.org/10.1002/uog.20278
Amudha P, Manochithra B. Implications of combined endocrinopathy of diabetes mellitus and hypothyroidism on pregnancy. Int J Reprod Contracept Obstet Gynecol. 2017;6(1):267. DOI: https://doi.org/10.18203/2320-1770.ijrcog20164672
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 Obstet. 2010;281:215-20. DOI: https://doi.org/10.1007/s00404-009-1105-1
Haddow JE, Palomaki GE, Allan WC, Williams JR, Knight GJ, Gagnon J, et al. Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child. N Engl J Med. 1999;341(8):549-55. DOI: https://doi.org/10.1056/NEJM199908193410801
Dhanwal DK, Bajaj S, Rajput R, Subramaniam KAV, Chowdhury S, Bhandari R, et al. Prevalence of hypothyroidism in pregnancy: An epidemiological study from 11 cities in 9 states of India. Indian J Endocrinol Metab. 2016;20(3):387-90. DOI: https://doi.org/10.4103/2230-8210.179992
Ziegler KA, Paul DA, Hoffman M, Locke R. Variation in NICU admission rates without identifiable cause. Hosp Pediatr. 2016;6(5):255-60. DOI: https://doi.org/10.1542/hpeds.2015-0058
Zhuo L, Wang Z, Yang Y, Liu Z, Wang S, Song Y. Obstetric and offspring outcomes in isolated maternal hypothyroxinaemia: a systematic review and meta-analysis. J Endocrinol Investig. 2023;46(6):1087-101. DOI: https://doi.org/10.1007/s40618-022-01967-4
Wakwoya EB, Fita FU. Adverse maternal outcome and its association with gestational diabetes among women who gave birth in selected public hospitals in Eastern Ethiopia. Trop J Obstet Gynecol. 2018;35(1):58-62. DOI: https://doi.org/10.4103/TJOG.TJOG_69_17
Choudhary M, Rathore SB, Chowdhary J, Garg S. Pre and post conception risk factors in PROM. Int J Res Med Sci. 2015;3(10):2594-8. DOI: https://doi.org/10.18203/2320-6012.ijrms20150797
Lokare PO, Karanjekar VD, Gattani PL, Kulkarni AP. A study of prevalence of anemia and sociodemographic factors associated with anemia among pregnant women in Aurangabad city, India. Ann Niger Med. 2012;6(1):30. DOI: https://doi.org/10.4103/0331-3131.100213
Hu CY, Li FL, Jiang W, Hua XG, Zhang XJ. Pre-Pregnancy health status and risk of preterm birth: a large, Chinese, rural, population-based study. Med Sci Monit Int Med J Exp Clin Res. 2018;24:4718. DOI: https://doi.org/10.12659/MSM.908548
Dutta RR, Chhabra P, Kumar T, Joshi A. Tackling anemia in pregnant women in india: reviewing the obstacles and charting a path forward. Cureus. 2023;15(8). DOI: https://doi.org/10.7759/cureus.43123
Hajifoghaha M, Teshnizi SH, Forouhari S, Dabbaghmanesh MH. Association of thyroid function test abnormalities with preeclampsia: a systematic review and meta-analysis. BMC Endocr Disord. 2022;22(1):240. DOI: https://doi.org/10.1186/s12902-022-01154-9
Yang Y, Wu N. Gestational diabetes mellitus and preeclampsia: correlation and influencing factors. Front Cardiovasc Med. 2022;9:831297. DOI: https://doi.org/10.3389/fcvm.2022.831297
Belay AS, Wudad T. Prevalence and associated factors of pre-eclampsia among pregnant women attending anti-natal care at Mettu Karl referal hospital, Ethiopia: cross-sectional study. Clin Hypertens. 2019;25:1-8. DOI: https://doi.org/10.1186/s40885-019-0120-1
Yeagle KP, O’brien JM, Curtin WM, Ural SH. Are gestational and type II diabetes mellitus associated with the Apgar scores of full-term neonates? Int J Women’s Health. 2018:603-7. DOI: https://doi.org/10.2147/IJWH.S170090
Hamm MP, Cherry NM, Martin JW, Bamforth F, Burstyn I. The impact of isolated maternal hypothyroxinemia on perinatal morbidity. J Obstet Gynaecol Canada. 2009;31(11):1015-21. DOI: https://doi.org/10.1016/S1701-2163(16)34345-6
Downloads
Published
How to Cite
Issue
Section
