甲状腺功能减退症和妊娠期糖尿病:有关系吗?

IF 0.2 Q4 MEDICINE, GENERAL & INTERNAL
V. Uchamprina, E. I. Bobrova, Violetta V. Kandalina, M. I. Sviridova, O. A. Ulyanova
{"title":"甲状腺功能减退症和妊娠期糖尿病:有关系吗?","authors":"V. Uchamprina, E. I. Bobrova, Violetta V. Kandalina, M. I. Sviridova, O. A. Ulyanova","doi":"10.15275/rusomj.2022.0210","DOIUrl":null,"url":null,"abstract":"Background and Objective — Subclinical gestational hypothyroidism (SGH) and gestational diabetes mellitus (GDM) constitute two most common endocrine pathologies encountered during pregnancy. SGH and GDM have common pathophysiological mechanisms, being interrelated pathological conditions that are capable of complicating the course of pregnancy, labor and the postpartum period both on the part of the mother and on the part of the fetus. We aimed to analyze the relationship between these pathologies and to assess the risk of developing GDM against the background of hypothyroidism. Materials and Methods — the study included 200 pregnant women observed at the Perinatal Center of the Maternity Hospital the Bauman State Clinical Hospital No. 29 during 2018-2020. The main group consisted of 133 women who visited the perinatal center for hypothyroidism (both SGH and primary hypothyroidism, detected prior to pregnancy); the control group comprised 67 women without endocrine pathology. Both groups were comparable in terms of age, height, weight, and the number of pregnancies in the anamneses. The main group received levothyroxine sodium therapy with the achievement of the target trimester-specific level of thyroid-stimulating hormone (TSH). The criteria for the diagnosis of SGH were the TSH level above 2.5 μIU/mL in combination with an enlarged titer of antithyroid antibodies and/or a burdened medical history of thyroid pathology, or the TSH level above 4.0 μIU/mL in the absence of antithyroid antibodies [1]. The diagnosis of GDM was established on the basis of fasting hyperglycemia (≥5.1 mmol/L), or based on the results of an oral glucose tolerance test (OGTT) with 75 g of glucose: fasting glucose level of ≥5.1 mmol/L; the concentration 1 hour after glucose intake ≥10.0 mmol/L; the content 2 hours after glucose intake ≥8.5 mmol/l) [2]. In both groups, the frequency of developing GDM, the timing of diagnosis, and the need for insulin therapy were evaluated. Statistical data processing was carried out using the StatTech v. 2.1.0 software. Quantitative indicators were assessed for compliance with the normal distribution via Shapiro-Wilk criterion or Kolmogorov-Smirnov criterion. Intergroup comparison was performed using Mann-Whitney U test or Pearson’s chi-squared test. Results — We discovered that among women with a burdened family history of thyroid pathology and diabetes mellitus, as well as with thyroid pathology prior to pregnancy, the prevalence of hypothyroidism was higher. The presence of thyroid pathology in the anamnesis of pregnant women was associated with an earlier diagnosis of hypothyroidism. We revealed a significant difference in the prevalence of GDM between two groups of subjects. The chances of detecting GDM in the hypothyroidism group were 8.6 times higher than in the euthyroidism group. The threshold level of TSH for the first trimester, predicting the development of GDM, was identified. The sensitivity and specificity of the model were 71.4% and 63.1%, respectively. Conclusion — Hypofunction of the thyroid and GDM are interrelated endocrine pathologies. In the presence of hypothyroidism (both primary and SGH), GDM develops significantly more often. The level of TSH in the first trimester ≥2.7 μIU/mL amplifies the chance of developing GDM by over 8 times; hence, it could be considered a signal for timely prevention and detection of this pathology.","PeriodicalId":21426,"journal":{"name":"Russian Open Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.2000,"publicationDate":"2022-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"1","resultStr":"{\"title\":\"Hypothyroidism And Gestational Diabetes Mellitus: Is There A Relationship?\",\"authors\":\"V. Uchamprina, E. I. Bobrova, Violetta V. Kandalina, M. I. Sviridova, O. A. Ulyanova\",\"doi\":\"10.15275/rusomj.2022.0210\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Background and Objective — Subclinical gestational hypothyroidism (SGH) and gestational diabetes mellitus (GDM) constitute two most common endocrine pathologies encountered during pregnancy. SGH and GDM have common pathophysiological mechanisms, being interrelated pathological conditions that are capable of complicating the course of pregnancy, labor and the postpartum period both on the part of the mother and on the part of the fetus. We aimed to analyze the relationship between these pathologies and to assess the risk of developing GDM against the background of hypothyroidism. Materials and Methods — the study included 200 pregnant women observed at the Perinatal Center of the Maternity Hospital the Bauman State Clinical Hospital No. 29 during 2018-2020. The main group consisted of 133 women who visited the perinatal center for hypothyroidism (both SGH and primary hypothyroidism, detected prior to pregnancy); the control group comprised 67 women without endocrine pathology. Both groups were comparable in terms of age, height, weight, and the number of pregnancies in the anamneses. The main group received levothyroxine sodium therapy with the achievement of the target trimester-specific level of thyroid-stimulating hormone (TSH). The criteria for the diagnosis of SGH were the TSH level above 2.5 μIU/mL in combination with an enlarged titer of antithyroid antibodies and/or a burdened medical history of thyroid pathology, or the TSH level above 4.0 μIU/mL in the absence of antithyroid antibodies [1]. The diagnosis of GDM was established on the basis of fasting hyperglycemia (≥5.1 mmol/L), or based on the results of an oral glucose tolerance test (OGTT) with 75 g of glucose: fasting glucose level of ≥5.1 mmol/L; the concentration 1 hour after glucose intake ≥10.0 mmol/L; the content 2 hours after glucose intake ≥8.5 mmol/l) [2]. In both groups, the frequency of developing GDM, the timing of diagnosis, and the need for insulin therapy were evaluated. Statistical data processing was carried out using the StatTech v. 2.1.0 software. Quantitative indicators were assessed for compliance with the normal distribution via Shapiro-Wilk criterion or Kolmogorov-Smirnov criterion. Intergroup comparison was performed using Mann-Whitney U test or Pearson’s chi-squared test. Results — We discovered that among women with a burdened family history of thyroid pathology and diabetes mellitus, as well as with thyroid pathology prior to pregnancy, the prevalence of hypothyroidism was higher. The presence of thyroid pathology in the anamnesis of pregnant women was associated with an earlier diagnosis of hypothyroidism. We revealed a significant difference in the prevalence of GDM between two groups of subjects. The chances of detecting GDM in the hypothyroidism group were 8.6 times higher than in the euthyroidism group. The threshold level of TSH for the first trimester, predicting the development of GDM, was identified. The sensitivity and specificity of the model were 71.4% and 63.1%, respectively. Conclusion — Hypofunction of the thyroid and GDM are interrelated endocrine pathologies. In the presence of hypothyroidism (both primary and SGH), GDM develops significantly more often. The level of TSH in the first trimester ≥2.7 μIU/mL amplifies the chance of developing GDM by over 8 times; hence, it could be considered a signal for timely prevention and detection of this pathology.\",\"PeriodicalId\":21426,\"journal\":{\"name\":\"Russian Open Medical Journal\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.2000,\"publicationDate\":\"2022-06-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"1\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Russian Open Medical Journal\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.15275/rusomj.2022.0210\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Russian Open Medical Journal","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.15275/rusomj.2022.0210","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 1

摘要

背景与目的-亚临床妊娠期甲状腺功能减退症(SGH)和妊娠期糖尿病(GDM)是妊娠期最常见的两种内分泌疾病。SGH和GDM具有共同的病理生理机制,是相互关联的病理状况,可使母亲和胎儿的妊娠、分娩和产后过程复杂化。我们的目的是分析这些病理之间的关系,并评估在甲状腺功能减退的背景下发生GDM的风险。材料和方法:该研究包括2018-2020年期间在鲍曼州立临床医院第29号妇产医院围产期中心观察的200名孕妇。主要组包括133名因甲状腺功能减退(妊娠前发现的SGH和原发性甲状腺功能减退)到围产期中心就诊的妇女;对照组为67例无内分泌病理的妇女。两组在年龄、身高、体重和怀孕次数方面具有可比性。主组在达到目标促甲状腺激素(TSH)妊娠特异性水平后接受左旋甲状腺素钠治疗。诊断SGH的标准是TSH水平高于2.5 μIU/mL,并伴有抗甲状腺抗体滴度增高和/或有沉重的甲状腺病理病史,或TSH水平高于4.0 μIU/mL,但无抗甲状腺抗体[1]。根据空腹高血糖(≥5.1 mmol/L)或75 g葡萄糖口服葡萄糖耐量试验(OGTT)结果确定GDM的诊断:空腹血糖水平≥5.1 mmol/L;葡萄糖摄入1小时后浓度≥10.0 mmol/L;葡萄糖摄入后2小时含量≥8.5 mmol/l)[2]。在两组中,评估发生GDM的频率、诊断时间和胰岛素治疗的必要性。统计数据处理采用StatTech v. 2.1.0软件。采用Shapiro-Wilk标准或Kolmogorov-Smirnov标准评价定量指标是否符合正态分布。组间比较采用Mann-Whitney U检验或Pearson卡方检验。结果:我们发现,有甲状腺病理和糖尿病家族史的女性,以及怀孕前有甲状腺病理的女性,甲状腺功能减退的患病率更高。在孕妇的记忆中,甲状腺病理的存在与甲状腺功能减退的早期诊断有关。我们发现两组受试者之间GDM患病率有显著差异。甲减组GDM的检出率是甲亢组的8.6倍。确定了妊娠早期TSH的阈值水平,预测GDM的发展。该模型的敏感性为71.4%,特异性为63.1%。结论:甲状腺功能减退与GDM是相互关联的内分泌病变。在存在甲状腺功能减退(原发性和SGH)的情况下,GDM的发展明显更频繁。妊娠早期TSH水平≥2.7 μIU/mL可使发生GDM的几率增加8倍以上;因此,它可以被认为是及时预防和发现这种病理的信号。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Hypothyroidism And Gestational Diabetes Mellitus: Is There A Relationship?
Background and Objective — Subclinical gestational hypothyroidism (SGH) and gestational diabetes mellitus (GDM) constitute two most common endocrine pathologies encountered during pregnancy. SGH and GDM have common pathophysiological mechanisms, being interrelated pathological conditions that are capable of complicating the course of pregnancy, labor and the postpartum period both on the part of the mother and on the part of the fetus. We aimed to analyze the relationship between these pathologies and to assess the risk of developing GDM against the background of hypothyroidism. Materials and Methods — the study included 200 pregnant women observed at the Perinatal Center of the Maternity Hospital the Bauman State Clinical Hospital No. 29 during 2018-2020. The main group consisted of 133 women who visited the perinatal center for hypothyroidism (both SGH and primary hypothyroidism, detected prior to pregnancy); the control group comprised 67 women without endocrine pathology. Both groups were comparable in terms of age, height, weight, and the number of pregnancies in the anamneses. The main group received levothyroxine sodium therapy with the achievement of the target trimester-specific level of thyroid-stimulating hormone (TSH). The criteria for the diagnosis of SGH were the TSH level above 2.5 μIU/mL in combination with an enlarged titer of antithyroid antibodies and/or a burdened medical history of thyroid pathology, or the TSH level above 4.0 μIU/mL in the absence of antithyroid antibodies [1]. The diagnosis of GDM was established on the basis of fasting hyperglycemia (≥5.1 mmol/L), or based on the results of an oral glucose tolerance test (OGTT) with 75 g of glucose: fasting glucose level of ≥5.1 mmol/L; the concentration 1 hour after glucose intake ≥10.0 mmol/L; the content 2 hours after glucose intake ≥8.5 mmol/l) [2]. In both groups, the frequency of developing GDM, the timing of diagnosis, and the need for insulin therapy were evaluated. Statistical data processing was carried out using the StatTech v. 2.1.0 software. Quantitative indicators were assessed for compliance with the normal distribution via Shapiro-Wilk criterion or Kolmogorov-Smirnov criterion. Intergroup comparison was performed using Mann-Whitney U test or Pearson’s chi-squared test. Results — We discovered that among women with a burdened family history of thyroid pathology and diabetes mellitus, as well as with thyroid pathology prior to pregnancy, the prevalence of hypothyroidism was higher. The presence of thyroid pathology in the anamnesis of pregnant women was associated with an earlier diagnosis of hypothyroidism. We revealed a significant difference in the prevalence of GDM between two groups of subjects. The chances of detecting GDM in the hypothyroidism group were 8.6 times higher than in the euthyroidism group. The threshold level of TSH for the first trimester, predicting the development of GDM, was identified. The sensitivity and specificity of the model were 71.4% and 63.1%, respectively. Conclusion — Hypofunction of the thyroid and GDM are interrelated endocrine pathologies. In the presence of hypothyroidism (both primary and SGH), GDM develops significantly more often. The level of TSH in the first trimester ≥2.7 μIU/mL amplifies the chance of developing GDM by over 8 times; hence, it could be considered a signal for timely prevention and detection of this pathology.
求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
Russian Open Medical Journal
Russian Open Medical Journal MEDICINE, GENERAL & INTERNAL-
CiteScore
0.90
自引率
0.00%
发文量
39
期刊介绍: Russian Open Medical Journal (RusOMJ) (ISSN 2304-3415) is an international peer reviewed open access e-journal. The website is updated quarterly with the RusOMJ’s latest original research, clinical studies, case reports, reviews, news, and comment articles. This Journal devoted to all field of medicine. All the RusOMJ’s articles are published in full on www.romj.org with open access and no limits on word counts. Our mission is to lead the debate on health and to engage, inform, and stimulate doctors, researchers, and other health professionals in ways that will improve outcomes for patients. The RusOMJ team is based mainly in Saratov (Russia), although we also have editors elsewhere in Russian and in other countries.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信