Department of Obstetrics, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Division of Endocrinology and Metabolism, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Thyroid. 2021 Aug;31(8):1282-1288. doi: 10.1089/thy.2020.0920. Epub 2021 Mar 22.
Human chorionic gonadotropin (hCG) is a marker of placental function, which also stimulates the maternal thyroid gland. Maternal thyroid function can be associated with the pathophysiology of gestational diabetes mellitus (GDM). We aimed to study whether there is an association of hCG concentrations in early pregnancy with GDM and whether it is mediated through maternal thyroid hormones. This study included 18,683 pregnant women presenting at a tertiary hospital in Shanghai, China, between January 2015 and December 2016. GDM was diagnosed using a 2-hour, 75-g, oral glucose tolerance test (OGTT) according to the American Diabetes Association guidelines. Multivariable logistic or linear regression models were used to identify associations, adjusting for maternal age, education level, family history of diabetes, parity, fetal sex, thyroperoxidase antibody (TPOAb) status, and prepregnancy body-mass index. Higher hCG concentrations were associated with a lower plasma glucose level during the OGTT, but not with fasting plasma glucose or hemoglobin A1c concentrations tested during early pregnancy. hCG in early pregnancy was negatively associated with GDM risk ( = 0.027). Mediation analysis identified that an estimated 21.4% of the association of hCG-associated GDM risk was mediated through changes in free thyroxine (fT4) concentrations ( < 0.05). In the sensitivity analysis restricted to TPOAb-positive women, hCG was not associated with GDM ( = 0.452). Higher hCG levels in early pregnancy are associated with a lower risk of GDM. Maternal fT4 may act as an important mediator in this association.
人绒毛膜促性腺激素（hCG）是胎盘功能的标志物，也可刺激母体甲状腺。母体甲状腺功能可能与妊娠期糖尿病（GDM）的病理生理学有关。我们旨在研究妊娠早期 hCG 浓度与 GDM 是否存在关联，以及它是否通过母体甲状腺激素介导。
该研究纳入了 2015 年 1 月至 2016 年 12 月期间在中国上海一家三级医院就诊的 18683 名孕妇。根据美国糖尿病协会的指南，使用 2 小时 75g 口服葡萄糖耐量试验（OGTT）诊断 GDM。使用多变量逻辑或线性回归模型来确定关联，调整了母体年龄、教育水平、糖尿病家族史、产次、胎儿性别、甲状腺过氧化物酶抗体（TPOAb）状态和孕前体重指数。
较高的 hCG 浓度与 OGTT 期间较低的血糖水平相关，但与妊娠早期检测的空腹血糖或糖化血红蛋白浓度无关。妊娠早期的 hCG 与 GDM 风险呈负相关（ = 0.027）。中介分析确定，hCG 与 GDM 风险相关的估计 21.4%是通过游离甲状腺素（fT4）浓度的变化介导的（ < 0.05）。在仅限于 TPOAb 阳性妇女的敏感性分析中，hCG 与 GDM 无关（ = 0.452）。
妊娠早期较高的 hCG 水平与较低的 GDM 风险相关。母体 fT4 可能是这种关联的重要中介。
