Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
Department of Endocrinology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
J Womens Health (Larchmt). 2022 Feb;31(2):293-298. doi: 10.1089/jwh.2020.8825. Epub 2021 Apr 7.
Maternal subclinical hypothyroidism (SCH) has been associated with adverse pregnancy outcomes. This study aimed to explore whether SCH in the first trimester contributed to the development of gestational diabetes mellitus (GDM). A total of 8,777 pregnant women who first visited before 13 weeks and 6 days of gestation and accepted routine prenatal service at the Third Affiliated Hospital of Sun Yat-Sen University from January 2015 to September 2018 were recruited in this study. Thyroid functions (thyroid stimulating hormone [TSH], free T4, and thyroid peroxidase antibody [TPOAb]) were measured before 13 weeks and 6 days of gestation and data of 7,536 subjects with TSH ≥0.1 mIU/L were analyzed. A 2-hour 75-g oral glucose tolerance test was performed between 24 and 28 gestational weeks. Chi-square test and multivariate logistic regression analysis were applied to evaluate the relationship between SCH and GDM. The prevalence of SCH in this population was 7.53%. After stratifying the relationship between SCH and GDM according to TSH concentrations (slightly elevated TSH: ≥2.5, <4.0 mIU/L; moderately elevated TSH: ≥4.0, <10.0 mIU/L) and TPOAb status, a moderately elevated TSH combined with positive TPOAb (23.9% vs. normal 13.0%, chi-square = 6.317, = 0.012) was found to increase the incidence of GDM. Furthermore, after adjusting for confounders (maternal age, educational levels, parity, and pregestational body mass index [preBMI]), the SCH group still exhibited a higher risk of GDM (relative risk [RR] 1.867, 95% confidence interval [CI] 1.018-3.424). Our findings indicated that SCH during early pregnancy, in the presence of moderately elevated TSH levels and positive TPOAb, might lead to an increased risk of GDM.
母体亚临床甲状腺功能减退症（SCH）与不良妊娠结局有关。本研究旨在探讨妊娠早期 SCH 是否导致妊娠期糖尿病（GDM）的发生。
本研究共纳入 2015 年 1 月至 2018 年 9 月在中山大学附属第三医院首次就诊且孕周<13 周+6 天行常规产前检查的 8777 例孕妇。于妊娠 13 周+6 天前检测甲状腺功能（促甲状腺激素[TSH]、游离 T4 和甲状腺过氧化物酶抗体[TPOAb]），分析 TSH≥0.1mIU/L 的 7536 例患者的数据。于妊娠 24-28 周行 2 小时 75g 口服葡萄糖耐量试验。采用卡方检验和多因素 logistic 回归分析评估 SCH 与 GDM 的关系。
该人群 SCH 的患病率为 7.53%。根据 TSH 浓度（轻度升高 TSH：≥2.5，<4.0mIU/L；中度升高 TSH：≥4.0，<10.0mIU/L）和 TPOAb 状态分层后，发现中度升高 TSH 合并 TPOAb 阳性（23.9%比正常 13.0%，卡方=6.317，P=0.012）可增加 GDM 的发生率。此外，校正混杂因素（母亲年龄、教育程度、产次和孕前体质量指数[preBMI]）后，SCH 组仍有更高的 GDM 风险（相对风险[RR]1.867，95%可信区间[CI]1.018-3.424）。
本研究结果表明，妊娠早期合并中度升高 TSH 水平和 TPOAb 阳性的 SCH 可能会增加 GDM 的风险。
