Milovanović Zagorka, Filimonović Dejan, Soldatović Ivan, Karadžov Orlić Nataša
Clinic for Gynaecology and Obstetrics Narodni Front, Kraljice Natalije 62, 11000 Belgrade, Serbia.
Faculty of Medicine, University of Belgrade, Dr Subotica Starijeg 8, 11000 Belgrade, Serbia.
J Clin Med. 2022 Jul 5;11(13):3916. doi: 10.3390/jcm11133916.
This study aimed to evaluate the clinical utility of the subclinical hypothyroidism (SCH) marker, elevated thyroid-stimulating hormone (TSH) and thyroid antibodies in their ability to predict subsequent gestational diabetes mellitus (GDM). In a prospective clinical trial, 230 pregnant women were screened for thyroid function during the first trimester of pregnancy. Increased TSH levels with normal free thyroxine (fT4) were considered SCH. The titers of thyroid peroxidase antibody (anti TPO Ab) at >35 IU/mL and thyroglobulin antibody (anti Tg Ab) at >115 IU/mL were considered as antibodies present. According to the OGTT results, the number of pregnant women with GDM showed the expected growth trend, which was 19%. Two groups of pregnant women were compared, one with GDM and the other without. Increased TSH levels and the presence of thyroid antibodies showed a positive correlation with the risk of GDM. TSH levels were significantly higher in pregnant women with GDM, p = 0.027. In this study, 25.6% of pregnant women met the diagnostic criteria for autoimmune thyroiditis. Hashimoto’s thyroiditis was significantly more common in GDM patients, p < 0.001. Through multivariate logistic regression, it was demonstrated that patient age, TSH 4 IU/mL, and anti TPO Ab > 35 IU/mL are significant predictors of gestational diabetes mellitus that may improve first-trimester pregnancy screening performance, AUC: 0.711; 95% CI: 0.629−0.793.
本研究旨在评估亚临床甲状腺功能减退（SCH）标志物、甲状腺刺激激素（TSH）升高及甲状腺抗体预测后续妊娠期糖尿病（GDM）的临床效用。在一项前瞻性临床试验中，对230名孕妇在妊娠早期进行了甲状腺功能筛查。促甲状腺激素（TSH）水平升高而游离甲状腺素（fT4）正常被视为亚临床甲状腺功能减退。甲状腺过氧化物酶抗体（抗TPO Ab）滴度>35 IU/mL和甲状腺球蛋白抗体（抗Tg Ab）滴度>115 IU/mL被视为存在抗体。根据口服葡萄糖耐量试验（OGTT）结果，患有妊娠期糖尿病的孕妇人数呈预期增长趋势，为19%。比较了两组孕妇，一组患有妊娠期糖尿病，另一组未患。TSH水平升高和甲状腺抗体的存在与妊娠期糖尿病风险呈正相关。患有妊娠期糖尿病的孕妇TSH水平显著更高，p = 0.027。在本研究中，25.6%的孕妇符合自身免疫性甲状腺炎的诊断标准。桥本甲状腺炎在妊娠期糖尿病患者中更为常见，p < 0.001。通过多因素逻辑回归分析表明，患者年龄、TSH 4 IU/mL以及抗TPO Ab > 35 IU/mL是妊娠期糖尿病的重要预测因素，可能改善孕早期妊娠筛查性能，曲线下面积（AUC）：0.711；95%置信区间（CI）：0.629−0.793。
