Raets Lore, Minschart Caro, Van den Bruel Annick, Van den Bogaert Emmelien, Van Crombrugge Paul, Moyson Carolien, Verhaeghe Johan, Vandeginste Sofie, Verlaenen Hilde, Vercammen Chris, Maes Toon, Dufraimont Els, Roggen Nele, De Block Christophe, Jacquemyn Yves, Mekahli Farah, De Clippel Katrien, Loccufier Anne, Laenen Annouschka, Devlieger Roland, Mathieu Chantal, Decallonne Brigitte, Benhalima Katrien
Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
Department of Endocrinology, AZ St Jan Brugge, Ruddershove 10, 8000 Brugge, Belgium.
J Clin Med. 2022 Aug 26;11(17):5016. doi: 10.3390/jcm11175016.
Aim: To determine the association between thyroid function and the risk of developing gestational diabetes mellitus (GDM) and adverse pregnancy outcomes. Methods: This case−control study was a sub-analysis of the BEDIP-N study, in which 199 GDM women were matched for age and body mass index with 398 controls. Thyroid-stimulating hormone (TSH), free thyroxine (fT4), free triiodothyronine (fT3), and thyroid peroxidase (TPO) antibodies were measured at 6−14 weeks and 26−28 weeks during pregnancy. TSH and fT4 were also measured in early postpartum in GDM women. Results: The fT3-to-fT4 ratio at 26−28 weeks was positively associated with GDM risk with an adjusted odds ratio (aOR for smoking, education, parity, ethnicity, gestational weight gain, and (family) history of diabetes or GDM) of 2.12 (95% CI 1.07; 4.23), comparing the highest with the lowest tertile. Higher fT3 levels and a higher fT3-to-fT4 ratio were associated with a less favorable metabolic profile with higher BMI and more insulin resistance during pregnancy and postpartum. Women in the upper fT3 tertile and the upper fT3-to-fT4 ratio had a higher rate of preeclampsia [4.6% (10) vs. 1.0% (2), p = 0.040, and 4.4% (9) vs. 0.5% (1), p = 0.020], gestational hypertension [8.3% (18) vs. 3.1% (6), p = 0.034 and 8.9% (18) vs. 2.0% (4), p = 0.003], and caesarean sections [29.4% (63) vs. 16.1% (31), p = 0.002 and 32.2% (65) vs. 12.7% (25), p < 0.001]. Conclusion: A higher fT3-to-fT4 ratio late into pregnancy was associated with GDM, adverse pregnancy outcomes, and an adverse metabolic profile in early postpartum.
确定甲状腺功能与妊娠期糖尿病（GDM）发生风险及不良妊娠结局之间的关联。方法：本病例对照研究是BEDIP-N研究的一项亚分析，其中199例GDM女性按年龄和体重指数与398例对照进行匹配。在孕期6 - 14周和26 - 28周时测量促甲状腺激素（TSH）、游离甲状腺素（fT4）、游离三碘甲状腺原氨酸（fT3）和甲状腺过氧化物酶（TPO）抗体。还对GDM女性产后早期的TSH和fT4进行了测量。结果：与最低三分位数相比，26 - 28周时的fT3/fT4比值与GDM风险呈正相关，调整后的优势比（针对吸烟、教育程度、产次、种族、孕期体重增加以及糖尿病或GDM家族史进行调整）为2.12（95%置信区间1.07；4.23）。较高的fT3水平和fT3/fT4比值与孕期和产后更不利的代谢状况相关，表现为更高的体重指数和更多的胰岛素抵抗。fT3三分位数较高组和fT3/fT4比值较高组的子痫前期发生率更高[4.6%（10例）对1.0%（2例），p = 0.040，以及4.4%（9例）对0.5%（1例），p = 0.020]，妊娠期高血压发生率更高[8.3%（18例）对3.1%（6例），p = 0.0? 34以及8.9%（18例）对2.0%（4例），p = 0.003]，剖宫产率更高[29.4%（63例）对16.1%（31例），p = 0.002以及32.2%（65例）对12.7%（25例），p < 0.001]。结论：妊娠晚期较高的fT3/fT4比值与GDM、不良妊娠结局以及产后早期不良代谢状况相关。 （注：原文中“p = 0.0? 34”疑似有误，翻译时保留原文状态）
