Is the link between elevated TSH and gestational diabetes mellitus dependant on diagnostic criteria and thyroid antibody status: a systematic review and meta-analysis

Kent, Nykola L.; Young, Sophia; Akison, Lisa K.; Cuffe, James

doi:10.1007/s12020-021-02733-x

Cited by 33 publications

(27 citation statements)

References 42 publications

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“…This result indicated that SCH in early pregnancy could significantly increase the incidence of abnormal glucose metabolism in pregnant women, an observation that was similar to prior studies. 22 , 29 , 30 During pregnancy, the thyroid hormone has dual effects on islet cells. Not only does it regulate the sensitivity of the body to insulin, but it can also affect its degradation.…”

Section: Discussionmentioning

confidence: 99%

Impact of TPOAb-negative maternal subclinical hypothyroidism in early pregnancy on adverse pregnancy outcomes

Zhu

Chu

et al. 2021

Therapeutic Advances in Endocrinology

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Purpose: To investigate the effect of subclinical hypothyroidism on pregnancy outcomes of women early in their pregnancy with different thyroid-stimulating hormone levels and thyroid peroxidase antibody–negative status and to explore reasonable thyroid-stimulating hormone levels for subclinical hypothyroidism in early pregnancy. Methods: A total of 2378 women early in their pregnancy were studied retrospectively. The baseline characteristics were collected from medical records. Pregnancy outcomes were compared between the euthyroidism and subclinical hypothyroidism groups that were diagnosed by 2011 or 2017 American Thyroid Association guidelines. In addition, the effect of different maternal thyroid-stimulating hormone levels on adverse pregnancy outcomes was analyzed using binary logistic regression. Results: According to the 2011 American Thyroid Association diagnostic criteria of subclinical hypothyroidism, the prevalence of pregnancy outcomes was not significantly higher in the subclinical hypothyroidism group than in the euthyroidism group. However, pregnant women with subclinical hypothyroidism identified by the 2017 American Thyroid Association criteria had a higher risk of premature delivery (odds ratio = 3.93; 95% confidence interval = 1.22–12.64), gestational diabetes mellitus (odds ratio = 2.69; 95% confidence interval = 1.36–5.32), and gestational anemia (odds ratio = 3.28; 95% confidence interval = 1.60–6.75). Moreover, no differences in the prevalence of adverse pregnancy outcomes were observed between the mildly elevated thyroid-stimulating hormone group (2.5 < thyroid-stimulating hormone ⩽4.0 mIU/l) and the normal thyroid-stimulating hormone group (0.27 < thyroid-stimulating hormone ⩽2.5 mIU/l). The significantly elevated thyroid-stimulating hormone group (4.0 < thyroid-stimulating hormone < 10.0 mIU/l) had a higher prevalence of premature delivery, gestational diabetes mellitus, and gestational anemia than the normal thyroid-stimulating hormone group, even after controlling for potential confounding factors. Conclusion: A mildly elevated thyroid-stimulating hormone level or maternal subclinical hypothyroidism diagnosed by 2011 American Thyroid Association guidelines during early pregnancy in thyroid peroxidase antibody–negative women was not associated with adverse pregnancy outcomes. However, maternal subclinical hypothyroidism identified by the 2017 American Thyroid Association guidelines increased the risks of several adverse pregnancy outcomes in women untreated with levothyroxine. The 2017 American Thyroid Association guidelines could be more reasonable for the diagnosis of subclinical hypothyroidism in southern China.

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Section: Discussionmentioning

confidence: 99%

Impact of TPOAb-negative maternal subclinical hypothyroidism in early pregnancy on adverse pregnancy outcomes

Zhu

Chu

et al. 2021

Therapeutic Advances in Endocrinology

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“…Finally, is it noteworthy, that in another recent meta-analysis on the association between thyroid disorders and GDM, the presence of TAI together with SCH led to the highest OR; 2.04 (95% CI, 1.32–3.13) compared to the presence of each risk factor separately ( 28 ).…”

Section: Discussionmentioning

confidence: 95%

“…Therefore, if we would have been able to include TgAb positive women, the group with TAI might have become more important and the association stronger. Indeed, in the meta-analysis discussed earlier, it was shown that the presence of increased TgAb levels only was associated with a higher prevalence of GDM compared with that in case of positivity for TPOAb; OR 1.88 (95% CI, 1.13–3.12) vs OR 1.65 (95% CI, 1.13–2.40) ( 28 ).…”

Section: Discussionmentioning

confidence: 98%

Association between thyroid autoimmunity and gestational diabetes mellitus in euthyroid women

Sitoris

Veltri

Ichiche

et al. 2022

European Thyroid Journal

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Objective: Pregnant women with autoimmune (subclinical) hypothyroidism have an increased risk of developing gestational diabetes mellitus (GDM). However, this association remains controversial in euthyroid women with thyroid autoimmunity (TAI). Therefore, the aim of the study was to determine the association between TAI and GDM in euthyroid women in a logistic regression analysis with adjustments for baseline / demographic parameters. Methods: Cross-sectional study in 1447 euthyroid women who performed their biological work-up and oral glucose tolerance test (OGTT) in our center. At median 13 (11-17) weeks of gestation, TSH, free T4 and thyroid peroxidase antibodies (TPOAb) were measured, baseline characteristics recorded and an OGTT was performed between 24-28 weeks of pregnancy. Exclusion criteria were pre-pregnancy diabetes, assisted pregnancies, and women with (treated) thyroid dysfunction before or after screening. The diagnosis of GDM was based on 2013 WHO criteria, and TAI was defined as TPOAb levels ≥60 kIU/L. Results: Two hundred eighty women were diagnosed with GDM (19.4%), 26.1% in women with TAI and 18.9% in women without TAI (p=0.096). In the logistic regression analysis, TAI was associated with GDM in women older than 30 years (adjusted odds ratio (aOR) 1.68 (95% CI, 1.01-2.78); p=0.048). Maternal age >30 years, pre-pregnancy BMI ≥30 kg/m2 and another than Caucasian background were also associated with GDM; aOR 1.93 (95% CI, 1.46-2.56); p<0.001, 2.03 (95% CI, 1.46-2.81); p<0.001 and 1.46 (95% CI, 1.03-2.06); p=0.034, respectively. Conclusions: In older pregnant women, the presence of TAI in euthyroid women was associated with GDM. In line with literature data, (higher) age and BMI were strongly associated strongly with GDM.

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“…Compared with overt hypothyroidism, the effect of subclinical hypothyroidism during pregnancy on adverse pregnancy outcomes is not clear. Existing research suggests that patients with subclinical hypothyroidism in pregnancy may have an increased risk of gestational diabetes, spontaneous abortion, and preterm delivery compared with euthyroid pregnant women (37)(38)(39). In addition, short-term neurodevelopment as well as long-term mental development, and motor development may also be affected in offspring (40,41).…”

Section: Discussionmentioning

confidence: 99%

Relationship Between Subclinical Hypothyroidism in Pregnancy and Hypertensive Disorder of Pregnancy: A Systematic Review and Meta-Analysis

Han

Wang

et al. 2022

Front. Endocrinol.

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ObjectiveStudies have shown a high incidence of subclinical hypothyroidism in pregnancy, but the adverse pregnancy outcomes caused by it are not clear. Therefore, we conducted a systematic review and meta-analysis to evaluate the relationship between subclinical hypothyroidism in pregnancy and hypertensive disorders of pregnancy(HDP) to guide clinical practice.MethodWe searched the MEDLINE (PubMed), Cochrane Central, EMBASE, Web of Science, and SCOPUS databases and screened all studies evaluating the relationship between subclinical hypothyroidism in pregnancy and hypertensive disorders of pregnancy. Two researchers independently evaluated the quality of all eligible original studies using the Newcastle-Ottawa Scale (NOS). We also performed a meta-analysis using STATA15.1. Sensitivity analyses were also performed by examining the effects of individual studies as well as using different effect models and detecting any publication bias using the harbord test.ResultsTwenty-two studies were included in the final meta-analysis. Our results indicated that pregnant women with subclinical hypothyroidism had an increased risk of HDP (OR = 1.54(95% CI: 1.21-1.96) I²=67.1%), compared with euthyroidism. Subclinical hypothyroidism in pregnancy was not associated with hypertensive disorders of pregnancy at TSH diagnostic cut-off of less than 3.0 mIU/L (P = 0.077). Curiously, the risk of HDP increases when the TSH diagnostic cut-off value is higher or lower than 4 mIU/L. Although only 9 studies were above the threshold, the risk of developing HDP was still 1.69 times, which was highest in all subgroup analyses. This is consistent with the newly recommended diagnostic cut-off value of 4 mIU/L for TSH by the ATA. Our results consider that the risk of hypertensive disorder complicating pregnancy is increased regardless of the diagnosis of subclinical hypothyroidism at any stage of pregnancy. Unfortunately, there is insufficient evidence to support that patients can benefit from treatment with levothyroxine.ConclusionThe results of this meta-analysis indicate that subclinical hypothyroidism in pregnancy is associated with an increased risk of developing HDP, and this association exists regardless of the gestational period. However, the available evidence cannot support these patients receiving thyroxine intervention can benefit from it, so routine screening is only recommended for pregnant women with risk factors for hypothyroidism. Further research is needed to validate more scientific and rigorous clinical studies to clarify the relationship between subclinical hypothyroidism and HDP to improve patient prognosis.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, PROSPERO (CRD42021286405)

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Is the link between elevated TSH and gestational diabetes mellitus dependant on diagnostic criteria and thyroid antibody status: a systematic review and meta-analysis

Cited by 33 publications

References 42 publications

Impact of TPOAb-negative maternal subclinical hypothyroidism in early pregnancy on adverse pregnancy outcomes

Impact of TPOAb-negative maternal subclinical hypothyroidism in early pregnancy on adverse pregnancy outcomes

Association between thyroid autoimmunity and gestational diabetes mellitus in euthyroid women

Relationship Between Subclinical Hypothyroidism in Pregnancy and Hypertensive Disorder of Pregnancy: A Systematic Review and Meta-Analysis

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