First trimester thyroid function in pregnant women residing in Saint Petersburg (Russia): reference values and risk of gestational diabetes

Background. Subclinical hypothyroidism during pregnancy and gestational diabetes mellitus (GDM) is known to be associated with maternal and child morbidity. The concept of subclinical dysfunction of the thyroid gland in pregnant women depends on the population-specific and trimester-specific reference values so fixed universal cutoff concentrations for thyroid-stimulating hormone (TSH) that were recommended earlier now are put under the question. Population-specific and trimester-specific reference values have not been defined for pregnant women residing in Saint Petersburg. The data concerning the association of maternal thyroid status with GDM development are controversial. Aims. The aim of the study was to determine the reference values of TSH and free thyroxin (fT4) in the first trimester of pregnancy in women living in St. Petersburg, and to assess the relationship between thyroid status and the risk of subsequent development of GDM. Materials and methods. The levels of TSH, fT4 and thyroid peroxidase antibodies (TPO-Ab) were analyzed in 503 pregnant women before the 14th week of gestation. The women underwent oral glucose tolerance test (OGTT) at 2428 weeks to find out those with GDM. The association between thyroid function, thyroid autoimmunity and the risk of GDM we estimated. Results. The reference values for TSH were 0.07 4.40 mU /L, and for fT4 11.7 20.3 pmol/L. The prevalence of subclinical hypothyroidism in the 503 pregnant women was 16.9% according to the diagnostic criteria of TSH 2.5 mIU / L and 3.8% using our calculated reference interval. Hypothyroxinemia was registered in 5,3% using reference values recommended by diagnostic tests manufacturer and in 2,8% according to our calculated reference interval for fT4. GDM was diagnosed in 23% of women. Logistic regression analysis showed associations of hypothyroxinemia and TPO-Ab-positivity with the increased risk of GDM that remained significant after adjustments on age and body mass index (BMI) [adjusted OR (95% CI) = 7.39 (1.2742.93) for hypothyroxinemia, p=0.026; and adjusted OR (95% CI) = 2.02 (1.014.04) for TPO-Ab-positivity, p=0.047). Conclusions. Reference intervals for first trimester TSH and fT4 have been established for pregnant women living in St. Petersburg. Hypothyroxinemia and TPO-Ab-positivity were associated with the increased risk of GDM.

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Evaluation of Thyroid Function in Pregnant Women Using Automated Immunoassays

Clinical Chemistry ◽

10.1093/clinchem/hvab009 ◽

2021 ◽

Author(s):

K Aaron Geno ◽

Matthew S Reed ◽

Mark A Cervinski ◽

Robert D Nerenz

Keyword(s):

Pregnant Women ◽

Equilibrium Dialysis ◽

Reference Interval ◽

First Trimester ◽

Reference Intervals ◽

Free Thyroxine ◽

Specific Reference ◽

Childbearing Age ◽

Thyroid Autoantibody ◽

The Impact

Abstract Introduction Automated free thyroxine (FT4) immunoassays are widely available, but professional guidelines discourage their use in pregnant women due to theoretical under-recoveries attributed to increased thyroid hormone binding capacity and instead advocate the use of total T4 (TT4) or free thyroxine index (FTI). The impact of this recommendation on the classification of thyroid status in apparently euthyroid pregnant patients was evaluated. Methods After excluding specimens with thyroid autoantibody concentrations above reference limits, thyroid-stimulating hormone (TSH), FT4, TT4, and T-uptake were measured on the Roche Cobas® platform in remnant clinical specimens from at least 147 nonpregnant women of childbearing age and pregnant women at each trimester. Split-sample comparisons of FT4 as measured by the Cobas and equilibrium dialysis were performed. Results FT4 decreased with advancing gestational age by both immunoassay and equilibrium dialysis. TSH declined during the first trimester, remained constant in the second, and increased throughout the third, peaking just before delivery. Interpretation of TT4 concentrations using 1.5-times the nonpregnant reference interval classified 13.6% of first trimester specimens below the lower reference limit despite TSH concentrations within trimester-specific reference intervals. Five FTI results from 480 pregnant individuals (about 1.0%) fell outside the manufacturer’s reference interval. Conclusions Indirect FT4 immunoassay results interpreted in the context of trimester-specific reference intervals provide a practical and viable alternative to TT4 or FTI. Declining FT4 and increasing TSH concentrations near term suggest that declining FT4 is not an analytical artifact but represents a true physiological change in preparation for labor and delivery.

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SUBCLINICAL HYPOTHYROIDISM IN PREGNANCY; IS THERE A NEED FOR PHARMACOLOGICAL INTERVENTION?

International Journal of Pharmacy and Pharmaceutical Sciences ◽

10.22159/ijpps.2017v9i3.16542 ◽

2017 ◽

Vol 9 (3) ◽

pp. 186

Author(s):

Shripad Hebbar ◽

Sahan Kumar ◽

Sapna Amin ◽

Sneha Doizode

Keyword(s):

Gestational Diabetes ◽

Pregnant Women ◽

Preterm Delivery ◽

Subclinical Hypothyroidism ◽

First Trimester ◽

Pharmacological Intervention ◽

Complication Rates ◽

Geographic Population ◽

First Trimester Of Pregnancy ◽

Tsh Levels

Objective: To find the prevalence of subclinical hypothyroidism in the first trimester of pregnancy and to compare the maternal and perinatal outcome in them with euthyroid mothers.Methods: The present study was a prospective observational case-control study done in a tertiary hospital over the period of one and half years. Pregnant women in the first trimester of pregnancy were tested for Thyroid Stimulating Hormone (TSH) levels and those who had TSH>2.5mIU/l, free T3 and free T4 estimation was carried out on the same sample. A total of 171 women could be followed up till delivery and their first-trimester thyroid profile was available for analysis. They were grouped into two groups, Group 1: all women with TSH level>2.5 mIU/l, considered to be hypothyroid (n=79), Group 2: women with euthyroid status with TSH levels 0.1 to 2.5 mIU/l (n=95). All the neonates delivered in the first group had cord blood TSH estimation.Results: In the study period, there were 2632 deliveries. The number of pregnant women with first trimester TSH levels>2.5 mIU/l were 79, giving the prevalence rate of 3 % for subclinical hypothyroidism during pregnancy. The obstetric complications observed were gestational hypertension 3.8%, gestational diabetes 6.3%, placenta praevia1.3% and preterm delivery 7.6%. The perinatal complications included Intrauterine growth restriction (IUGR) 1.3%, Low Birth Weight (LBW) 3.8%, perinatal asphyxia 2.5% and neonatal hypothyroidism 1.3%. Only preterm delivery appeared to be significantly associated with subclinical hypothyroidism.Conclusion: The observed complication rates were much similar, in fact, lesser with gestational diabetes, pregnancy hypertension, IUGR, LBW compared to global and Indian prevalence rates. This indicates that the cut-off for diagnosing subclinical hypothyroidism should be derived from TSH assays from the local geographic population and should guide the treating physician to establish appropriate TSH ranges where definite therapeutic intervention is required to improve the maternal and foetal outcome.

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Mild Anemia May Affect Thyroid Function in Pregnant Chinese Women During the First Trimester

Frontiers in Endocrinology ◽

10.3389/fendo.2021.772917 ◽

2021 ◽

Vol 12 ◽

Author(s):

Guan-ying Nie ◽

Rui Wang ◽

Peng Liu ◽

Ming Li ◽

Dian-jun Sun

Keyword(s):

Pregnant Women ◽

Thyroid Function ◽

Normal Control ◽

Subclinical Hypothyroidism ◽

First Trimester ◽

Specific Reference ◽

American Thyroid Association ◽

Mild Anemia ◽

Upper Limit ◽

Tsh Levels

BackgroundPregnant women are often susceptible to anemia, which can damage the thyroid gland. However, compared with moderate and severe anemia, less attention has been paid to mild anemia. The purpose of this study was to evaluate the effect of mild anemia on the thyroid function in pregnant women during the first trimester.MethodsA total of 1,761 women in the first trimester of their pregnancy were enrolled from Shenyang, China, and divided into mild anemia and normal control groups based on their hemoglobin levels. Thyroid-stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3) levels were compared between the two groups.ResultsThe TSH levels of pregnant women with mild anemia were higher than those of pregnant women without mild anemia (p < 0.05). Normal control women were selected to set new reference intervals for TSH, FT3, and FT4 levels during the first trimester, which were 0.11–4.13 mIU/l, 3.45–5.47 pmol/l, and 7.96–16.54 pmol/l, respectively. The upper limit of TSH 4.13 mU/l is close to the upper limit 4.0 mU/l recommended in the 2017 American Thyroid Association (ATA) guidelines, indicating that exclusion of mild anemia may reduce the difference in reference values from different regions. Mild anemia was related to 4.40 times odds of abnormally TSH levels (95% CI: 2.84, 6.76) and 5.87 increased odds of abnormal FT3 (95% CI: 3.89, 8.85). The proportion of hypothyroidism and subclinical hypothyroidism in patients with mild anemia was higher than that in those without anemia (0.6% vs. 0, p = 0.009; 12.1% vs. 1.9%, p < 0.001). Mild anemia was related to 7.61 times increased odds of subclinical hypothyroidism (95% CI: 4.53, 12.90).ConclusionsMild anemia may affect thyroid function during the first trimester, which highlights the importance of excluding mild anemia confounding when establishing a locally derived specific reference interval for early pregnancy.

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Red Blood Cells in The First Trimester and The Risk of Gestational Diabetes: A Prospective Cohort Study

10.21203/rs.3.rs-156418/v1 ◽

2021 ◽

Author(s):

Jiajing Jia ◽

Ying Yang ◽

Minjin Zhang ◽

Li Lin ◽

Yequn Chen ◽

...

Keyword(s):

Cohort Study ◽

Gestational Diabetes ◽

Blood Cell ◽

Pregnant Women ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Hematological Parameters ◽

First Trimester ◽

Logistic Regression Models ◽

Increased Risk

Abstract Background: This research aimed to assess the potential association of gestational diabetes (GDM) with early trimester hematological parameters including hemoglobin (Hb), red blood cell (RBC), white blood cell (WBC), and platelet count (PLT) through a prospective cohort study.Methods: The prospective cohort included pregnant women subjected to prenatal examination at Shantou and Beijing hospitals in China from March 2014 to December 2015. Data were collected since the first perinatal visit in obstetrics clinics, and then participants were followed up at 24, 32, 36 gestational weeks and the time of delivery, respectively. Multivariable adjusted logistic regression models were conducted to estimate odds ratio (OR) and its corresponding 95% confidence interval (95% CI).Results: A total of 1004 pregnant women with singletons, less than 12 gestational weeks, and without history of chronic disease were eligible for analysis. The incidence of GDM was 18.82%, and the mean age was 29.50 ± 3.84 years. Total of 187 (18.63%) women who had abnormal RBC level and 222 (22.11%) had abnormal Hb in the first trimester of pregnancy. After multivariable adjustment, each unit increment in numeric RBC or Hb was associated with 177% and 4% increased risk for GDM. The risk for GDM was significantly increased with higher RBC (OR: 2.00 for RBC>4.55×1012 /L) and Hb (OR: 2.14 for Hb>139 g/L) levels in the first trimester.Conclusions: Elevated RBC and Hb in the first trimester are associated with increasing risk of GDM. Further evidence are warranted to confirm these possible causal relationships.

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Vitamin D status and association with gestational diabetes mellitus in a pregnant cohort in Iceland

Food & Nutrition Research ◽

10.29219/fnr.v65.5574 ◽

2021 ◽

Author(s):

Kristin S. Magnusdottir ◽

Ellen A. Tryggvadottir ◽

Ola K. Magnusdottir ◽

Laufey Hrolfsdottir ◽

Thorhallur I. Halldorsson ◽

...

Keyword(s):

Diabetes Mellitus ◽

Vitamin D ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Pregnant Women ◽

First Trimester ◽

Vitamin D Status ◽

Increased Risk ◽

Vitamin D Levels ◽

25Ohd Concentration

Background: Vitamin D deficiency has been associated with an increased risk of gestational diabetes mellitus (GDM), one of the most common pregnancy complications. The vitamin D status has never previously been studied in pregnant women in Iceland. Objective: The aim of this research study was to evaluate the vitamin D status of an Icelandic cohort of pregnant women and the association between the vitamin D status and the GDM incidence. Design: Subjects included pregnant women (n = 938) who attended their first ultrasound appointment, during gestational weeks 11–14, between October 2017 and March 2018. The use of supplements containing vitamin D over the previous 3 months, height, pre-pregnancy weight, and social status were assessed using a questionnaire, and blood samples were drawn for analyzing the serum 25‑hydroxyvitamin D (25OHD) concentration. Information regarding the incidence of GDM later in pregnancy was collected from medical records. Results: The mean ± standard deviation of the serum 25OHD (S-25OHD) concentration in this cohort was 63±24 nmol/L. The proportion of women with an S-25OHD concentration of ≥ 50 nmol/L (which is considered adequate) was 70%, whereas 25% had concentrations between 30 and 49.9 nmol/L (insufficient) and 5% had concentrations < 30 nmol/L (deficient). The majority of women (n = 766, 82%) used supplements containing vitamin D on a daily basis. A gradual decrease in the proportion of women diagnosed with GDM was reported with increasing S-25OHD concentrations, going from 17.8% in the group with S-25OHD concentrations < 30 nmol/L to 12.8% in the group with S-25OHD concentrations ≥75 nmol/L; however, the association was not significant (P for trend = 0.11). Conclusion: Approximately one-third of this cohort had S-25OHD concentrations below adequate levels (< 50 nmol/L) during the first trimester of pregnancy, which may suggest that necessary action must be taken to increase their vitamin D levels. No clear association was observed between the vitamin D status and GDM in this study.

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First trimester uric acid level: a reliable marker for gestational diabetes mellitus

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20192430 ◽

2019 ◽

Vol 8 (6) ◽

pp. 2358

Author(s):

Suvarna Jyothi Ganta ◽

Sunanda R. Kulkarni

Keyword(s):

Diabetes Mellitus ◽

Uric Acid ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Pregnant Women ◽

Serum Uric Acid ◽

First Trimester ◽

Family History Of Diabetes ◽

Increased Risk ◽

In Pregnancy

Background: The prevalence of diabetes mellitus (DM) is increasing worldwide and more in developing countries like India. The diabetic epidemic experienced in India can be due to strong genetic factors coupled with increasing urbanization, sedentary lifestyle, changes in the dietary patterns and increasing obesity. Indians are at an 11-fold increased risk of developing gestational glucose intolerance and hence universal screening is essential. Uric acid is a known marker of oxidative stress. Hyperuricemia in early pregnancy may be an indicator of the existing metabolic disturbance which can hinder the maternal physiological adaptations generally seen in pregnancy thus making the pregnant women more vulnerable to the development of gestational diabetes mellitus. The objective of this study was to investigate the association between elevated uric acid levels in the first trimester of pregnancy with gestational diabetes.Methods: This prospective observational study was conducted in Chinmaya mission hospital, Bangalore from June 2016 to March 2017 (10 months). Three hundred and twelve (312) pregnant women of gestational age less than 12 weeks who attended the OBG outpatient department within this time of period for regular antenatal check-up were enrolled in the study. Along with the other antenatal investigations serum uric acid levels were estimated before 12 weeks and also between 24-28 weeks. At 24-28 weeks screening for GDM was done by OGCT using 75 gms of glucose (IADPISG criteria). Other parameters like age, parity, BMI, family history of diabetes was noted and compared.Results: In our study, among the 312 pregnant women, 88 (28%) developed GDM. Of these 74 Women (84%) with GDM had uric acid levels above 3.5 mg/dl and 14 women (15.9%) with GDM had uric acid levels below 3.5 mg/dl. Women with higher BMI showed high uric acid levels.Conclusions: Elevated serum uric acid in the first trimester has a significant correlation with development of GDM. In present study; the cut-off level of maternal serum uric acid of 3.5 mg/dl in the first trimester appears to have a good sensitivity and specificity in identifying those patients who are most likely to develop GDM later in pregnancy.

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86-LB: Elevated First-Trimester Neutrophil Count Is Associated with the Development of Gestational Diabetes Mellitus in Pregnant Women

Diabetes ◽

10.2337/db19-86-lb ◽

2019 ◽

Vol 68 (Supplement 1) ◽

pp. 86-LB

Author(s):

TIANGE SUN ◽

FANHUA MENG ◽

RUI ZHANG ◽

ZHIYAN YU ◽

SHUFEI ZANG ◽

...

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Pregnant Women ◽

Neutrophil Count ◽

First Trimester

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EXPRESS: Method dependent variation in TSH and FT4 reference intervals in pregnancy: a systematic review

Annals of Clinical Biochemistry International Journal of Laboratory Medicine ◽

10.1177/00045632211026955 ◽

2021 ◽

pp. 000456322110269

Author(s):

O E Okosieme ◽

Medha Agrawal ◽

Danyal Usman ◽

Carol Evans

Keyword(s):

Systematic Review ◽

Reference Interval ◽

First Trimester ◽

Reference Intervals ◽

Assay Method ◽

Specific Reference ◽

Upper Limits ◽

Wide Range ◽

Assay Methods ◽

In Pregnancy

Background: Gestational TSH and FT4 reference intervals may differ according to assay method but the extent of variation is unclear and has not been systematically evaluated. We conducted a systematic review of published studies on TSH and FT4 reference intervals in pregnancy. Our aim was to quantify method-related differences in gestation reference intervals, across four commonly used assay methods, Abbott, Beckman, Roche, and Siemens. Methods: We searched the literature for relevant studies, published between January 2000 and December 2020, in healthy pregnant women without thyroid antibodies or disease. For each study, we extracted trimester-specific reference intervals (2.5â97.5 percentiles) for TSH and FT4 as well as the manufacturer provided reference interval for the corresponding non-pregnant population. Results: TSH reference intervals showed a wide range of study-to-study differences with upper limits ranging from 2.33 to 8.30 mU/L. FT4 lower limits ranged from 4.40â13.93 pmol/L, with consistently lower reference intervals observed with the Beckman method. Differences between non-pregnant and first trimester reference intervals were highly variable, and for most studies the TSH upper limit in the first trimester could not be predicted or extrapolated from non-pregnant values. Conclusions: Our study confirms significant intra and inter-method disparities in gestational thyroid hormone reference intervals. The relationship between pregnant and non-pregnant values is inconsistent and does not support the existing practice in some laboratories of extrapolating gestation references from non-pregnant values. Laboratories should invest in deriving method-specific gestation reference intervals for their population.

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TSH/miR‐17‐5p/ZNF367 axis is related to spontaneous abortion in patients with TSH above 2.5 mIU/L

Journal of Molecular Endocrinology ◽

10.1530/jme-20-0335 ◽

2021 ◽

Author(s):

Yang Yang ◽

Jiashu Li ◽

Yingying Zhou ◽

Wen Dai ◽

Weiping Teng ◽

...

Keyword(s):

Pregnant Women ◽

Spontaneous Abortion ◽

Biological Function ◽

Zinc Finger Protein ◽

First Trimester ◽

Cell Counting ◽

Luciferase Reporter ◽

Migration And Invasion ◽

Chorionic Villi ◽

Increased Risk

Elevated thyroid stimulating hormone (TSH) is associated with an increased risk of spontaneous abortion (SA); however, the associated mechanism remains unclear. This study aimed to investigate the expression of microRNAs (miRNAs) and pathogenesis in the chorionic villi of TSH > 2.5 mIU/L-related SA patients. The chorionic villi were collected from pregnant women in the first trimester with TSH > 2.5 mIU/L with or without SA, as well as TSH < 2.5 mIU/L with or without SA to determine the level of miRNA expression. Differentially expressed miRNAs were confirmed by qRT-PCR in a total of 92 subjects. Cell counting kit-8 (CCK8), wound healing, transwell assays, and Western blotting were used to measure cellular biological functions and related protein in HTR-8/SVneo cells. The potential mechanisms were determined using a Luciferase reporter assay and rescue experiment. Compared with normal pregnant women, miR-17-5p was decreased and zinc finger protein 367 (ZNF367) was upregulated in the chorionic villi of TSH > 2.5 mIU/L-related SA patients. Using HTR-8/SVneo cells, we demonstrated that elevated TSH inhibited miR-17-5p expression, as well as trophoblast migration and invasion. The overexpression of miR-17-5p targeted and inhibited ZNF367 expression promoting the biological function of trophoblasts. Further studies confirmed that ZNF367 interference partially reversed the biological function of the miR-17-5p inhibitor on HTR-8/SVneo cells. Taken together, our results showed that miR-17-5p promoted biological function of trophoblasts by suppressing ZNF367.

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The role of the platelet profile in the prediction of gestational diabetes

10.51271/kmj-0012 ◽

2021 ◽

pp. 50-54

Keyword(s):

Body Mass Index ◽

Blood Glucose ◽

Gestational Diabetes ◽

Pregnant Women ◽

Body Mass ◽

First Trimester ◽

Oral Glucose ◽

Mean Corpuscular Hemoglobin ◽

Lymphocyte Ratio ◽

Significant Difference

Objective: In our study, the results of oral glucose tolerance test (OGTT) and other hemogram parameters of pregnant women with and without gestational diabetes mellitus (GDM) were compared. The aim of our study is to investigate the benefit of these parameters in predicting GDM risk. Material and Method: The study was planned as a descriptive, retrospective and cross-sectional study. It was included 218 pregnant women who applied to the Gynecology and Obstetrics Clinic of Amasya Sabuncuoğlu Şerefeddin Training and Research Hospital between January 01, 2019 and January 31, 2020. It was examined complete blood count parameters, ultrasound findings, complete urinalysis, first trimester blood glucose, body mass index, age, and gravide parameters the patients we included in the study. The results were analyzed retrospectively and was evaluated the statistical significance relationship with gestational diabetes. Results: There was no statistically significant difference in age, body mass index (BMI), obesity status and number of gravida between the pregnant women who were examined and those without GDM (p> 0.05). The hemoglobin, platelet count, mean platelet volume (MPV), mean corpuscular volume (MCV), mean corpuscular hemoglobine (MCH), and mean corpuscular hemoglobin concentration (MCHC) values, and neutrophil, lymphocyte, monocyte and basophil counts, urine density and femur length were statistically significant. There was no difference (p> 0.05). No statistically significant difference was found in terms of neutrophile lymphocyte ratio (NLR), neutrophile monocyte ratio (NMR), platelet lymphocyte ratio (PLR), monocyte eosinophil ratio (MER), platelet MPV ratio (PMPVR), and platelet neutrophile ratio (PNR) values (p> 0.05) Conclusion: HbA1c, hematocrit and blood glucose in the first trimester may be predictors of GDM. In addition, we think that further studies are needed in a prospective design in more patients in terms of others parameters.

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