Thyroid function during pregnancy and the postpartum period: iodine metabolism and disease states.

OBJECTIVE: To review various aspects of thyroid function during and early after pregnancy. METHODS: We discuss biochemical and potential pathologic changes in the thyroid associated with the gestational and postpartum periods. RESULTS: Urinary iodine excretion during the last trimester of gestation in healthy euthyroid women shows that, in areas with mild iodine intake, iodine supplementation is necessary during pregnancy and the postpartum period. This measure should be considered in iodine-sufficient areas as well. Thyroglobulin is the main biochemical marker of persistent thyroidal stimulation. Alterations in thyroid volume during pregnancy can persist after delivery, especially in breast-feeding mothers. In most patients, the goitrogenic stimulus of pregnancy can be suppressed with iodine supplementation. Autoimmune thyroid disease during pregnancy and the postpartum period is reflected by monitoring of thyroid peroxidase antibodies (TPO-Ab). Women with positive test results for TPO-Ab early in gestation showed a highly significant decrease in free thyroxine and increased thyroid-stimulating hormone levels late in gestation. The main marker of Graves' disease during pregnancy is thyroid-stimulating antibodies. Nonautoimmune gestational hyperthyroidism differs from Graves' disease in that thyroid-stimulating antibodies are not detectable. CONCLUSION: Clinicians should be alert to the fact that pregnancy can induce thyroidal pathologic conditions.

Reclassification after delivery of diabetes in pregnancy.

Gestational diabetes mellitus (GDM) constitutes a risk factor for the development of non insulin-dependent diabetes mellitus (NIDDM). The search for parameters to provide discrimination between a high risk and a low risk for future development of NIDDM is today the aim of many investigations. The absence or presence of several factors such as glycemia during pregnancy and post partum, the need for insulin treatment, disorders of the pancreatic insulin secretion, the number of pregnancies, maternal obesity, the early diagnosis of GDM, the family history of diabetes mellitus, the race and immune disorders give rise to a very high relative risk (RR) of developing NIDDM. To know the degree of risk will allow a future appropriate clinical intervention to reduce the incidence of NIDDM and its economic cost.

Autoimmune thyroid disease and insulin-dependent diabetes mellitus during pregnancy and post partum.

The aim of this study was to assess thyroid dysfunction and autoimmunity in pregnant insulin-dependent diabetes mellitus (IDDM) women during pregnancy and early post partum. Fifteen pregnant IDDM women and 77 healthy pregnant women were studied. Free T4, TSH, TPO-Ab and Tg-Ab were assayed during the first and third trimester of pregnancy and 3 months post partum. In IDDM women FT4 levels significantly decreased (p < 0.05) during third trimester and 3 months post partum and also TPO-Ab during third trimester (p < .01). 26% of IDDM and 4% of the controls presented post partum thyroid dysfunction. We recommend that prepregnant IDDM be screened for TPO-Ab. Those with a positive result would be followed with serial monitoring of free T4 and TSH levels during each trimester as well as during the post partum period.

[Gestational diabetes: new approaches to an old and growing problem]. / Diabetes gestacional: nuevos planteamientos a un antiguo y creciente problema.

Gestational diabetes is defined as glucose intolerance of variable severity with onset or first recognition during pregnancy. Gestational Diabetes generally disappears as soon as the pregnancy is terminated. The prevalence of gestational diabetes is 2% to 13%, depending on the genetic characteristics and environment of the population under study. Classic risk factors identify a population of women at risk of gestational diabetes (obesity, family history of diabetes, or previous poor obstetric history); however, these risk factors identify only 60% of women diagnosed as having gestational diabetes. Therefore, it is necessary to screen all pregnant women, regardless of history, for gestational diabetes. The optimal time to screen for gestational diabetes in pregnancy is between 24 and 28 weeks of gestation. The screening test consist of 50 g of oral glucose followed by a plasma determination at 1 hour. If the plasma glucose 1 hour after the oral load is > or = 140 mg/dl, a glucose tolerance test is indicated. The goal of management (diet, insulin and exercise) of the gestational diabetic women is to maintain normoglycemia, needed to avoid complications for the fetus and mother.

[Diet and non-insulin-dependent diabetes mellitus: historic and current perspectives]. / Dieta y diabetes mellitus no insulinodependiente: perspectiva histórica y actual.

A great majority of patients suffering non insulin dependent dependent diabetes mellitus (NIDDM) can be efficiently controlled with diet, not requiring oral antidiabetic drugs or insulin. The main objective, given the tight relationship between obesity and this type of diabetes, is to decrease caloric intake as well as reducing the amount of saturated fats from the diet in an attempt to delay the onset of cardiovascular manifestations of the disease. Accumulated experience suggests that an increase in carbohydrate intake (60% of the diet) most of which should be food rich in fiber should be recommended given the proven efficacy in improving the control of in blood sugar and lipids. We advocate on the consumption of dry vegetables, and we think that this different attitude in their use is of major importance in NIDDM.