Prevalence of thyroid dysfunction and autoimmunity in pregnant women with gestational diabetes and diabetes type 1.

OBJECTIVE: The aim of the present study was to determine the prevalence of abnormal thyroid function and antithyroid antibodies during pregnancy in women with diabetes type 1 and gestational diabetes mellitus (GDM). METHODS: The study group included 83 pregnant women who attended the Outpatient Department of the Endocrinology, Diabetes and Metabolic Disorders Clinic in the period from 05.2009 to 11.2009. The one hundred-g. oral glucose tolerance test (OGTT) was conducted on the pregnant women except for women with diabetes type 1. Thyroid functions were evaluated in all the pregnant women. After routine screening for GDM, thirty of the pregnant women were healthy and GDM was diagnosed in forty of them. The rest, thirteen women, had diabetes type 1. RESULTS: The women who developed GDM showed a mean free thyroxin concentration (fT4) significantly lower than that observed in the healthy pregnant women and women with diabetes type 1. Among the pregnant women with GDM, 10 women or 25% had fT4 concentrations below the lower cut-off with normal thyroid-stimulating hormone concentrations (TSH). A statistically significant difference was found in the prevalence of antithyroid antibodies (anti-TPO) between the (30%) women with diabetes type 1 and (10%) healthy pregnant women (p<0.05). In the women positive for anti-TPO, TSH was significantly higher (p<0.05). CONCLUSION: The significantly higher prevalence of hypothyroxinemia in GDM pregnancies and anti-TPO titres in pregnancies with diabetes type 1, than in healthy pregnant women warrants routine screening for thyroid abnormalities in these groups of pregnant women.

Dyslipidaemia and hypertension in patients with subclinical hypothyroidism.

OBJECTIVE: The aim of this study was to assess whether subclinical hypothyroidism (SCH) is associated with dyslipidaemia and arterial hypertension. METHODS: At the Department of Endocrinology, Diabetes and Metabolic Disorders, Skopje, R. Macedonia, we examined 24 consecutive patients with SCH and 13 healthy controls in a period of 6 months. SCH was defined as an elevated thyrotropin (TSH) (> 4.2 mU/l) and normal free thyroxine (fT4) level (10.3-24.45 pmol/l). None of the patients had been previously treated with thyroxine. In all participants we determined blood pressure, body mass index (BMI), TSH, fT4, antibodies to thyroid peroxidise (TPOabs), total lipids (TL), total cholesterol (TH), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides. RESULTS: Mean diastolic blood pressure increased in SCH patients vis-a-vis controls (85 vs. 74 mmHg; p < 0.05). Mean values of TL, TH, HDL-C, LDL-C, triglycerides, TC/HDL-C, and LDL-C/HDL-C were no different in patients with SCH compared with controls. Individual analysis revealed that the percentages of patients with SCH having arterial hypertension (29%), hypertriglyceridaemia (34.78%), elevated LDL-C (41.66%), elevated TC/HDL-C (21.7%), and LDL-C/HDL-C (21.74%) ratios were higher than the percentages in controls. No significant correlation between TSH and biochemical parameters was detected. CONCLUSION: Our study revealed that SCH patients have a greater prevalence of dyslipidaemia and arterial hypertension, and, as well, a greater value of mean diastolic pressure vs. control patients.

Association between foetal growth and different maternal metabolic characteristics in women with gestational diabetes mellitus.

OBJECTIVE: The aim of the study was to investigate the association between foetal growth and different maternal metabolic characteristics in women with gestational diabetes mellitus (GDM). METHODS: The study group included 200 consecutive pregnant women who attended the Endocrinology, Diabetes and Metabolic Disorders Outpatient Department in the period from 02.2006 to 02.2009 with singleton pregnancy and GDM diagnosed following ADA criteria. The following parameters were studied: pre-pregnancy maternal body mass index (BMI), 3-hours 100g oral glucose tolerance test (OGTT) results, glycosylated haemoglobin (HbA1c), total lipids (TL), total cholesterol (TH), triglycerides (TG), HDL- and LDL-cholesterol levels at admission. Neonatal birth weight and the prevalence of being large for gestational age (LGA) was an end-point. RESULTS: We found a significant association between birth weight and pre-pregnancy BMI, HDL-C and birth weight of a large child born previously. Birth weight of a large child born previously was the strongest independent predictor for LGA. The prevalence of LGA (from 27% to 80%) was related to a number of altered maternal characteristics. CONCLUSION: Pre-pregnancy BMI, HDL-C and birth weight of a large child born previously are the independent predictors for LGA, but results of glucose levels during OGTT are not useful in the prediction of LGA in GDM pregnancies. Probably more factors and other maternal metabolic parameters than glucose levels during OGTT are responsible for the risk of LGA.

Gestational Diabetes Mellitus - the impact of maternal body mass index and glycaemic control on baby's birth weight.

OBJECTIVES: To asses the influence of the maternal BMI and glycaemic control in women with GDM on the baby's birth weight (BW). MATERIAL AND METHODS: We analysed 180 women with GDM. Macrosomia has been defined as BW > 4000 gm, small for gestational age < 2700 gm and appropriate for gestational age between both. According to the baby s BW the pregnant women were divided into three groups: group 1 (G1) with BW < 2700 gm (n = 26); group 2 (G2) with BW between 2700 to 4000 gm (n = 117), and group 3 (G3) with BW > 4000 gm (n = 37). We also analysed BMI (kg/m2), HbA1c (%), PPG (mmol/L) and time of delivery (WG). RESULTS: Comparisons between G1 and G2 showed: BMI (30.7 +/- 5 & 31 +/- 5.2; p < 0.7), HbA1c (6.4 +/- 0.8 & 5.1 +/- 0.8, p < 0.002), PPG (8.2 +/- 1.7 & 6.9 +/- 1.5, p < 0.02), time of delivery (35.2 +/- 3.8 & 38.6 +/- 1.5, p < 0.0001) and BW (2289 +/- 504 & 3474 +/- 334, p < 0.0001). Comparisons between G2 and G3 showed: BMI (31 +/- 5. 2 & 33.4 +/- 6.1; p < 0.02), HbA1c (5.2 +/- 1.1 & 6.4 +/- 2.3, p < 0.02), PPG (6.9 +/- 1.5 & 8.2 +/- 1.9, p < 0.02), time of delivery (38.6 +/- 1.5 & 39.3 +/- 1.4, p < 0.01) and BW (3474 +/- 334 & 4431 +/- 302, p < 0.0001). Comparisons between G1 and G3 showed the difference at delivery time and the baby's BW (p < 0.0001). CONCLUSIONS: Maternal obesity and PPG contribute to macrosomia and also PPG to SGE.