Abstract

Introduction: Gestational diabetes mellitus is a major contributor of perinatal morbidity and mortality. Thyroid hormones play an important role in glucose metabolism and any derangement in its production may lead to development of gestational diabetes mellitus. Thus we aim to find out whether hypothyroidism detected first time in pregnancy is associated with development of gestational diabetes mellitus. Methodology: Antenatal women visiting our medical college hospital out patient department during first trimester satisfying the inclusion criteria, after informed consent were enrolled in the study and routine antenatal investigations that includes serum TSH was done. Between 24-28 weeks gestation oral glucose tolerance test (OGTT) was done. The incidence of GDM in hypothyroid and euthyroid was calculated, based on the International Association of Diabetes in Pregnancy Study Group (IADPSG) criteria for the diagnosis of gestational. Results: The incidence of gestational diabetes was found to be 46.9% in hypothyroid women when compared to 20.8% in euthyroid women. The chance of developing GDM in hypothyroid antenatal women were 3.35 times more than euthyroid antenatal women. Highest number of diagnosis was made with 1 hour blood sugar values both in hypothyroid and euthyroid women as per IADPSG criteria. Conclusion: Our study found a significant number of hypothyroid women developed GDM as compared with euthyroid women. Hence identification of Hypothyroidism in first trimester and screening of GDM subsequently in 2nd trimester using a standardised criteria are important in-order to predict and prevent the perinatal morbidity and mortality caused due to GDM.

• 1.   Tirosh D, Benshalom-Tirosh N, Novack L, Press F, Beer-Weisel R, Wiznitzer A et al. Hypothyroidism and diabetes mellitus - a risky dual gestational endocrinopathy. PeerJ. 2013 Mar 19;1.
• 2.   Nguyen CL, Pham NM, Binns CW, Duong DV, Lee AH. Prevalence of Gestational Diabetes Mellitus in Eastern and Southeastern Asia: A Systematic Review and Meta-Analysis. J Diabetes Res. 2018 Feb 20;2018:6536974.
• 3.   Behboudi-Gandevani S, Amiri M, Bidhendi Yarandi R, Ramezani Tehrani F. The impact of diagnostic criteria for gestational diabetes on its prevalence: a systematic review and meta-analysis. Diabetol Metab Syndr. 2019 Feb 1;11:11.
• 4.   Dhanwal DK, Bajaj S, Rajput R, Subramaniam KA, Chowdhury S, Bhandari R, et al. Prevalence of hypothyroidism in pregnancy: An epidemiological study from 11 cities in 9 states of India. Indian J Endocrinol Metab. 2016 May-Jun;20(3):387-90.
• 5.   Gong LL, Liu H, Liu LH. Relationship between hypothyroidism and the incidence of gestational diabetes: A meta-analysis. Taiwan J Obstet Gynecol. 2016 Apr;55(2):171-5. doi: 10.1016/j.tjog.2016.02.004. PMID: 27125397.
• 6.   Das BP, Deka N, Baishya S. Relationship of Gestational Diabetes Mellitus with Hypothyroidism in Pregnancy Sch. J. App. Med. Sci., October 2015; 3(7D):2719-2723.
• 7.   Erik K. Alexander, Elizabeth N. Pearce, Gregory A. Brent, Rosalind S. Brown, Herbert Chen, Chrysoula Dosiou et al. Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid.Mar,2017.315,389.
• 8.   Mohan V, Mahalakshmi MM, Bhavadharini B, Maheswari K, Kalaiyarasi G, Anjana RM, et al. Comparison of screening for gestational diabetes mellitus by oral glucose tolerance tests done in the non-fasting (random) and fasting states. Acta Diabetol. 2014;51:1007–13.
• 9.   Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy: a World Health Organization Guideline. Diabetes Res Clin Pract. 2014 Mar; 103(3): 341-63.
• 10.   Alejandra Duran, Sofıa Saenz, Marıa J. Torrejon, Elena Bordiu, Laura del Valle, Mercedes Galindo, et al. Introduction of IADPSG Criteria for the Screening and Diagnosis of Gestational Diabetes Mellitus Results in Improved Pregnancy Outcomes at a Lower Cost in a Large Cohort of Pregnant Women: The St. Carlos Gestational Diabetes Study, Diabetes Care Sep 2014, 37 (9) 2442-2450.
• 11.   Mathiyalagen P, Davis P, Sarasveni M. Updated BG Prasad Socio-Economic Classification: The 2020 Update [published online ahead of print, 2020 Jun 5]. Indian J Pediatr. 2020;10.1007/ s12098-020-03362-4.
• 12.   Sreelakshmi PR, Nair S, Soman B, Alex R, Vijayakumar K, Kutty VR. Maternal and neonatal outcomes of gestational diabetes: A retrospective cohort study from Southern India. J Family Med Prim Care. 2015;4(3): 395- 398.
• 13.   Manouchehr Iranparvar, Hosein Ghorbani, Ahad Azami , Hosein Darvishkhah. Thyroid dysfunction and autoimmunity in pregnant women with gestational diabetes mellitus: a cross-sectional study. International Journal of Advances in Medicine. 2015 Nov;2(4):350-353.
• 14.   Giannakou K, Evangelou E, Yiallouros P, Christophi CA, Middleton N, Papatheodorou E et al. Risk factors for gestational diabetes: An umbrella review of meta-analyses of observational studies. PLoS One. 2019 Apr 19;14(4).
• 15.   Vij P, Jha S, Gupta SK, Aneja A, Mathur R, Waghdhare S, et al. Comparison of DIPSI and IADPSG criteria for diagnosis of gestational diabetes mellitus-a prospective study in a suburban multi-speciality hospital. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. Int J Reprod Contracept Obstet Gynecol. 2023 Mar;12(3): 650-653.
• 16.   Nayak PK, Mitra S, Sahoo JP, Daniel M, Mathew A, Padma A. Feto-maternal outcomes in women with and without gestational diabetes mellitus according to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) diagnostic criteria. Diabetes Metab Syndr. 2013;7(4):206-209.
• 17.   Chu SY, Callaghan WM, Kim SY, Schmid CH, Lau J, England LJ, et al. Maternal obesity and risk of gestational diabetes mellitus. Diabetes Care. 2007;30(8):2070-2076.
• 18.   Rajput R, Yadav Y, Nanda S, Rajput M. Prevalence of gestational diabetes mellitus and associated risk factors at a tertiary care hospital in Haryana. Indian J Med Res. 2013;137(4): 728-733.
• 19.   Abu-Heija AT, Al-Bash MR, Al-Kalbani MA. Effects of maternal age, parity and prepregnancy body mass index on the glucose challenge test and gestational diabetes mellitus. J Taibah Univ Med Sci. 2017;12(4):338-342.
• 20.   Hashim M, Radwan H, Hasan H, Obaid RS, Ghazal HA, Hilali MA, et al. Gestational weight gain and gestational diabetes among Emirati and Arab women in the United Arab Emirates: results from the MISC cohort. BMC Pregnancy Childbirth. 2019;19(1):463.
• 21.   Hedderson MM, Gunderson EP, Ferrara A. Gestational weight gain and risk of gestational diabetes mellitus [published correction appears in Obstet Gynecol. 2010 May;115(5):1092]. Obstet Gynecol. 2010;115(3):597-604.
• 22.   MacDonald SC, Bodnar LM, Himes KP, Hutcheon JA. Patterns of Gestational Weight Gain in Early Pregnancy and Risk of Gestational Diabetes Mellitus. Epidemiology (Cambridge, Mass.). 2017 May;28(3):419-427.
• 23.   Song L, Shen L, Li H, Liu B, Zheng X, Zhang L, et al. Socio-economic status and risk of gestational diabetes mellitus among Chinese women. Diabet Med. 2017;34(10):1421- 1427.
• 24.   Bouthoorn SH, Silva LM, Murray SE, Steegers EA, Jaddoe VW, Moll H, et al. Low-educated women have an increased risk of gestational diabetes mellitus: the Generation R Study. Acta Diabetol. 2015;52(3):445-452.
• 25.   Carroll X, Liang X, Zhang W, Zhang W, Liu G, Turner N, et al. Socioeconomic, environmental and lifestyle factors associated with gestational diabetes mellitus: A matched casecontrol study in Beijing, China. Sci Rep. 2018;8(1):8103.
• 26.   Mwanri AW, Kinabo J, Ramaiya K, Feskens EJ. Prevalence of gestational diabetes mellitus in urban and rural Tanzania. Diabetes Res Clin Pract. 2014;103(1):71-78.
• 27.   Arora GP, Thaman RG, Prasad RB, Almgren P, Brøns C, Groop LC, et al. Prevalence and risk factors of gestational diabetes in Punjab, North India: results from a population screening program. Eur J Endocrinol. 2015;173(2): 257-267.
• 28.   Bhavadharini B, Mahalakshmi MM, Anjana RM, Maheswari K, Uma R, Deepa M et al. Prevalence of Gestational Diabetes Mellitus in urban and rural Tamil Nadu using IADPSG and WHO 1999 criteria (WINGS 6). Clin Diabetes Endocrinol. 2016 Apr 5;2:8.

Data Sharing Statement

Funding