Gestational diabetes mellitus and hypothyroidism: two sides of the same coin
https://doi.org/10.23946/2500-0764-2023-8-2-120-128
Abstract
Aim. To perform a systematic review of common risk factors and prognostic markers of gestational diabetes mellitus (GDM) and hypothyroidism (HT), as well as maternal and perinatal complications in these diseases. For achieving this task, we screened and analysed the relevant data from the publications in a PubMed database over the past 6 years.
Key Points. A common risk factor for both diseases is obesity, which is characterized by pregestational insulin resistance, as well as the combination of by low-grade chronic inflammation and metabolic dysfunction termed as meta-inflammation. Antibodies to the thyroid-stimulating hormone receptor (TSHR) are associated with the reduced the risk of GDM. Studies on pathogenesis of pre-eclampsia in patients with GDM and HT have shown unequivocal results, although most of them suggest both HT and GDM as risk factors for the development of this pregnancy complication. Elevated levels of thyroid-stimulating hormone are associated with reduced antioxidant capacity and long-term endothelial activation. The heterogeneity of the anemia in GDM requires a rigorous differential diagnosis.
Conclusion. GDM and HT are the most common endocrine diseases during pregnancy which significantly increase the risk of maternal and perinatal complications. Common risk factors, interrelationship, and ambiguous data on GDM and HT development mechanisms indicate the need for screening and detailed monitoring of patients with thyroid dysfunction for early detection and correction of hyperglycemia.
About the Authors
M. L. Leffad
Peoples’ Friendship University of Russia
Russian Federation
Russian Federation
Dr. Mohamed L. Leffad, MD, PhD Student, Department of Obstetrics, Gynecology and Perinatology, Medical Institute
6, Miklukho-Maklaya Street, Moscow, 117198
N. M. Startseva
Peoples’ Friendship University of Russia
Russian Federation
Russian Federation
Prof. Nadezhda M. Startseva, MD, DSc, Professor, Department of Obstetrics, Gynecology and Perinatology
6, Miklukho-Maklaya Street, Moscow, 117198
S. M. Semyatov
Peoples’ Friendship University of Russia
Russian Federation
Russian Federation
Prof. Said M. Semyatov, MD, DSc, Professor, Department of Obstetrics, Gynecology and Perinatology
6, Miklukho-Maklaya Street, Moscow, 117198
A. S. Anikeev
Peoples’ Friendship University of Russia
Russian Federation
Russian Federation
Dr. Andrey S. Anikeev, MD, PhD Student, Department of Obstetrics, Gynecology and Perinatology
6, Miklukho-Maklaya Street, Moscow, 117198
M. I. Sviridova
Bauman City Clinical Hospital No. 29
Russian Federation
Russian Federation
Dr. Maria I. Sviridova, MD, PhD, Head of the Center for Pregnant Women Endocrine Diseases
2, Gospitalnaya Square, Moscow, 111020
References
1. Gestatsionnyi sakharnyi diabet. Diagnostika, lechenie, akusherskaya taktika, poslerodovoe nablyudenie. Rossiiskaya assotsiatsiya endokrinologov, Rossiiskoe obshchestvo akusherov-ginekologov. 2020. (In Russ). Available at: http://niiomm.ru/attachments/article/523/Гестационный%20са-харный%20диабет.%20Диагностика,%20лечение,%20акушерская%20тактика,%20послеродовое%20наблюдение%20.pdf. Accessed: 10 March 2023.
2. International Diabetes Federation. IDF Diabetes atlas. 10 the edn. Brussels, Belgium : 2021. Available at: https://www.diabetesatlas.org. Accessed: 10 March 2023.
3. Wang H, Li N, Chivese T, Werfalli M, Sun H, Yuen L, Hoegfeldt CA, Elise Powe C, Immanuel J, Karuranga S, Divakar H, Levitt N, Li C, Simmons D, Yang X; IDF Diabetes Atlas Committee Hyperglycaemia in Pregnancy Special Interest Group. IDF Diabetes Atlas: Estimation of Global and Regional Gestational Diabetes Mellitus Prevalence for 2021 by International Association of Diabetes in Pregnancy Study Group's Criteria. Diabetes Res Clin Pract. 2022;183:109050. https://doi.org/10.1016/j.diabres.2021.109050
4. Ortega-Contreras B, Armella A, Appel J, Mennickent D, Araya J, González M, Castro E, Obregón AM, Lamperti L, Gutiérrez J, Guzmán-Gutiérrez E. Pathophysiological Role of Genetic Factors Associated With Gestational Diabetes Mellitus. Front Physiol. 2022;13:769924. https://doi.org/10.3389/fphys.2022.769924
5. Song RH, Wang B, Yao QM, Li Q, Jia X, Zhang JA. The Impact of Obesity on Thyroid Autoimmunity and Dysfunction: A Systematic Review and Meta-Analysis. Front Immunol. 2019;10:2349. https://doi.org/10.3389/fimmu.2019.02349
6. Startseva NM, Sviridova MI, Uchamprina VA. Anikeev AS, Leffad L.M. Gestational diabetes mellitus and hypothyroidism: disease comorbidity. Obstetrics and Gynecology: News, Opinions, Training. 2021;9(3):11-16. https://doi.org/10.33029/2303-9698-2021-9-3-11-16
7. Biondi B, Kahaly GJ, Robertson RP. Thyroid Dysfunction and Diabetes Mellitus: Two Closely Associated Disorders. Endocr. Rev. 2019;40(3):789-824. https://doi.org/10.1210/er.2018-00163
8. Uchamprina VA, Bobrova EI, Kandalina VV, Sviridova MI, Ulyanova OA. Hypothyroidism and gestational diabetes mellitus: Is there a relationship? Russian Open Medical Journal. 2022;11:e0210 (In Russ). https://doi.org/10.15275/rusomj.2022.0210
9. Gipotireoz. Clinical guidelines. Rossiiskaya assotsiatsiya endokrinologov. 2021. Available at: https://diseases.medelement.com. Accessed: 10 March 2023.
10. Dedov II. Endocrinology: a national guide. Moscow: GEOTAR-Media; 2021:1112 p. (in Russ). ISBN 978-5-9704-6054-2
11. López-Muñoz E, Mateos-Sánchez L, Mejía-Terrazas GE, Bedwell-Cordero SE. Hypothyroidism and isolated hypothyroxinemia in pregnancy, from physiology to the clinic. Taiwan J Obstet Gynecol. 2019;58(6):757-763. https://doi.org/10.1016/j.tjog.2019.09.005
12. Blokhin NG, Shevchenko DM. Gestational diabetes mellitus. VF Snegirev archives of obstetrics and gynecology. 2017;4(2):61-67. (In Russ). https:// doi.org/ 10.18821/2313-8726-2017-4-2-61-67.
13. Plows JF, Stanley JL, Baker PN, Reynolds CM, Vickers MH. The Pathophysiology of Gestational Diabetes Mellitus. Int J Mol Sci. 2018;19(11):3342. https://doi.org/10.3390/ijms19113342
14. Modzelewski R, Stefanowicz-Rutkowska MM, Matuszewski W, Bandurska-Stankiewicz EM. Gestational Diabetes Mellitus-Recent Literature Review. J Clin Med. 2022;11(19):5736. https://doi.org/10.3390/jcm11195736
15. Mosavat M, Omar SZ, Jamalpour S, Tan PC. Serum Glucose-Dependent Insulinotropic Polypeptide (GIP) and Glucagon-Like Peptide-1 (GLP-1) in association with the Risk of Gestational Diabetes: A Prospective Case-Control Study. J Diabetes Res. 2020;9072492. https://doi.org/10.1155/2020/9072492..
16. Kapustin RV, Onopriĭchuk AR, Arzhanova ON, Polyakova VO, Alekseyenkova EN. Pathophysiology of placenta and fetus in diabetes mellitus. Journal of Obstetrics and Women’s Diseases. 2018;67(6):79-92. (In Russ). https://doi.org/10.17816/JOWD67679-92
17. Shahid MM, Rahman KMT, Gomes RR, Ferdous M, Ferdousi S, Zahan T. Association of gestational diabetes mellitus and thyroid status during pregnancy: a cross-sectional study in a tertiary health care center of Bangladesh. Gynecol Endocrinol. 2021;37(4):312-314. https://doi.org/10.1080/09513590.2020.1866531
18. Sweeting A, Wong J, Murphy HR, Ross GP. A Clinical Update on Gestational Diabetes Mellitus. Endocr Rev. 2022;26(43):763-793. https://doi.org/10.1210/endrev/bnac003
19. Popova PV, Klyushina AA, Vasilyeva LB, Tkachuk AS, Vasukova EA, Anopova AD, Pustozerov EA, Gorelova IV, Kravchuk EN, Li O, Pervunina TM, Kostareva AA, Grineva EN. Association of Common Genetic Risk Variants With Gestational Diabetes Mellitus and Their Role in GDM Prediction. Front Endocrinol (Lausanne). 2021;12:628582. https://doi.org/10.3389/fendo.2021.628582
20. Dasari P, Nanda N. Pregnancies Complicated by Diabetes, Hypertension and Hypothyroidism: Role of Insulin Resistance. Int J Clin Exp Physiol. 2020;7(4):131-4. https://doi.org/10.5530/ijcep.2020.7.4.35.
21. O'Malley EG, Reynolds CME, Killalea A et al. Maternal Obesity And Dyslipidemia Associated With Gestational Diabetes mellitus (GDM). Eur J Obstet Gynecol Reprod Biol. 2020;246:67-71. https://doi.org/10.1016/j.ejogrb.2020.01.007
22. Epishkina-Minina AA, Hamoshina MB, Grabovskij VM, Startseva NM, Papysheva OV, Kostin IN. Gestacionnyj saharnyj diabet: sovremennoe sostojanie problemy. Obstetrics and gynecology. News. Views. Education. 2018;2018;S3:23-29. (In Russ). https://doi.org/10.24411/2303-9698-2018-13903
23. Dash P, Tiwari R, Nayak S, Jena SK, Mangaraj M. Prevalence of Subclinical Hypothyroidism in Pregnancy and Its Association With Antithyroperoxidase Antibody and the Occurrence of Gestational Diabetes Mellitus. Cureus. 2022;14(1):e21087. https://doi.org/10.7759/cureus.21087
24. Wang J, Gong XH, Peng T, Wu JN. Association of Thyroid Function During Pregnancy With the Risk of Pre-eclampsia and Gestational Diabetes Mellitus. Endocr Pract. 2021;27(8):819-825. https://doi.org/10.1016/j.eprac.2021.03.014
25. Leng J, Li W, Wang L, Zhang S, Liu H, Li W, Wang S, Shao P, Pan L, Wang S, Liu E. Higher thyroid-stimulating hormone levels in the first trimester are associated with gestational diabetes in a Chinese population. Diabet Med. 2019;36(12):1679-1685. https://doi.org/10.1111/dme.14106
26. Parveen H, Durrani AM, Ali SM. Noor N. Association of hypothyroidism in pregnant women with hyperglycaemia. Int J Health Sci Res. 2019;9(9):325-329.
27. Rawal S, Tsai MY, Hinkle SN, Zhu Y, Bao W, Lin Y, Panuganti P, Albert PS, Ma RCW, Zhang C. A Longitudinal Study of Thyroid Markers Across Pregnancy and the Risk of Gestational Diabetes. J Clin Endocrinol Metab. 2018;103(7):2447-2456. https://doi.org/10.1210/jc.2017-02442
28. Zhang Y, Sun W, Zhu S, Huang Y, Huang Y, Gao Y, Zhang J, Yang H, Guo X. The Impact of Thyroid Function and TPOAb in the First Trimester on Pregnancy Outcomes: A Retrospective Study in Peking. J Clin Endocrinol Metab. 2020;105(3):dgz167. https://doi.org/10.1210/clinem/dgz167
29. Yanachkova V, Kamenov Z. The relationship between thyroid dysfunction during pregnancy and gestational diabetes mellitus. Endokrynol. Pol. 2021;72(3):226-231. https://doi.org/10.5603/EP.a2021.0016
30. Wang Y, Sun F, Wu P, Huang Y, Ye Y, Yang X, Yuan J, Liu Y, Zeng H, Wen Y, Qi X, Yang CX, Wang Y, Liu G, Chen D, Li L, Pan XF, Pan A. A Prospective Study of Early-pregnancy Thyroid Markers, Lipid Species, and Risk of Gestational Diabetes Mellitus. J Clin Endocrinol Metab. 2022;107(2):e804-e814. https://doi.org/10.1210/clinem/dgab637
31. Lee SY, Cabral HJ, Aschengrau A, Pearce EN. Associations Between Maternal Thyroid Function in Pregnancy and Obstetric and Perinatal Outcomes. J Clin Endocrinol Metab. 2020;105(5). https://doi.org/10.1210/clinem/dgz275
32. Mallawa Kankanamalage O, Zhou Q, Li X. Understanding The Pathogenesis of Gestational Hypothyroidism. Front Endocrinol (Lausanne). 2021;25(12). https://doi.org/10.3389/fendo.2021.653407
33. Vinogradova OP, Rakhmatullov FK, Ostanin MA. The thyroid status of the mother, as an indicator of fetal development. Universum: meditsina i farmakologiya. 2021;7-8(79). (In Russ). https://doi.org/10.32743/UniMed.2021.79.7-8.12178
34. Han Y, Wang J, Wang X, Ouyang L, Li Y. Relationship Between Subclinical Hypothyroidism in Pregnancy and Hypertensive Disorder of Pregnancy: A Systematic Review and Meta-Analysis. Front Endocrinol (Lausanne). 2022;13:823710. https://doi.org/10.3389/fendo.2022.823710
35. Banik P, Devi RKP, Bidya A, Tamphasana A, Agalya M, Singh L.R. et al. Thyroid Dysfunction In Preeclampsia And Related Fetomaternal Outcomes. Int. J. Reprod. Contracept. Obstet. Gynaecol. 2019;8(5):1928-1933. https:// doi.org/10.18203/2320-1770.ijrcog20191944
36. Ye W, Luo C, Huang J, Li C, Liu Z, Liu F. Gestational diabetes mellitus and adverse pregnancy outcomes: systematic review and meta-analysis. BMJ. 2022;377:e067946. https://doi.org/10.1136/bmj-2021-067946
37. Kiran Z, Sheikh A, Humayun KN, Islam N. Neonatal Outcomes And Congenital Anomalies In Pregnancies Affected By Hypothyroidism. Ann Med. 2021;53:1560-1568. https://doi.org/10.1080/07853890.2021.1970798
38. Mahadik K, Choudhary P, Roy PK. Study of thyroid function in pregnancy, its feto-maternal outcome; a prospective observational study. BMC Pregnancy Childbirth. 2020;20(1):769. https://doi.org/10.1186/s12884-020-03448-z
39. Lee SY, Cabral HJ, Aschengrau A, Pearce EN. Associations maternal thyroid function in pregnancy and obstetric and perinatal outcomes. J. Clin. Endocrinol. Metab. 2020;105(5):e2015-e2023. https:// doi.org/10.1210/clinem/dgz275
40. Urvanova EYu. Chastota patologii shchitovidnoy zhelezy u beremennykh s gestatsionnym sakharnym diabetom. Aktual'nye voprosy nauki i obrazovaniya: teoreticheskie i prakticheskie aspekty: materialy mezhdunar. nauchn.-prakt. konf. Neftekamsk: Mir nauki; 2020:148-151. (In Russ).
41. Preeklampsiya. Eklampsiya. Oteki, proteinuriya i gipertenzivnye rasstroĭstva vo vremya beremennosti, v rodakh i poslerodovom periode. Klinicheskie rekomendatsii. ROAG, AAR, AAAR. 2021. (In Russ). Available at: https:// diseases.medelement.com/disease/преэклампсия-эклампсия-отеки-про-теинурия-и-гипертензивные-расстройства-во-время-беременно-сти-в-родах-и-послеродовом-периоде-кп-рф-2021/16973. Accessed: 10 March 2023.
42. Mahadik K, Choudhary P, Roy PK. Study of thyroid function in pregnancy, its feto-maternal outcome; a prospective observational study. BMC Pregnancy Childbirth. 2020;20(1):769. https://doi.org/10.1186/s12884-020-03448-z
43. Cherukuri SV, Anuradha M, Shanmugapriya C, Debora P. Impact of maternal hypothyroidism in women with gestational diabetes mellitus and its adverse pregnancy outcomes in south indian population - a prospective study. Journal of Pharmaceutical Negative Results. 2022;13(5):1551-1556. https://doi.org/10.47750/pnr.2022.13.S05.%20243
44. Barišić T, Mandić V, Vasilj A, Tiric D. Higher levels of thyrotropin in pregnancy and adverse pregnancy outcomes. J Matern Fetal Neonatal Med. 2019;32(17):2883-2888. https://doi.org/10.1080/14767058.2018.1451509
45. Khadir F, Rahimi Z, Vaisi-Raygani A, Shakiba E., Naseri R. Gestational diabetes mellitus (gdm), hypothyroidism, and gene variants (keap1 rs11085735) in patients with preeclampsia. Rep Biochem Mol Biol. 2022;11(3):493-501. https://doi.org/10.52547/rbmb.11.3.493
46. Khadir F, Rahimi Z, Vaisi-Raygani A, Shakiba E, Naseri R. Gestational Diabetes Mellitus (GDM), Hypothyroidism, and Gene Variants (Keap1 Rs11085735) in Patients with Preeclampsia. Rep Biochem Mol Biol. 2022;11(3):493-501. https://doi.org/10.52547/rbmb.11.3.493
47. Abel MH, Caspersen IH, Sengpiel V, Jacobsson B, Meltzer HM, Magnus P, Alexander J, Brantsæter AL. Insufficient maternal iodine intake is associated with subfecundity, reduced foetal growth, and adverse pregnancy outcomes in the Norwegian Mother, Father and Child Cohort Study. BMC Med. 2020;18(1):211. https://doi.org/10.1186/s12916-020-01676-w
48. Businge CB, Longo-Mbenza B, Kengne AP. Iodine deficiency in pregnancy along a concentration gradient is associated with increased severity of preeclampsia in rural Eastern Cape, South Africa. BMC Pregnancy Childbirth. 2022;22(1):98. https://doi.org/10.1186/s12884-021-04356-6
49. Poon LC, Shennan A, Hyett JA, Kapur A, Hadar E, Divakar H, McAuliffe F, da Silva Costa F, von Dadelszen P, McIntyre HD, Kihara AB, Di Renzo GC, Romero R, D'Alton M, Berghella V, Nicolaides KH, Hod M. The International Federation of Gynecology and Obstetrics (FIGO) initiative on pre-eclampsia: A pragmatic guide for first-trimester screening and prevention. Int J Gynaecol Obstet. 2019;145 Suppl1(Suppl1):1-33. https:// doi.org/10.1002/ijgo.12802
50. Epishkina-Minina AA, Hamoshina MB, Startseva NM, Damirova SF, Zyukina ZV, Anikeev AS. Gestacionnyj saharnyj diabet i anemija: kontraversii patogeneza. Obstetrics and gynecology. News. Views. Education. 2020;8(3):86-93. (In Russ). https://doi.org/10.24411/2303-9698-2020-13914
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For citations:
Leffad M.L., Startseva N.M., Semyatov S.M., Anikeev A.S., Sviridova M.I. Gestational diabetes mellitus and hypothyroidism: two sides of the same coin. Fundamental and Clinical Medicine. 2023;8(2):120-128. (In Russ.) https://doi.org/10.23946/2500-0764-2023-8-2-120-128
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