Bennur ESEN, Eser Şefik ÖZYÜREK, Dede SİT, Didem KAFADAR, Vüsale GÖZÜTOK, Emel SAĞLAM GÖKMEN, Saadet PİLTEN GÜZEL, Ahmet Engin ATAY

Association of altered thyroid hormone levels with insulin resistance and vitamin D levels in pregnancy

Aim: Thyroid disorders have a crucial impact on maternal and fetal health During pregnancy, there are different results regarding therelationship between thyroid disorders, insulin resistance (IR) and vitamin D levels in different studies.We aimed to investigate theassociation between thyroid hormone levels and IR and vitamin D levels in pregnant women.Material and Methods: In this study, a total of 187 pregnant women between 5-39 gestational weeks consisting of 101 patients withaltered TSH and free T4 (FT4) levels, and 86 patients with normal TSH and FT4 levels, were enrolled in four months period. Their TSH,FT4, Anti TG, Anti TPO,25-hydroxy vitamin D, insulin, glucose,creatinine,hemoglobin levels and age, gravidea, gestational week andinsulin resistance (IR) were defined. Statistical methods were used for analyses.Results: In the group with thyroid hormone alterations, FT4 (p=0.010), creatinine (p=0.001) and glucose (p=0.044) levels weresignificantly higher.Pregnancy week was significantly earlier in the hyperthyroidism group (p=0.001). Vitamin D levels were notassociated with BMI, TSH, FT4, anti TG and anti TPO. Although not significant TSH, anti TPO and vitamin D mean levels were higherin patients who had IR .Those with positive anti-TG and anti-TPO and presence of IR were higher in the study group.Conclusion: In our study, levels of vitamin D and thyroid hormones were not associated; anti TG and anti TPO levels and higherIR presence were observed in pregnant women with altered thyroid hormone levels. During the early gestational weeks, patientsshould closely be monitored for hyperthyroidism and hypothyroidism as well as insulin resistance for detecting DM throughout thetrimesters of gestational period.

PDF

___

1. Krassas GE, Poppe K, Glinoer D. Thyroid function and human reproductive health. Endocr Rev 2010;31:702- 55.
2. De Vivo A, Mancuso A, Giacobbe A, et al. Thyroid function in women found to have early pregnancy loss. Thyroid 2010;20:633-7.
3. Sezer K, Kamel N, Unlu C, et al.Impact of first trimester and postpartum period thyroid autoantibodies on abortus incidence in Turkish pregnant women. Gynecol Endocrinol 2009;25:387-91.
4. Prummel MF, Wiersinga WM.Thyroid autoimmunity and miscarriage. Eur J Endocrinol 2004;150:751-5.
5. De Groot L, Abalovich M, Alexander EK, et al. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2012;97:2543-65.
6. Ashwal E, Hod M. Gestational diabetes mellitus: Where are we now? Clin Chim Acta 2015 7;451:14-20.
7. Sheffield JS, Butler-Koster EL, Casey BM, et al.Maternal diabetes mellitus and infant malformations. Obstet Gynecol 2002:100:925-30.
8. Kc K, Shakya S, Zhang H. Gestational diabetes mellitus and macrosomia: a literature review. Ann Nutr Metab 2015;66:14-20.
9. Negro R, Mestman JH. Thyroid disease in pregnancy. Best Pract Res Clin Endocrinol Metab. 2011;25:927- 43.
10. Bodnar LM, Catov JM, Simhan HN, et al. Maternal vitamin D deficiency increases the risk of preeclampsia. J Clin Endocrinol Metab.2007; 92:3517-22.
11. Alzaim M, Wood RJ. Vitamin D and gestational diabetes mellitus. Nutr Rev 2013;71:158-67.
12. Levenson CW, Figueirôa SM. Gestational vitamin D deficiency: long-term effects on the brain. Nutr Rev 2008;66:726-9.
13. Matthews DR, Hosker JP, Rudenski AS, et al. Homeostasis model assessment: Insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985;28:412-9.
14. Holick MF. Vitamin D Status: Measurement, interpretation, and clinical application.Ann Epidemiol 2009;19:73-8.
15. Pascual Corrales E, Andrada P, Aubá M, et al. Is autoimmune thyroid dysfunction a risk factor for gestational diabetes? Endocrinol Nutr 2014;61:377- 81.
16. Yang Y, Li Q, Wang Q, et al.Thyroid antibodies and gestational diabetes mellitus: a meta-analysis. Fertil Steril 2015;104:665-71.
17. Olivieri A, Valensise H, Magnani F, et al. High frequency of antithyroid autoantibodies in pregnant women at increased risk of gestational diabetes mellitus. Eur J Endocrinol 2000;143:741-7.
18. Bitterman O, Bongiovanni M, Giuliani C, et al.Anti thyroperoxidase and anti thyroglobulin antibodies in diabetic pregnancies. J Endocrinol Invest 2014;37:911-5.
19. Agarwal MM, Dhatt GS, Punnose J,et al. Thyroid function abnormalities and antithyroid antibody prevalence in pregnant women at high risk for gestational diabetes mellitus.Gynecol Endocrinol 2006;22:261-6.
20. Velkoska Nakova V, Krstevska B, Dimitrovski Ch, et al. Prevalence of thyroid dysfunction and autoimmunity in pregnant women with gestational diabetes and diabetes type 1. Prilozi 2010;31:51-9.
21. Shahbazian H, Shahbazian N, Rahimi Baniani M, et al. Evaluation of thyroid dysfunction in pregnant women with gestational and pre-gestational diabetes. Pak J Med Sci 2013;29:638-41.
22. Stohl HE, Ouzounian J, Rick AM, et al. Thyroid disease and gestational diabetes mellitus (GDM): is there a connection? J Matern Fetal Neonatal Med 2013; 26:1139-42.
23. Zhou X, Li Z, Li B, et al. Expression and Clinical Significance of Serum 25-OH-D in pregnant women with SCH (Subclinical Hypothyroidism) and GDM (Gestational Diabetes Mellitus). Pak J Med Sci. 2018;34:1278-82.
24. Haddow JE, Metzger BE, Lambert-Messerlian G, et al. Maternal BMI, Peripheral Deiodinase Activity, and Plasma Glucose: Relationships Between White Women in the HAPO Study. J Clin Endocrinol Metab. 2019;104:2593-600.
25. Mutlu N, Esra H, Begum A, et al. Relation of maternal vitamin D status with gestational diabetes mellitus and perinatal outcome. Afr Health Sci. 2015;15:523- 31.
26. Takiishi T, Gysemans C, Bouillon R, et al. Vitamin D and diabetes. Endocrinol Metab Clin North Am 2010;39:419-46.
27. Palomer X, González-Clemente JM, Blanco-Vaca F, et al. Role of vitamin D in the pathogenesis of type 2 diabetes mellitus. Diabetes Obes Metab. 2008;10:185- 97.
28. Zhao Y,Miao W, Li C,et al.Dynamic changes in serum 25-hydroxyvitamin D during pregnancy and lack of effect on thyroid parameters. PLoS One 2014;9:90161.
29. Choi YM, Kim WG, Kim TY, et al. Low levels of serum vitamin D3 are associated with autoimmune thyroid disease in pre-menopausal women. Thyroid 2014;24: 655-61.
30. Wang J, Lv S, Chen G, et al. Meta-analysis of the association between vitamin D and autoimmune thyroid disease. Nutrients 2015;7:2485-98.
31. Goswami R, Marwaha RK, Gupta N, et al. Prevalence of vitamin D deficiency and its relationship with thyroid autoimmunity in Asian Indians: a community-based survey. Br J Nutr 2009;102:382-6.
32. Rhee CM .The interaction between thyroid and kidney disease: an overview of the evidence. Curr Opin Endocrinol Diabetes Obes 2016;23:407-15.
33. Buraczewska E,Sokołowska B, Mazurkiewicz B, et al.An analysis of the level of knowledge about diabetes among pregnant women. Family Medicine & Primary Care Review 2016;18:225-9.
34. Yong HY, Zalilah MS, Tan CW, et al. Pre-pregnancy BMI and intake of energy and calcium are associated with the vitamin D intake of pregnant Malaysian women. Family Medicine & Primary Care Review 2017;19:417- 23.