Study Of The Correlation Of Gestational Diabetes And Gestational Hypertensive Disorders And Thyroid Dysfunction In The Pregnancy

Background Thyroid disfuction, Gestational diabetes (GDM) and Gestationalhypertension is a common complication in pregnant women, If this diseases not bediagnosed and treated on time,it will have a negative impact on the health of mother andchild. Most of the previous research focuses on the relationship of hyperthyroidism andhypothyroidism during pregnancy with GDM and gestational hypertension disease, fewstudies have examined the relationship of mild thyroid dysfunction (including normalthyroid function but positive thyroid peroxidase antibodies, clinicalhyperthyroidism and the subclinical hypothyroidism, low T4hyperlipidemia) and GDMand gestational hypertensive. The purpose of this study is to analyse the way of thyroidfunction changes in the patient who get GDM and gestational hypertensive disorders indifferent periods of pregnancy by retrospective case-control study, and the morbidityincidence of thyroid dysfunction in those people; Try to provide a reference for theprevention of common complications of pregnancy.Objective To investigate the correlation of the thyroid dysfunction and gestationaldiabetes and hypertensive disorders in pregnancy.Methods By retrospective case-control study,take total of1230patients in thestudy who came to Beijing Friendship Hospital, Capital Medical University maternityclinic for prenatal care early maternal from August2010to May2012, confirmed asingle live births by B-ultrasound, hypertension, diabetes before pregnancy wereexcluded; There was no history of thyroid disease and other diseases. Study group are257cases, diagnosed as gestational diabetes after20weeks,(diabetic group) and48patients after20weeks of pregnancy diagnosed as hypertensive disorders(hypertensiongroup); control group are total925cases, gestational age matched group of diabeticgroup and hypertension group, the third trimester of pregnancy blood pressure andblood sugar is normal and not have diseases of other systems. By Chemiluminescence method, in8-12weeks of pregnancy (first trimester),24-28weeks (second trimester),36weeks-before delivery (third trimester) detected three groups of maternal thyroidfunction (8-12weeks of pregnancy thyroid hormone uptake, T3, T4, FT3, FT4, TSH;24-28weeks of pregnancy,36weeks-pre-delivery inspection FT4and TSH), comparethe level of thyroid function and thyroid function abnormalities of the three groups inthe different periods of pregnancy.Results: The Features of three groups of pregnancy three periods in thyroidfunction: As the pregnancy progresses, Thyroid fuction of the three groups showsincreases in TSH median value, downward trend in FT4median value, and from earlypregnancy trimester to mid-pregnancy changed faster.TSH median in the hypertensiongroup increased by10.53%, the GDM group increased by8.02%, the control groupincreased by9.73%, The difference is no statistically significant;FT4median valuedecline of27.5%in the hypertension group, the GDM group decreased by29.63%, adecrease of22.78%in the control group, the difference of GDM group and controlgroup is statistically significant (P=0.025); The TSH median value of hypertensiongroup and GDM group are higher than that of the control group, and the growth trend ishigher than the control group, FT4median value in the hypertension group and diabetesgroup was significantly lower than the the control group, the difference of diabeticgroup and the control group was significant (P=0.03). The morbidity of clinicalthyrotoxicosis in Diabetic group only early pregnancy higher than that of the controlgroup, but by the number of cases limits the difference was not statistically significant,The morbidity of the low T4hypothyroxinemia and subclinical thyroid dysfunctionwere significantly higher than those in the control group, and the difference wasstatistically significant (respectively P=0.018, P=0.001). In the hypertension groupsubclinical hypothyroidism morbidity and low T4hyperlipidemia are higher than that incontrol group, to the third trimester low T4hyperlipidemia cumulative morbidity wassignificantly higher than that in the control group, and the difference was statisticallysignificant (P=0.035)(3)The morbidity of TPO positive and normal thyroid function inhypertensive group was significantly higher than that in the control group,approximately is1.75times of the control group, the difference was significant (P= 0.016). This thyroid dysfunction lower in the diabetic group than the control group, thecontrol group was approximately2.83times the diabetic group, and the difference wasstatistically significant (P=0.000).Conclusion Compared with normal pregnant women, hypertensive disordersin pregnancy and GDM patients with higher TSH levels and lower level of FT4,andTSH rises and FT4drop even more sharply with the progress of pregnancy, suggestingthat hypertensive disorders in pregnancy and gestational diabetes patients before thediagnosed as those disease,thyroid function is already not compensated.(2) withnormal pregnant women, the morbidity of thyroid dysfunction hypertensive disorders ishigher in the patients who had gestational hypertensive disorders and gestationaldiabetes, especially the incidence of mild thyroid dysfunction, it is recommended thatthis routine screening of thyroid function is necessary in those patients.