Correlation Study Of The GDM And The Thyroid Function And The Preliminary Study Of The Serum 25-hydroxy Vitamin D Levels Association With The Both

BackgroundGestational diabetes mellitus(GDM)refers to the normal glucose metabolism or potential decreased glucose tolerance before pregnancy,and has classically been defined as any glucose intolerance first identified during pregnancy.The criteria of diagnosis and treatment of GDM proposed by American Diabetes Association was as follows:doing the 75-g OGTTs test at 24-28 weeks of gestation,all women with a fasting plasma glucose level>5.1 mmol/L(92 mg/dL),a 1-hour level>10.0 mmol/L(180 mg/dL),or a 2-hour level>8.5 mmol/L(153 mg/dL)as diagnostic for GDM.With the International Association of Diabetes and Pregnancy Study Groups(IADPSG)screening criteria,in the Irish,the GDM morbidity was 12.4%,and in China,the incidence of GDM was about 17.5%.Along with the opening two child policy and the increasing of advanced maternal age 35,its will lcad to the incidence of GDM to rise further.Gestational thyroid disease is the second most common endocrine disease after the GDM in pregnancy.In recent years,its as a hot field among endocrinology and perinatology,and its diagnostic criteria was different according to the different guidelines and regional differences.Endocrine society clinical practice guidelines has pointed out that gestational thyroid diseases were divided into hyperthyroidism(including clinical and subclinical hyperthyroidism),subclinical hypothyroidism,clinical hypothyroidism,Hypothyroxinemia,etc.their morbidity was 0.1-0.4%,2-3%,0.3-0.5%,1-2%respectively,and the rate of subclinical hypothyroidism was highest.The high incidence of GDM and gestational thyroid diseases has brought many adverse pregnancy outcomes,such as premature birth,abortion,low birth weight and macrosomia.Meanwhile,a large number of studies shows that the GDM and gestational thyroid disease increase the risk of their own.For example,two retrospective study had shown that the incidence of GDM is 4-7%,and the thyroid disease patients to got GDM was high to 12.3%;thyroid diseases incidence was 6.1%,and the GDM patients was 16.6%.This phenomenon shows that two kinds of diseases incidence of interaction,and its result of the interaction of these two diseases and the common pathogenesis of these two diseases.Related studies has shown that common pathogenesis and illness risk factors maybe existed in the two diseases,including systemic inflammatory response and immune regulation,the lack of vitamin D and trace elements like selenium,pre-pregnancy and pregnancy are overweight or obesity,gene polymorphism and susceptibility factors.Among them,vitamin D deficiency was the most common in clinical and has not been a widely understanding of obstetrics and gynecology doctors,so the effects on clinically was unclear.Moreover,because of it is convenient to detect vitamin D,we tested serum 25-hydroxy serum vitamin D levels(25(OH)D)to evaluation the status of vitamin D in pregnancy,to clear whether vitamin D deficiency/insufficiency increasing the risk of gestational thyroid disease and GDM,and to guide the treatment of vitamin D deficiency/insufficiency during pregnancy.Part 1.Correlation study of the GDM and the thyroid functionObjectiveTo observe the correlation between the plasma blood glucose levels and thyroid function in pregnancy,to discuss thyroid dysfunction whether increasing the risk of gestational diabetes mellitus(GDM).Methods1.Research subjects:Retrospective analysis 514 cases of pregnant women hospitalized in the Obstetrics and Gynecology Clinic to screen thyroid function and OGTT examination at the Third Affiliated Hospital of Southern Medical University from June 2015 to December 2015.Exclusion criteria:(1)A history of thyroid disease,pre-gestational diabetes mellitus;(2)Hyperemesis gravidarum,trophoblastic cell disease;(3)Autoimmune diseases;(4)A history of severe chronic disease,high blood pressure,liver disease,allergic disease,malignant tumor and acute infection.2.Research method:2.1 General data collection:average age(28.1±3.8),gestational age(TI:211 cases,T2 274 cases,T3 29 cases),with 412 cases testing TPO-Ab.2.2 The experiments were divided into GDM and non-GDM groups according to the IADPSG diagnostic criteria.3.Statistical analysis:Statistical analyses were undertaken using SPSS version 19.0 software Package(SPSS Inc,Chicago,IL,USA).Data conformed to a normal distribution were represented as mean±SD,comparison between the numerical variables used independent samples t-test analysis,classification variables between groups performed with Chi-square(?2)test.Gestational age as covariate,the relationship between thyroid dysfunction in trimester of pregnancy and GDM were analyzed by CMH test,and were adopted Spearman rank correlation.The multi-factor Logistic regression analysis were analyzed after adjustment for confounding factors.P<0.05(two-tailed)was recognized as statistically significant.Results1.The morbidity of thyroid dysfunction,clinical hyperthyroidism,subclinical hyperthyroidism,clinical hypothyroidism,subclinical hypothyroidism was 21.2%,3.7%,1.9%,0.2%,15.4%,respectively,and the rate of positive TPO-Ab was 9.7%.The incidence of GDM was 16.3%.2.The morbidity of gestational thyroid dysfunction and TPO-Ab positive(?2=0.407.1.051,P=0.523.0.305)between two group were not significant.3.The rate of positive TPOAb in GDM group was higher than that in non-GDM group,the difference was statistically significant(?2=6.362,P=0.012).But the rate of positive TPO-Ab in middle-late pregnancy between two group were not significant.4.FT4 only associated with fasting plasma glucose(r =-0.148,P =0.001),the correlation between TSH and blood glucose levels were not significant.ConclusionThe morbidity of gestational thyroid dysfunction in GDM group was higher than that in non-GDM group.Part 2.The preliminary study of the serum 25-hydroxy vitamin D levels association with the GDM and the gestational thyroid functionObjective1.To observe the differences of serum 25-hydroxy vitamin D level between the two group in pregnancy,and to clear whether vitamin D insufficiency or deficiency increasing the risk of gestational thyroid dysfunction and the rate of thyroid peroxidase antibody positive.2.To clear the differences of serum 25-hydroxy vitamin D level between the group with GDM and the group without GDM in pregnancy,and to discuss whether vitamin D deficiency/insufficiency increasing the risk of gestational diabetes mellitus(GDM).Methods1.Research subjects:Selected 165 cases of pregnant women who screening thyroid function in the department of obstetrics and gynecology,the third affiliated hospital of Southern Medical University from November 2015 to April 2016.Including 80 patients with normal thyroid function and 85 patients with abnormal thyroid function.In the normal thyroid function group,There were 45 cases of pregnant women with OGTT screening and fasting insulin determination,including 21 cases of GDM group and 24 cases of non-GDM group.Exclusion criteria:(1)A history of DM and thyroid diseases;(2)The administration of drugs affect vitamin D levels;(3)Pregnancy-related complications,including hyperemesis gravidarum,trophoblastic cell disease,and so on.(4)Other autoimmune diseases;(5)A history of severe chronic disease,high blood pressure,liver disease,allergic disease,malignant tumor and acute infection.2.Research method:2.1 General data collection:age,pre-pregnancy BMI,the last menstrual period,gestational age,parity,negative reproductive history,family history of diabetes,high blood pressure and thyroid disease.2.2 Laboratory tests:2.2.1 Thyroid function tests:using roche original auxiliary reagent(Automatic chemiluminescence immune analyzer)for detection of serum thyroid stimulating hormone(thyroid stimulating hormone,TSH)and free thyroxine(free thyroxine,FT4),thyroid peroxidase antibody(TPO-Ab).differences in difference between batch and batch(CV)are volatility between 1.7%?7.0%.2.2.2 25-hydroxy vitamin D detection:cantrifugal serum samples stored in-80?refrigerator and measured by euzymelinked immunosorbent assay(25-hydroxy vitamin Ds EIA).2.2.3 Using glucose oxidase method and electrochemical luminescence method for detection of blood sugar and fasting insulin respectively.Using the HOMA homeostasis model(HOMA-IR=fasting glucose levelxfasting insulin level-22.5)according to the fasting plasma glucose and insulin levels to evaluate insulin resistance index).2.3 The experimental group and definition:2.3.1 Based on thyroid function were divided into normal thyroid function and thyroid dysfunction group,abnormal thyroid function including clinical hyperthyroidism and subclinical hyperthyroidism,clinical hypothyroidism,subclinical hypothyroidism,hypothyroxinemia and TPO-Ab(+).2.3.2 The experiments were divided into GDM and non-GDM groups according to the IADPSG diagnostic criteria.2.3.3 Guidelines recommended:vitamin D status was defined as vitamin D deficiency(25(OH)D?50 nmol/L),insufficiency(50<25(OH)D<75nmol/L)and sufficiency(25(OH)D?75 nmol/L).3.Statistical methods:Statistical analyses were undertaken using SPSS version 19.0 software Package.Data conformed to a normal distribution were represented as mean±SD,comparison between the numerical variables used independent samples t-test analysis,comparison among groups of normal thyroid function and thyroid dysfunction were analyzed by One-way ANOVA.Data in skewness distribution were reported as medians(interquartile range),comparison between the numerical variables used Mann-Whitney U test.Comparison of rate or classification variables between groups performed with Chi-square(?2)test.The association between the levels of serum 25-hydroxy vitamin D and FT4?TSH?TPO-Ab was analysis by Spearman correlation.P<0.05(two-tailed)was recognized as statistically significant.Result1.The total incidence of abnormal vitaminD was 66.1%,vitamin D insufficiency was 39.4%and deficiency was 26.7%.2.The level of 25(OH)D in thyroid dysfunction group was lower than that in normal thyroid function group,but there was no significant difference between the two groups(Z ?-1.523,P-0.128).3.The incidence of vitamin D insufficiency and deficiency in GDM group was higher than that in non-GDM group,but there was no significant difference between the two groups(?2=6.703,P=0.035).4.The levels of 25(OH)D associated with 1 and 2-hour glucose after OGTT(r=-0.364,-0.342;P=0.014,0.021),the correlation between fasting glucose and 25(OH)D were no significant(r=-0.285;P=0.057).Conclusion1.Vitamin D deficiency/insufficiency during pregnancy was common.2.The incidence of vitamin D deficiency and deficiency in thyroid dysfunction group was higher than normal thyroid function group,but there was no significant difference between the two groups.3.The incidence of vitamin D insufficiency and deficiency in GDM group was obviously higher than non-GDM group.