Effects Of Hypothyroidism During Pregnancy With Gestational Diabetes Mellitus On Perinatal Period

Objectives To explore the bad effects of hypothyroidism during pregnancy combined gestational diabetes mellitus(GDM)on the outcome of pregnancy and childbirth,through comparing maternal related indicators in pregnancy and maternal and child outcomes among maternity with hypothyroidism complicated by gestational diabetes mellitus.Methods Select a total of 2482 pregnant women who were documented,routinely tested and delivered in the Beijing Aerospace Hospital in the period of from May 2014 to April2015.Thyroid function screening and 75 g glucose tolerance test during pregnancy were performed on them,and their medical records were collected for retrospective analysis.After screening,there were 181 pregnant women who had hypothyroidism as the simple hypothyroidism group,and 92 with hypothyroidism combined GDM as the hypothyroidism combined GDM group.The pregnancy outcomes of the two groups of pregnant women were observed,and the incidence of adverse pregnancy outcomes was compared.Results 1 The pregnant women in the hypothyroidism and GDM group have the average age of(26.98±3.56)years of patients,the average gestational age of(38.57±2.41)weeks,the average BMI of(27.34±2.87)kg/m~2,and the weight gain during pregnancy of(14.65±3.69)kg.The pregnant women in the simple hypothyroidism group have the average age of(27.84±3.27)years of patients,the average gestational age of(39.23±1.14)weeks,the average BMI of(24.56±2.14)kg/m~2,and the weight gain during pregnancy of(15.37±4.48)kg.There is no significant difference in gestational age,BMI,and weight gain during pregnancy(t=1.243,1.546,1.978,2.022,P>0.05)between the two groups.Serum TSH in the hypothyroidism combined GDM group is(3.45±1.29mU/L),and FT4 is(11.02±1.78pmol/L).Serum TSH is(3.49±1.42mU/L)and FT4 is(10.73±1.82pmol/L)in the simple hypothyroidism group.There is no difference in serum TSH and FT4 levels between the two groups(t=0.878,1.995,P>0.05).2 The serum triglyceride,serum cholesterol and serum low-density lipoprotein levels in the hypothyroidism and GDM group are higher than those in the hypothyroidism group,and the difference was statistically significant(t=2.196、3.658、3.054,P<0.05).The levels of high-density lipoprotein in the hypothyroidism and GDM groups are lower than those in the hypothyroidism group(t=2.138,P<0.05).3 There were no differences in creatinine,uric acid,and urea nitrogen between the two groups of pregnant women.4 Two groups of pregnant women have no difference in fasting blood glucose before delivery and 2 hours after meal.HbA1 c is higher in the hypothyroidism and GDM group(5.64±0.59%)than that in the hypothyroidism group(5.39±0.69%),and the difference was statistically significant(t=3.676、P<0.05).5 The incidence of pregnancy-induced hypertension in the hypothyroidism and GDM group(19.56%)is higher than that in the simple hypothyroidism group(7.73%).The difference is statistically significant(χ~2=8.250,P<0.05).There is no difference in the incidence of anemia,placenta previa,polyhydramnios,and oligohydramnios.6 The incidence of postpartum hemorrhage in the hypothyroidism and GDM group is higher than that in the simple hypothyroidism group(χ~2=4.654,P<0.05).The rate of cesarean section in the hypothyroidism and GDM group is higher(47.84%)than that in the simple hypothyroidism group(39.23%).The difference is statistically significant(χ~2=4.338,P<0.05).There is no difference in the rates of fetal distress,placental abruption,premature rupture of membranes,and premature birth between the two groups.7 The incidence of macrosomia in hypothyroidism and GDM group(9.78%)is higher than that of simple hypothyroidism group(4.42%).The difference is statistically significant(χ~2=5.351,P<0.05).But there is no significant difference in the incidence of neonatal asphyxia and low-birth weight infants.Conclusion 1Pregnancy women with hypothyroidism and GDM are more serious in body’s lipid metabolism disorders than pregnant women with hypothyroidism.2 Pregnant women with hypothyroidism and GDM are more prone to hypertensive disorders during pregnancy than pregnant women with hypothyroidism,and the incidence of cesarean section and postpartum hemorrhage increases.3 The incidence of macrosomia in pregnant women with hypothyroidism and GDM is significantly higher than that of simple hyperthyroidism,and no increase in the incidence of neonatal asphyxia and low birth weight infants is found.