Comparison of thyroid function tests and blood count in pregnant women with versus without gestational diabetes mellitus

Blood Cell Parameters From Early to Middle Pregnancy and Risk of Gestational Diabetes Mellitus

CONTEXT

Chronic low-grade inflammation may play a crucial role in the pathogenesis of gestational diabetes mellitus (GDM). However, prospective studies on the relations of inflammatory blood cell parameters during pregnancy with GDM are lacking.

OBJECTIVE

To prospectively investigate the associations of inflammatory blood cell parameters in both early and middle pregnancy, and their change patterns from early to middle pregnancy, with GDM risk.

METHODS

We used data from the Tongji-Shuangliu Birth Cohort. Inflammatory blood cell parameters (white blood cells [WBC], neutrophils, lymphocytes, monocytes, neutrophil to lymphocyte ratio [NLR], and platelets) were assayed before 15 weeks and between 16 and 28 weeks of gestational age. Logistic regression was used to evaluate the associations between inflammatory blood cell parameters and GDM.

RESULTS

Of the 6354 pregnant women, 445 were diagnosed with GDM. After adjustment for potential confounders, WBC, neutrophils, lymphocytes, monocytes, and NLR in early pregnancy were positively associated with GDM risk (odds ratios [95% CI] for extreme-quartile comparison were 2.38 [1.76-3.20], 2.47 [1.82-3.36], 1.40 [1.06-1.85], 1.69 [1.27-2.24], and 1.51 [1.12-2.02], respectively, all P for trend ≤ .010). Similarly, higher levels of WBC, neutrophils, monocytes, and NLR in middle pregnancy were associated with increased risk of GDM (all P for trend ≤ .014). Stable high levels (≥ median in both early and middle pregnancy) of WBC, neutrophils, monocytes, and NLR were positively associated with GDM risk (all P ≤ .001).

CONCLUSION

Increased WBC, neutrophils, monocytes, and NLR in both early and middle pregnancy and their stable high levels from early to middle pregnancy were associated with higher GDM risk, highlighting that they might be clinically relevant for identifying individuals at high risk for GDM.

Hemoglobin at the first visit of pregnancy and developing gestational diabetes mellitus: Results of a prospective registry cohort study

BACKGROUND AND AIM

Gestational diabetes mellitus (GDM) is associated with a considerable risk of diabetes in the future. Few studies focused on the association between hemoglobin levels and developing gestational diabetes. This study aimed to determine the association of hemoglobin in early pregnancy and developing gestational diabetes mellitus.

METHODS

A prospective registry cohort study was designed for the recall of women with gestational diabetes mellitus. The registry was implemented in the health centers of Ahvaz City in 2019. Biological and clinical assessments were done, and interviewer-administered questionnaires were used to collect data on socio-demographic Features, medical and obstetric history, and risk factors of GDM. SPSS used for data analysis. The optimal hemoglobin cut-off point, its sensitivity, and specificity for the prediction of GDM were estimated using ROC analysis.

RESULTS

The prevalence of anemia was 17.1% in pregnant women (8.1% in women with gestational diabetes versus %24.2% in the healthy group, p < 0.001). The hemoglobin mean in women with GDM was significantly higher than in healthy women (P < 0.001). Hemoglobin at the first visit was significantly associated with a greater risk of gestational diabetes (OR = 3.80, 95% CI: 3.05-4.74). The area under the curve (AUC) was 0.76 (95% CI 0.73-79), and the optimal cut-off point for hemoglobin was 11.90 g/dL, with a sensitivity of 75% and a specificity of 68%. Women with a higher hemoglobin level had a 3.8- more risk of developing GDM.

CONCLUSION

Measurement of hemoglobin can be a relatively good tool for predicting gestational diabetes in the first months of pregnancy. The combination of hemoglobin with fasting blood sugar and BMI improves the predictive value for gestational diabetes incidence.

An Evaluation of the Second Trimester Thyroid Function Test in Gestational Diabetes Mellitus: A Case-Control Study

INTRODUCTION

Gestational diabetes mellitus (GDM) is defined as glucose intolerance in a female with its onset or first recognition during pregnancy. Females with GDM are at higher risk of developing antenatal complications like preeclampsia during pregnancy and increased risk of type 2 diabetes as well as cardiovascular disorders later in their life. Maternal thyroid changes in the first and second trimesters of pregnancy have been widely related to the risk of GDM. Hypothyroidism during pregnancy is associated with early and late complications like abortions, anaemia, gestational hypertension, placental abruption and postpartum haemorrhage, impaired infant neurodevelopment, and low birth weight.

OBJECTIVES

This study aims to compare the thyroid function test (TFT) (serum fT3, fT4, TSH) and thyroid peroxidase antibody (anti TPO) between GDM and non GDM pregnant women in the second trimester and to correlate the adverse pregnancy outcomes with TFT in GDM and non GDM women.

METHODS

A nested case-control study was done in the Department of Obstetrics and Gynaecology, Department of Endocrinology, Department of Paediatrics, University College of Medical Sciences, and Guru Teg Bahadur (GTB) Hospital, Delhi. About 350 pregnant women from 13 weeks till 28 weeks period of gestation were screened out of which 40 GDM and 40 non GDM women were selected after performing an oral glucose tolerance test (OGTT). A TFT and anti TPO test were compared between GDM and non GDM participants. Furthermore, various parameters like sociodemographic profile, mode of delivery, pregnancy outcomes, and adverse maternal and adverse neonatal outcomes were compared.

CONCLUSION

The mean age of GDM women is found to be more than non GDM women. The mean TFT values are significantly lower in women with GDM as compared to non GDM women. In addition, higher values of anti TPO antibody (thyroid autoantibody) were found in the GDM group which aids in insulin resistance. Maternal complications like polyhydramnios, preterm labour, and pregnancy-induced hypertension were found to be more frequent in the GDM group compared to the non GDM group, but the results were statistically not significant. There was a higher incidence of caesarean delivery in the GDM group. Thus, we recommend the implementation of routine thyroid function profile testing in all antenatal females especially those who are at risk of developing GDM. Our study is one of the few Indian studies to evaluate the association of TFT in GDM, and we recommend similar research with a larger sample size and postnatal follow-up.

Platelet counts affect the association between hyperhomocysteinemia and pregnancy complications

BACKGROUND

The joint effect of platelet and other modifiers on the risk of pregnancy complications is unknown. This study investigated whether platelet count (PC) and total homocysteine (tHcy) level have a synergistic effect on the incidence of pregnancy complications in a Chinese population.

METHODS

Total 11,553 consecutive pregnant women who received whole blood cell and biochemical tests at the time of admission for labor in Changzhou Maternal and Child Health Care Hospital were analyzed. The primary outcome was the prevalence of pregnancy complications: gestational diabetes mellitus (GDM), intrahepatic cholestasis of pregnancy (ICP), pre-eclampsia (PE), and pregnancy induced hypertension (PIH).

RESULTS

The prevalence of GDM, ICP, PE, and PIH was 8.4%, 6.2%, 3.4%, and 2.1%, respectively. The highest rate of ICP (28.6%) was observed in women with high tHcy (> 15 μmol/L) and low PC (quartile 1); and the lowest rate of GDM (0.6%) was found in women with high tHcy and high PC (quartiles 2 to 4). In low PC group, the prevalence of ICP in women with high tHcy was significantly higher than that in women with low tHcy (≤ 15 μmol/L) (28.6% vs. 8.4%), representing an absolute risk increment of 20.2% and a relative risk increment of 3.3-fold (OR: 3.34; 95% CI: 1.55, 7.17; P = 0.002), whereas no joint effect was observed among high PC group.

CONCLUSIONS

Among Chinese pregnant women, one subgroup (high tHcy and low PC) has the highest risk of ICP and another (high tHcy and high PC) has the lowest risk of GDM; tHcy and platelet could be used as indicators to identify the women with high risk of ICP or low risk of GDM.

Exosome Proteomics Reveals the Deregulation of Coagulation, Complement and Lipid Metabolism Proteins in Gestational Diabetes Mellitus

Exosomes are small extracellular vesicles with a variable protein cargo in consonance with cell origin and pathophysiological conditions. Gestational diabetes mellitus (GDM) is characterized by different levels of chronic low-grade inflammation and vascular dysfunction; however, there are few data characterizing the serum exosomal protein cargo of GDM patients and associated signaling pathways. Eighteen pregnant women were enrolled in the study: 8 controls (CG) and 10 patients with GDM. Blood samples were collected from patients, for exosomes’ concentration. Protein abundance alterations were demonstrated by relative mass spectrometric analysis and their association with clinical parameters in GDM patients was performed using Pearson’s correlation analysis. The proteomics analysis revealed 78 significantly altered proteins when comparing GDM to CG, related to complement and coagulation cascades, platelet activation, prothrombotic factors and cholesterol metabolism. Down-regulation of Complement C3 (C3), Complement C5 (C5), C4-B (C4B), C4b-binding protein beta chain (C4BPB) and C4b-binding protein alpha chain (C4BPA), and up-regulation of C7, C9 and F12 were found in GDM. Our data indicated significant correlations between factors involved in the pathogenesis of GDM and clinical parameters that may improve the understanding of GDM pathophysiology. Data are available via ProteomeXchange with identifier PXD035673.

Hypothyroidism And Gestational Diabetes Mellitus: Is There A Relationship?

Background and Objective — Subclinical gestational hypothyroidism (SGH) and gestational diabetes mellitus (GDM) constitute two most common endocrine pathologies encountered during pregnancy. SGH and GDM have common pathophysiological mechanisms, being interrelated pathological conditions that are capable of complicating the course of pregnancy, labor and the postpartum period both on the part of the mother and on the part of the fetus. We aimed to analyze the relationship between these pathologies and to assess the risk of developing GDM against the background of hypothyroidism. Materials and Methods — the study included 200 pregnant women observed at the Perinatal Center of the Maternity Hospital the Bauman State Clinical Hospital No. 29 during 2018-2020. The main group consisted of 133 women who visited the perinatal center for hypothyroidism (both SGH and primary hypothyroidism, detected prior to pregnancy); the control group comprised 67 women without endocrine pathology. Both groups were comparable in terms of age, height, weight, and the number of pregnancies in the anamneses. The main group received levothyroxine sodium therapy with the achievement of the target trimester-specific level of thyroid-stimulating hormone (TSH). The criteria for the diagnosis of SGH were the TSH level above 2.5 μIU/mL in combination with an enlarged titer of antithyroid antibodies and/or a burdened medical history of thyroid pathology, or the TSH level above 4.0 μIU/mL in the absence of antithyroid antibodies [1]. The diagnosis of GDM was established on the basis of fasting hyperglycemia (≥5.1 mmol/L), or based on the results of an oral glucose tolerance test (OGTT) with 75 g of glucose: fasting glucose level of ≥5.1 mmol/L; the concentration 1 hour after glucose intake ≥10.0 mmol/L; the content 2 hours after glucose intake ≥8.5 mmol/l) [2]. In both groups, the frequency of developing GDM, the timing of diagnosis, and the need for insulin therapy were evaluated. Statistical data processing was carried out using the StatTech v. 2.1.0 software. Quantitative indicators were assessed for compliance with the normal distribution via Shapiro-Wilk criterion or Kolmogorov-Smirnov criterion. Intergroup comparison was performed using Mann-Whitney U test or Pearson’s chi-squared test. Results — We discovered that among women with a burdened family history of thyroid pathology and diabetes mellitus, as well as with thyroid pathology prior to pregnancy, the prevalence of hypothyroidism was higher. The presence of thyroid pathology in the anamnesis of pregnant women was associated with an earlier diagnosis of hypothyroidism. We revealed a significant difference in the prevalence of GDM between two groups of subjects. The chances of detecting GDM in the hypothyroidism group were 8.6 times higher than in the euthyroidism group. The threshold level of TSH for the first trimester, predicting the development of GDM, was identified. The sensitivity and specificity of the model were 71.4% and 63.1%, respectively. Conclusion — Hypofunction of the thyroid and GDM are interrelated endocrine pathologies. In the presence of hypothyroidism (both primary and SGH), GDM develops significantly more often. The level of TSH in the first trimester ≥2.7 μIU/mL amplifies the chance of developing GDM by over 8 times; hence, it could be considered a signal for timely prevention and detection of this pathology.

Gestational diabetes mellitus is associated with blood inflammatory indicators in a Chinese pregnant women population

OBJECTIVE

This study aimed to investigate relationships between blood inflammatory and metabolic biomarkers in pregnant Chinese women with gestational diabetes mellitus (GDM) in Southwest China and to compare the contributions of blood inflammatory indicators to GDM identification.

SUBJECTS AND METHODS

In total, 1,347 pregnant women were divided by gestational week into early-, middle- and late-pregnancy groups. Fasting samples were collected for complete blood count (CBC) and biochemical indicator measurements. Receiver operating characteristic (ROC) curves were used to predict GDM. Multivariate logistic regression was used to examine the associations between blood inflammatory indicators and GDM prevalence in pregnant women.

RESULTS

Significant differences were found in blood inflammatory indicators and metabolic markers in different pregnancy trimesters. For the pregnant women with GDM, FPG, 1 h-PG, 2 h-PG levels, NLR and PLR, WBC and neutrophil counts were statistically differences when compared with non-GDM groups. ROC curve analysis indicated that the NLR, PLR, WBC and neutrophil counts have predictive value for GDM from 24-28 gestational weeks. The FPG levels in 24th-28th weeks of pregnant women were positively correlated with the NLR, PLR, 1 h-PG, 2 h-PG levels and negatively correlated with lymphocyte count. Following adjustment for the age, PLR, and FPG level, multivariate logistic regression showed that the NLR was an independent factor predicting GDM in the 24th-28th weeks of pregnancy.

CONCLUSION

The blood inflammatory indicators NLR, PLR, and WBC and neutrophil counts were higher in GDM women than in healthy pregnant women, suggesting that blood inflammatory indicators are associated with GDM.

Association of circulating inflammatory cells and platelets with gestational diabetes and pregnancy outcomes

Gestational diabetes mellitus (GDM) is the most common cause of hyperglycemia during pregnancy, and its prevalence has increased over the past decades. GDM is directly related to the recent obstetric outcomes and long-term maternal and child health, which can be greatly improved by early identification and diagnosis of GDM. However, the prediction of the disease has always been a difficult problem due to the lack of simple and practical serological markers. Despite the controversy, recent studies have identified that circulating inflammatory cells and platelets, routinely included in the obstetric blood tests, are related to the development of GDM and adverse pregnancy outcomes. In this review, we summarized the studies in this field based on the recent literature. The inflammatory cell components we included were the total number of white blood cells, neutrophils, lymphocytes, monocytes and platelets, which were routinely examined in the blood tests in pregnancy. The aim of this review is not only to enrich our understanding of the pathogenesis of GDM but also to provide evidence for the value of these novel and practical serological markers in early identification of GDM and the prevention and its adverse outcomes.

Association of thyroid disorders with gestational diabetes mellitus: a meta-analysis

PURPOSE

The current meta-analysis aimed to evaluate the association of thyroid dysfunction and autoimmunity with gestational diabetes mellitus (GDM).

METHODS

A comprehensive search from PubMed, Embase, MEDLINE, and Cochrane databases until November 2020 was conducted. Fixed-effect model was used to combine the results when I² was <50%. Random-effect model was used to summarize the results when I² was >50%.

RESULTS

A total of 44 studies were included in the meta-analysis. Low FT4 levels were closely related with GDM in the first and second trimesters of gestation. Hypothyroxinemia (OR: 1.45; 95% CI: 1.25, 1.68; P < 0.00001), overt (OR: 1.80; 95% CI: 1.73, 1.86; P < 0.00001), and subclinical (OR: 1.54; 95% CI: 1.03, 2.30; P = 0.03) hypothyroidism, overt hyperthyroidism (OR: 1.49; 95% CI: 1.09, 2.04; P = 0.01), and positive thyroid antibodies (OR: 1.49; 95% CI: 1.07, 2.07; P < 0.00001) were observed significantly associated with the risk of GDM. Pregnant women with subclinical hyperthyroidism were less likely to develop GDM (OR: 0.62; 95% CI: 0.39, 0.97; P = 0.04).

CONCLUSIONS

Thyroid dysfunction and positive thyroid antibodies were associated with the risk of GDM. Our findings suggest that pregnant women with these thyroid diseases may be offered screening for GDM comprehensively.

A longitudinal study of thyroid markers during pregnancy and the risk of gestational diabetes mellitus and post-partum glucose metabolism

AIMS

To determine the relationship between thyroid markers during pregnancy and gestational diabetes mellitus (GDM) or post-partum glucose metabolism.

MATERIALS AND METHODS

Based on pregnancy 75-g oral glucose tolerance test (OGTT) results, 1467 subjects were grouped into normal glucose tolerance (NGTp; n = 768) and GDM (n = 699) groups. Furthermore, based on post-partum 75-g OGTT results, 286 GDM subjects, screened for glucose metabolism after delivery, were grouped into NGTd (n = 241) and abnormal glucose tolerance (AGT; n = 45) groups.

RESULTS

Maternal age, family history of diabetes, acanthosis nigricans, previous adverse pregnancy outcomes and caesarean section incidence, and thyroid positive antibody rates were higher in the GDM group than in the NGTp group. In the first trimester, free triiodothyronine (FT3), thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TgAb) levels were higher in the GDM group than in the NGTp group. In the second trimester, free thyroxine (FT4) levels were lower and TPOAb and TgAb levels were higher in the GDM group than in the NGTp group. After adjusting for confounding factors, FT3, TPOAb and TgAb (first trimester), and FT4, TPOAb and TgAb (second trimester) were risk factors for GDM. TPOAb and TgAb levels were higher in the AGT group than in the NGTd group and were potential predictors of abnormal post-partum glucose tolerance.

CONCLUSIONS

GDM risk significantly increased with increased FT3 (first trimester), TPOAb and TgAb (first and second trimesters) or with decreased FT4 (second trimester). Presence of thyroid antibodies predicted post-partum glucose abnormalities in subjects with GDM.

Gestational Diabetes Mellitus and Maternal Immune Dysregulation: What We Know So Far

Gestational diabetes mellitus (GDM) is an obstetric complication that affects approximately 5-10% of all pregnancies worldwide. GDM is defined as any degree of glucose intolerance with onset or first recognition during pregnancy, and is characterized by exaggerated insulin resistance, a condition which is already pronounced in healthy pregnancies. Maternal hyperglycaemia ensues, instigating a 'glucose stress' response and concurrent systemic inflammation. Previous findings have proposed that both placental and visceral adipose tissue play a part in instigating and mediating this low-grade inflammatory response which involves altered infiltration, differentiation and activation of maternal innate and adaptive immune cells. The resulting maternal immune dysregulation is responsible for exacerbation of the condition and a further reduction in maternal insulin sensitivity. GDM pathology results in maternal and foetal adverse outcomes such as increased susceptibility to diabetes mellitus development and foetal neurological conditions. A clearer understanding of how these pathways originate and evolve will improve therapeutic targeting. In this review, we will explore the existing findings describing maternal immunological adaption in GDM in an attempt to highlight our current understanding of GDM-mediated immune dysregulation and identify areas where further research is required.

Association between thyroid function and risk of gestational diabetes mellitus in assisted pregnancies: A retrospective cohort study

AIMS

To explore the association between thyroid function and gestational diabetes mellitus (GDM) risk in assisted pregnancies.

METHODS

We screened 57,386 pregnant women treated from February 2013 to October 2017, and 2211 patients were retrospectively enrolled, and their data were analyzed based on quintile groups constituted based on serum thyroid-stimulating hormone (TSH), free thyroxine (FT4), and thyroid peroxidase antibody (TPOAb) levels. Odds ratios (ORs) of GDM were analyzed by multivariate logistic regression, adjusted for maternal age and pre-pregnancy body mass index (BMI).

RESULTS

The prevalence rate of GDM was 20.1%. Lower FT4 levels were associated with an increased risk of GDM (OR_Q2 = 1.512, 95% confidence interval [CI] 1.073-2.132, p = 0.018; OR_Q1 = 1.620, 95% CI 1.161-2.261, p = 0.005), but this association disappeared after adjustments. TPOAb+ titer was associated with an increased risk of GDM (aOR = 1.472, 95% CI 1.068-2.028, p = 0.018). Higher TSH (aOR_Q5 = 2.882, 95% CI 1.919-6.975, p = 0.019) or lower FT4 (aOR_Q1 = 3.156, 95% CI 1.088-9.115, p = 0.034) levels were associated with an increased risk of GDM in assisted pregnancies for TPOAb+ patients.

CONCLUSION

TPOAb+ is an independent risk factor for GDM in patients with assisted pregnancies. Higher TSH or lower FT4 levels, with TPOAb+ detection, are risk factors for GDM in assisted pregnancies.

Is there an association between platelet and blood inflammatory indices and the risk of gestational diabetes mellitus?

Objective

Gestational diabetes mellitus (GDM) is the most prevalent medical complication in pregnancy. Early diagnosis of GDM can influence maternal/neonatal outcomes. To assess the association between platelet and blood inflammatory indices and the risk of GDM occurrence using the complete blood count (CBC) test. We also aimed to determine the sensitivity of each parameter for an early screening of this disorder during pregnancy.

Methods

This case-control study included 2 groups of 110 pregnant women with and without GDM. The women in each group were compared after the routine screening for GDM and after the CBC test at 24–28 weeks' gestation after being matched according to the inclusion criteria. Data were analyzed using SPSS version 16 and Medcalc version 14.8.1 software.

Results

There were statistically significant intergroup differences in white blood cell (WBC) count, platelet count, mean platelet volume (MPV), plateletcrit (PCT), MPV to platelet ratio, platelet to lymphocyte ratio, and Rh values. The values of lymphocyte count, neutrophil count, neutrophil to lymphocyte ratio, and blood group were not significantly different between groups. The logistic regression analysis showed the predictive values of WBC, platelet, MPV, and PCT in GDM. According to the receiver operating characteristic curve for all 3 variables, the level below the PCT chart was more than that of the others.

Conclusion

Increasing platelet and inflammatory indices on the CBC test in the second trimester of pregnancy seemed to be associated with the probability of GDM occurrence.

The variation degree of coagulation function is not responsible for extra risk of hemorrhage in gestational diabetes mellitus

BACKGROUND

Gestational diabetes mellitus (GDM) is characterized as glucose intolerance of any degree that begins or first diagnosed during pregnancy. It possesses a higher risk of haemorrhage, which may be caused by the coagulation dysfunction. However, there has been no study focus on how coagulation state changes in the progress of GDM pregnancy. Our study is aimed to assess the association of coagulation function and haemorrhage in GDM.

METHODS

A total of 662 subjects (273 from a population-based study and 389 from a prospective cohort study) were selected to measure mean platelet volume (MPV), platelet distribution width (PDW), platelet (PLT), thrombocytocrit (PCT), prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), and fibrinogen (FIB). All pregnant individuals were divided into normal glucose tolerance (NGT) controls and GDM patients diagnosed between the 24th and 28th weeks of gestation.

RESULTS

Compared with NGT controls, GDM females showed shortened PT, shortened APTT, and increased blood FIB levels, while the platelet parameters MPV, PDW, PLT, and PCT remained unchanged in mid-pregnancy. By late pregnancy, the platelet parameters MPV, PDW, and PCT were increased in the GDM group compared with the NGT group, while PT and APTT were unchanged.

CONCLUSIONS

The GDM group was hypercoagulable compared with the NGT group rather than hypocoagulable as predicted, but still within the normal range. Therefore, our findings demonstrate that the variation degree of coagulation function is not responsible for extra risk of hemorrhage in GDM, and prevention of hemorrhage should focus on other causes.

First trimester thyroid function in pregnant women residing in Saint Petersburg (Russia): reference values and risk of gestational diabetes

Background. Subclinical hypothyroidism during pregnancy and gestational diabetes mellitus (GDM) is known to be associated with maternal and child morbidity. The concept of subclinical dysfunction of the thyroid gland in pregnant women depends on the population-specific and trimester-specific reference values so fixed universal cutoff concentrations for thyroid-stimulating hormone (TSH) that were recommended earlier now are put under the question. Population-specific and trimester-specific reference values have not been defined for pregnant women residing in Saint Petersburg. The data concerning the association of maternal thyroid status with GDM development are controversial. Aims. The aim of the study was to determine the reference values of TSH and free thyroxin (fT4) in the first trimester of pregnancy in women living in St. Petersburg, and to assess the relationship between thyroid status and the risk of subsequent development of GDM. Materials and methods. The levels of TSH, fT4 and thyroid peroxidase antibodies (TPO-Ab) were analyzed in 503 pregnant women before the 14th week of gestation. The women underwent oral glucose tolerance test (OGTT) at 2428 weeks to find out those with GDM. The association between thyroid function, thyroid autoimmunity and the risk of GDM we estimated. Results. The reference values for TSH were 0.07 4.40 mU /L, and for fT4 11.7 20.3 pmol/L. The prevalence of subclinical hypothyroidism in the 503 pregnant women was 16.9% according to the diagnostic criteria of TSH 2.5 mIU / L and 3.8% using our calculated reference interval. Hypothyroxinemia was registered in 5,3% using reference values recommended by diagnostic tests manufacturer and in 2,8% according to our calculated reference interval for fT4. GDM was diagnosed in 23% of women. Logistic regression analysis showed associations of hypothyroxinemia and TPO-Ab-positivity with the increased risk of GDM that remained significant after adjustments on age and body mass index (BMI) [adjusted OR (95% CI) = 7.39 (1.2742.93) for hypothyroxinemia, p=0.026; and adjusted OR (95% CI) = 2.02 (1.014.04) for TPO-Ab-positivity, p=0.047). Conclusions. Reference intervals for first trimester TSH and fT4 have been established for pregnant women living in St. Petersburg. Hypothyroxinemia and TPO-Ab-positivity were associated with the increased risk of GDM.

Mean Platelet Volume and Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis

AIM

To evaluate the association between mean platelet volume (MPV) and gestational diabetes mellitus (GDM).

METHODS

A systematic literature search was performed in PubMed, EMBASE, Web of Science, and The Cochrane Library up to 4 September 2017. Pooled standardized mean differences (SMD) and 95% confidence interval (CI) were calculated using a random-effect model.

RESULTS

Nineteen studies comprising 1361 GDM patients and 1911 normal pregnant women were included. MPV was increased in GDM patients when compared with healthy pregnant women (SMD: 0.79; 95% CI: 0.43-1.16; P < 0.001). Subgroup analyses revealed that such trend was consistent in the third-trimester (SMD: 1.35; 95% CI: 0.72-1.98), Turkish (SMD: 0.81; 95% CI: 0.43-1.19), and Italian (SMD: 2.78; 95% CI: 2.22-3.34) patients with GDM and the patients diagnosed based on Carpenter and Coustan criteria (SMD: 1.04; 95% CI: 0.42-1.65). Significantly higher MPV also were observed within cross-sectional studies (SMD: 0.99; 95% CI: 0.49-1.49). Remarkable between-study heterogeneity and potential publication bias were observed in this meta-analysis; however, sensitivity analysis indicated that the results were not unduly influenced by any single study.

CONCLUSIONS

GDM patients are accompanied by increased MPV, strengthening the clinical evidence that MPV may be a predictive marker for GDM.