| Peer-Reviewed

Diabetes and Hypothyroidism Alone and Simultaneously in Bulgarian Pregnant Women - Frequency and Features of Various Risk Factors

Received: 24 August 2021     Accepted: 16 September 2021     Published: 27 September 2021
Views:       Downloads:
Abstract

Gestational hypothyroidism affects the maturation and function of the beta cell, which can influence glucose metabolism. The aim of the study is to investigate the relationship between Hypothyroidism and Hyperglycemia in Bulgarian pregnant women and to look for the influence of various factors on the manifestation of each of these diseases separately, as well as their role in cases of simultaneous combination of the two diseases. Маterial: We studied 547 pregnant women, mean 30±5 years. The cross-sectional population-based multicenter study was conducted in 84 Bulgarian towns and villages. Pregnant women were divided into 4 groups according to the presence or absence of Diabetes (Diab) resp. Hypothyroidism (Thyr): Group 0 – 62.7% (n-343) – without Thyr or Diab; Group 1 – 22.9% (n-125) – Thyr; Group 2 – 11% (n-60) – Diab; Group 3 – 3.5% (n-19) – with Thyr and Diab. Methods: Fasting morning venous blood (TSH, FT4 - determined by ECLIA method) and fresh morning urine sample (to determine urine iodine concentration - UIC) was taken. A two-hour, 75 g oral glucose tolerance test (OGTT) was performed. The peripheral levels of 25(OH)D were tested using a standard assay in a central laboratory on the day of the sampling. The statistical analysis was conducted using standard SPSS 13.0 for Windows. Results: Group 2 were the oldest and Group 1 - the youngest, P<0.001. Group 2 as well as Group 3 had significantly higher BMI compared to Group 0 and Group 1, P<0.0001 / P<0.016. In Group 1 thyroid pathology had manifested itself earlier in the course of pregnancy, while in Group 2 dysglycemia occurred later, P<0.029 as well as for group 3, P<0.004. There was a significant negative correlation between 25(OH)D with level of fasting plasma glycemia - P<0.004, and at 120 minute of OGTT, P<0.003. In the group of pregnant women with Hyperglycaemia (n-79), deficiency of UIC (<150 µg / L) was reported in 45.6%, and twice more frequently artificial excess in the UIC level (>500 µg / L), compared with the Group with Normoglycemia (n-368). Conclusion: All international guidelines specifically emphasize the main risk factors when pregnant women should be screened for early detection of major endocrine diseases. However, the role of some additional factors, such as deficiency of 25(OH)D and iodine, should not be underestimated.

Published in International Journal of Diabetes and Endocrinology (Volume 6, Issue 3)
DOI 10.11648/j.ijde.20210603.14
Page(s) 114-124
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Pregnancy, Hypothyroidism, Diabetes, Age, BMI, Deficiency of 25(OH)D, Deficiency of UIC

References
[1] Taylor PN, Albrecht D, Scholz A, Gutierrez-Buey G, Lazarus J. H, Dayan C. M, Okosieme O. E. (2018). Global epidemiology of hyperthyroidism and hypothyroidism. Nat Rev Endocrinol 14 (5): 301–316. https://doi.org/10.1038/nrendo.2018.18.
[2] Cho NH, Shaw JE, Karuranga S, Huang Y, da Rocha Fernandes J. D, Ohlrogge A. W, Malanda B. (2018). IDF Diabetes Atlas: global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract 138: 271–281. https://doi.org/10.1016/j.diabres.2018.02.023.
[3] Duntas LH, Orgiazzi J, Brabant G. (2011). The interface between thyroid and diabetes mellitus. Clin Endocrinol 75 (1): 1–9. https://doi.org/10.1111/j.1365-2265.2011.04029.
[4] Panveloski-Costa AC, Serrano-Nascimento C, Bargi-Souza P, Poyares LL, Viana GDS, Nunes MT. (2018). Beneficial effects of thyroid hormone on adipose inflammation and insulin sensitivity of obese Wistar rats. Physiol Rep 6 (3): e13550. https://doi.org/10.14814/phy2.13550.
[5] Melchior H, Kurch-Bek D, Mund M. (2017). The prevalence of gestational diabetes. Dtsch Arztebl Int 114 (24): 412–418. https://doi.org/10.3238/arztebl.2017.0412.
[6] Lazarus J, Brown RS, Daumerie C, Hubalewska-Dydejczyk A, Negro R, Vaidya B. (2014). 2014 European thyroid association guidelines for the management of subclinical hypothyroidism in pregnancy and in children. Eur Thyroid J 3 (2): 76–94. https://doi.org/10.1159/000362597.
[7] Мedici M, de Rijke YB, Peeters RP, Visser W, de Muinck Keizer-Schrama SM, Jaddoe VV, Hofman A, Hooijkaas H, Steegers EA, Tiemeier H. (2012). Maternal early pregnancy and newborn thyroid hormone parameters: the generation R study. J Clin Endocrinol Metab. 97 (2): 646–652.
[8] Harris SE, De Blasio MJ, Davis MA, Kelly A. C, Davenport H. M, Wooding F. B. P, Blache D, Meredith D, Anderson M, Fowden A. L, Limesand S. W, Forhead A. J. (2017). Hypothyroidism in utero stimulates pancreatic beta cell proliferation and hyperinsulinaemia in the ovine fetus during late gestation. J Physiol 595 (11): 3331–3343. https://doi.org/10.1113/JP273555.
[9] Kemkem Y, Nasteska D, de Bray A, Bargi-Souza P, Peliciari-Garcia R. A, Guillou A, Mollard P, Hodson D. J, Schaeffer M. (2020). Maternal hypothyroidism in mice influences glucose metabolism in adult offspring. Diabetologia 63: 1822–1835. https://doi.org/10.1007/s00125-020-05172-x.
[10] Egan A. M, Bogdanet D, Biesty L. M, Kgosidialwa O, McDonagh C, O’Shea C, O’Shea P. M, Devane D, Dunne F. P. INSPIRED research group. (2020). Core Outcome Sets for Studies of Diabetes in Pregnancy: A Review. Diabetes Care 43 (12): 3129-3135. doi: 10.2337/dc20-1621.
[11] Ramulu, U. Ramchander Rao, Reshma Sultana Shaik. (2016). A Study of Prevalence of Subclinical Hypothyroidism in Patients of Type 2 Diabetes Mellitus. International Journal of Contemporary Medical Research 3 (10): 77-83.
[12] Вorissova A-M, Shinkov A, Vlahov J, Dakovska L, Todorov T, Svinarov D, Kassabova L. (2013). Vitamin D status in Bulgaria winter data. Arch. Osteoporosis 8: 133-137.
[13] Bischoff-Ferrari HA. (2012). Vitamin D–why does it matter? - defining vitamin D deficiency and its prevalence. Scand J Clin Lab Investig 72 (Suppl 243): 3–6.
[14] Rosen CJ, Abrams SA, Aloia JF, Brannon PM, Clinton SK, Durazo-Arvizu RA, Gallagher JC, Gallo RL, Jones G, Kovacs CS, Manson JE, Mayne ST, Ross AC, Shapses SA, Taylor CL. (2012). IOM committee members respond to Endocrine Society vitamin D guideline. J Clin Endocrinol Metab 97 (4): 1146-1152.
[15] Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM. (2011). Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 96 (7): 1911-1930.
[16] Dawson-Hughes B, Heaney RP, Holick MF, Lips P, Meunier PJ, Vieth R. (2005). Estimates of optimal vitamin D status. Osteoporos Int 16: 713-716.
[17] Dawson-Hughes B. Vitamin D deficiency in adults: Definition, clinical manifestations and treatment. Up To Date Review. 6 January 2017. Sector Editors: Marc K. Drezner, Clifford J Rosen. Deputi Editor: Jean E Mulder. Access date 19 January 2019. Available from: https://www.uptodate.com/contents/vitamin-ddeficiency-in-ad.ults-definition-clinical-manifestations-and treatment.
[18] Medical Association (2013). "Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects". JAMA. 310 (20): 2191–2194. doi: 10.1001/jama.2013.28105.
[19] Borissovа A-M, Ivanova L, Trifonova B, Dakovska L, Mihailova E, Vukov M. (2020). Iodine Status of Pregnant Women in Bulgaria. European Journal of Preventive Medicine 8 (4): 43-47.
[20] Forhead AJ, Fowden AL (2014). Thyroid hormones in fetal growth and prepartum maturation. J Endocrinol 221 (3): R87–R103. https:// doi.org/10.1530/JOE-14-0025.
[21] Peters K. E, Chubb S. A. P, Bruce D. G, Davis W. A, Davis T. M. E. (2020). The Fremantle Diabetes Study Phase II. Prevalence and Incidence of Thyroid Dysfunction in Type 1 Diabetes, Type 2 Diabetes and Latent Autoimmune Diabetes of Adults. Clin Endocrinol. 92 (4): 373-382.
[22] Borissova A-M, Shinkov A, Kovatcheva R, Vlahov J, Dakovska L, Todorov T. Changes in the Prevalence of Diabetes Mellitus in Bulgaria, 2006–2012. (2015). Clinical Medicine Insights: Endocrinology and Diabetes 8: 41–45. doi: 10.4137/CMed.s24742.
[23] Shinkov A, Borissova A-M, Kovatcheva R, Atanassova I, Vlahov J, Dakovska L. (2014). Age and Menopausal Status Affect Osteoprotegerin and Osteocalcin Levels in Women Differently, Irrespective of Thyroid Function. Clinical Medicine Insights: Endocrinology and Diabetes 7: 19–24. doi: 10.4137/CMed.s15466.
[24] Borissova A-M, Shinkov A, Vlahov J, Dakovska L, Todorov T, Kassabova L, Svinorov D. (2015). Dynamic of the seasonal levels of 25(OH)D in Bulgaria according to sex, age and winter status of vitamin D. Nutrition and Ageng 3, 2-4: 107-113.
[25] Borissovа A-M, Trifonova B, Dakovska L, Mihailova E, Vukov M. (2020). Vitamin D Supplementation for Pregnant Women in Bulgaria. European Journal of Preventive Medicine 8 (4): 56-60.
[26] Borissova A-M, Tankova T, Kirilov G, Dakovska L, Kovatcheva R. (2003). The Effect of vitamin D on the insulin secretion and peripheral insulin sensitivity. Int. J. Clin. Practice 57 (4): 258-261.
[27] de Morais N. S, Saraiva D. A, Corcino C, Berbara T, Schtscherbyna A, Moreira K, Vaisman M, Alexander E. K, Teixeira P. (2020). Consequences of Iodine Deficiency and Excess in Pregnancy and Neonatal Outcomes: A Prospective Cohort Study in Rio de Janeiro, Brazil. Thyroid 30 (12): 1792-1801. https://doi.org/10.1089/thy.2019.0462.
[28] World Health Organization. (2019). Classification of Diabetes mellitus 2019. ISBN 978-92-4-151570-2.
[29] Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, Grobman WA, Laurberg P, Lazarus JH, Mandel SJ. (2017). 2017 Guidelines of the American Thyroid Association for the diagnosis and Management of Thyroid Disease during Pregnancy and the postpartum. Thyroid. 27 (3): 315–389.
Cite This Article
  • APA Style

    Anna-Maria Borissovа, Boyana Trifonova, Lilia Dakovska, Eugenia Michaylova, Mircho Vukov. (2021). Diabetes and Hypothyroidism Alone and Simultaneously in Bulgarian Pregnant Women - Frequency and Features of Various Risk Factors. International Journal of Diabetes and Endocrinology, 6(3), 114-124. https://doi.org/10.11648/j.ijde.20210603.14

    Copy | Download

    ACS Style

    Anna-Maria Borissovа; Boyana Trifonova; Lilia Dakovska; Eugenia Michaylova; Mircho Vukov. Diabetes and Hypothyroidism Alone and Simultaneously in Bulgarian Pregnant Women - Frequency and Features of Various Risk Factors. Int. J. Diabetes Endocrinol. 2021, 6(3), 114-124. doi: 10.11648/j.ijde.20210603.14

    Copy | Download

    AMA Style

    Anna-Maria Borissovа, Boyana Trifonova, Lilia Dakovska, Eugenia Michaylova, Mircho Vukov. Diabetes and Hypothyroidism Alone and Simultaneously in Bulgarian Pregnant Women - Frequency and Features of Various Risk Factors. Int J Diabetes Endocrinol. 2021;6(3):114-124. doi: 10.11648/j.ijde.20210603.14

    Copy | Download

  • @article{10.11648/j.ijde.20210603.14,
      author = {Anna-Maria Borissovа and Boyana Trifonova and Lilia Dakovska and Eugenia Michaylova and Mircho Vukov},
      title = {Diabetes and Hypothyroidism Alone and Simultaneously in Bulgarian Pregnant Women - Frequency and Features of Various Risk Factors},
      journal = {International Journal of Diabetes and Endocrinology},
      volume = {6},
      number = {3},
      pages = {114-124},
      doi = {10.11648/j.ijde.20210603.14},
      url = {https://doi.org/10.11648/j.ijde.20210603.14},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijde.20210603.14},
      abstract = {Gestational hypothyroidism affects the maturation and function of the beta cell, which can influence glucose metabolism. The aim of the study is to investigate the relationship between Hypothyroidism and Hyperglycemia in Bulgarian pregnant women and to look for the influence of various factors on the manifestation of each of these diseases separately, as well as their role in cases of simultaneous combination of the two diseases. Маterial: We studied 547 pregnant women, mean 30±5 years. The cross-sectional population-based multicenter study was conducted in 84 Bulgarian towns and villages. Pregnant women were divided into 4 groups according to the presence or absence of Diabetes (Diab) resp. Hypothyroidism (Thyr): Group 0 – 62.7% (n-343) – without Thyr or Diab; Group 1 – 22.9% (n-125) – Thyr; Group 2 – 11% (n-60) – Diab; Group 3 – 3.5% (n-19) – with Thyr and Diab. Methods: Fasting morning venous blood (TSH, FT4 - determined by ECLIA method) and fresh morning urine sample (to determine urine iodine concentration - UIC) was taken. A two-hour, 75 g oral glucose tolerance test (OGTT) was performed. The peripheral levels of 25(OH)D were tested using a standard assay in a central laboratory on the day of the sampling. The statistical analysis was conducted using standard SPSS 13.0 for Windows. Results: Group 2 were the oldest and Group 1 - the youngest, P500 µg / L), compared with the Group with Normoglycemia (n-368). Conclusion: All international guidelines specifically emphasize the main risk factors when pregnant women should be screened for early detection of major endocrine diseases. However, the role of some additional factors, such as deficiency of 25(OH)D and iodine, should not be underestimated.},
     year = {2021}
    }
    

    Copy | Download

  • TY  - JOUR
    T1  - Diabetes and Hypothyroidism Alone and Simultaneously in Bulgarian Pregnant Women - Frequency and Features of Various Risk Factors
    AU  - Anna-Maria Borissovа
    AU  - Boyana Trifonova
    AU  - Lilia Dakovska
    AU  - Eugenia Michaylova
    AU  - Mircho Vukov
    Y1  - 2021/09/27
    PY  - 2021
    N1  - https://doi.org/10.11648/j.ijde.20210603.14
    DO  - 10.11648/j.ijde.20210603.14
    T2  - International Journal of Diabetes and Endocrinology
    JF  - International Journal of Diabetes and Endocrinology
    JO  - International Journal of Diabetes and Endocrinology
    SP  - 114
    EP  - 124
    PB  - Science Publishing Group
    SN  - 2640-1371
    UR  - https://doi.org/10.11648/j.ijde.20210603.14
    AB  - Gestational hypothyroidism affects the maturation and function of the beta cell, which can influence glucose metabolism. The aim of the study is to investigate the relationship between Hypothyroidism and Hyperglycemia in Bulgarian pregnant women and to look for the influence of various factors on the manifestation of each of these diseases separately, as well as their role in cases of simultaneous combination of the two diseases. Маterial: We studied 547 pregnant women, mean 30±5 years. The cross-sectional population-based multicenter study was conducted in 84 Bulgarian towns and villages. Pregnant women were divided into 4 groups according to the presence or absence of Diabetes (Diab) resp. Hypothyroidism (Thyr): Group 0 – 62.7% (n-343) – without Thyr or Diab; Group 1 – 22.9% (n-125) – Thyr; Group 2 – 11% (n-60) – Diab; Group 3 – 3.5% (n-19) – with Thyr and Diab. Methods: Fasting morning venous blood (TSH, FT4 - determined by ECLIA method) and fresh morning urine sample (to determine urine iodine concentration - UIC) was taken. A two-hour, 75 g oral glucose tolerance test (OGTT) was performed. The peripheral levels of 25(OH)D were tested using a standard assay in a central laboratory on the day of the sampling. The statistical analysis was conducted using standard SPSS 13.0 for Windows. Results: Group 2 were the oldest and Group 1 - the youngest, P500 µg / L), compared with the Group with Normoglycemia (n-368). Conclusion: All international guidelines specifically emphasize the main risk factors when pregnant women should be screened for early detection of major endocrine diseases. However, the role of some additional factors, such as deficiency of 25(OH)D and iodine, should not be underestimated.
    VL  - 6
    IS  - 3
    ER  - 

    Copy | Download

Author Information
  • Clinic of Endocrinology, University Hospital Sofiamed, Sofia, Bulgaria

  • Clinic of Endocrinology, University Hospital Sofiamed, Sofia, Bulgaria

  • Clinic of Endocrinology, University Hospital Sofiamed, Sofia, Bulgaria

  • Medical Diagnostic Laboratоry Bodimed, Sofia, Bulgaria

  • Clinic of Endocrinology, University Hospital Sofiamed, Sofia, Bulgaria

  • Sections