بررسی مقایسه‌ای دیابت بارداری در زنان مبتلا به هیپوتیروئیدی تحت بالینی تیروئید با زنان یوتیروئید

نوع مقاله : اصیل پژوهشی

نویسندگان

1 استادیار گروه مامایی، دانشکده پزشکی، دانشگاه آزاد اسلامی، واحد ورامین- پیشوا، تهران، ایران. محقق پسادکترای مرکز تحقیقات اندوکرینولوژی تولید مثل، پژوهشکده علوم غدد درون‌ریز و متابولیسم‌، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران.

2 استاد مرکز تحقیقات اندوکرینولوژی تولید مثل، پژوهشکده علوم غدد درون‌ریز و متابولیسم، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران.

3 دکترای آمار زیستی، مرکز تحقیقات اندوکرینولوژی تولید مثل، پژوهشکده علوم غدد درون‌ریز و متابولیسم، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران.

4 استاد مرکز تحقیقات غدد درون‌ریز، پژوهشکده علوم غدد درون‌ریز و متابولیسم، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران.

چکیده

مقدمه: ارتباط بین هیپوتیروئیدی تحت بالینی (SCH) و دیابت بارداری (GDM) موضوع بحث‌برانگیزی است. مطالعه حاضر با هدف مقایسه دیابت بارداری در زنان مبتلا به هیپوتیروئیدی تحت بالینی با زنان یوتیروئید انجام شد.
روشکار: در این مطالعه آینده‌نگر، از داده‌های به‌دست آمده از ۱۰۲۶ زن باردار (شامل ۶۸۳ یوتیروئید و ۳۴۳ زن مبتلا به SCH) در مطالعه کوهورت تیروئید و بارداری تهران استفاده شد. سطح سرمی تیروتروپین (TSH)، تیروکسین (T4)، T3-uptake و آنتی‌بادی پراکسیداز تیروئید (TPOAb) در اولین ویزیت سه ماهه اول بارداری مورد بررسی قرار گرفت و بر این اساس، زنان یوتیروئید و مبتلا به هیپوتیروئیدی تحت بالینی مشخص گردیدند. این دو گروه از نظر دیابت بارداری مورد مطالعه قرار گرفتند. تجزیه و تحلیل داده‌ها با استفاده از نرم‌افزار STATA (نسخه 13) انجام شد. متغیرهای پیوسته با استفاده از آزمون تی مستقل و من‌ویتنی و متغیرهای رسته‌ای  با استفاده از آزمون کی‌ دو یا آزمون دقیق فیشر بین دو گروه مقایسه شدند. به‌منظور شناسایی اثر SCH و مصرف لووتیروکسین بر GDM از مدل لگ باینومیال استفاده گردید میزان p کمتر از 05/0 معنی‌دار در نظر گرفته شد.
یافته‌ها: تفاوت معنی‌داری در دیابت بارداری در افراد مبتلا به هیپوتیروئیدی تحت بالینی در مقایسه با گروه کنترل چه در مدل تعدیل نشده و چه بعد از تعدیل اثر ریسک فاکتورها مشاهده نشد. همچنین تفاوت معنی‌داری در دیابت بارداری بین گروه هیپوتیروئیدی تحت بالینی باTPOAb+ ، گروه هیپوتیروئیدی تحت بالینی با TPOAb- و افراد یوتیروئید وجود نداشت. ریسک دیابت بارداری در گروه TPOAb+ تفاوت معنی‌داری با ریسک دیابت بارداری در گروه TPOAb+ منفی نداشت. سطح سرمی TSH (9/0=p)، T4 (8/0=p)، T3-uptake (7/0=p) و TPOAb (4/0=p) نیز در دو گروه مبتلا و غیرمبتلا به دیابت بارداری تفاوت معنی‌داری نداشتند.
نتیجه‌گیری: اگرچه در این مطالعه ارتباط معنی‌داری بین دیابت بارداری و هیپوتیروئیدی تحت بالینی مشاهده نشد، اما به‌نظر می‌رسد با توجه به عوامل مختلف مؤثر بر بروز هیپوتیروئیدی تحت بالینی و دیابت بارداری از جمله معیارهای تشخیصی و مقادیر مرجع مختلف، اثبات این موضوع نیازمند مطالعات بیشتری است.

کلیدواژه‌ها


عنوان مقاله [English]

Gestational diabetes incidence in women with subclinical hypothyroidism and euthyroid women

نویسندگان [English]

  • Sima Nazarpour 1
  • Fahimeh Ramezani Tehrani 2
  • Maryam Rahmati 3
  • Fereidoun Azizi 4
1 Assistant Professor, Department of Midwifery, Faculty of Medicine, Varamin-Pishva Branch, Islamic Azad University, Tehran, Iran. Postdoctorate Researcher, Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
2 Professor, Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
3 Ph.D. of Biostatistics, Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
4 Professor, Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
چکیده [English]

Introduction: The association between subclinical hypothyroidism (SCH) and gestational diabetes (GDM) is controversial. This study was performed with aim to compare the incidence of GDM in women with SCH and euthyroid women.
Methods: In this prospective study, data obtained from 1026 pregnant women (including 683 cases of euthyroid and 343 women with SCH) participating in the cohort study of Tehran thyroid and pregnancy (TTP) was used. Serum levels of thyrotropin (TSH), thyroxine (T4), T3-uptake, and thyroid peroxidase antibody (TPOAb) were measured at first visit of the first trimester of pregnancy; based on this, euthyroid and SCH women were identified. These two groups were evaluated for gestational diabetes. Data were analyzed using STATA software (version 13). The continuous variables were compared between the two groups using independent t-test and Mann-Whitney test, and categorical variables using chi-square test or Fisher's exact test. Log-binomial model was used to identify the effect of SCH and levothyroxine on GDM. P< 0.05 was considered statistically significant
Results: There was no significant difference in the incidence of GDM in SCH women compared to the control group either in the unadjusted model or after adjusting for the effective risk factors. Also, there was no significant difference in the incidence of GDM between SCH with TPOAb+, SCH with TPOAb-, and euthyroid groups. The risk of GDM in the TPOAb positive group was not significantly different from TPOAb negative group. Serum TSH (p=0.9), T4 (p=0.8), T3-uptake (p=0.7), and TPOAb (p=0.4) levels were not significantly different between the GDM and non-GDM groups.
Conclusion: Although no significant association was found between GDM and SCH in this study, however, it seems that due to various factors affecting the incidence of SCH and GDM, such as different diagnostic criteria and reference values, proving this issue requires further studies.

کلیدواژه‌ها [English]

  • Gestational diabetes
  • Hypothyroidism
  • insulin resistance
  • pregnancy
  • Thyroid
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