A longitudinal study of thyroid markers across pregnancy and the risk of gestational diabetes

Shristi Rawal, Michael Y. Tsai, Stefanie N. Hinkle, Yeyi Zhu, Wei Bao, Yuan Lin, Pranati Panuganti, Paul S. Albert, Ronald C.W. Ma, Cuilin Zhang

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44 Scopus citations


Context T3 is the biologically active thyroid hormone involved in glucose metabolism. The free T3 (fT3)/free T4 (fT4) ratio, a marker indicating conversion of fT4 to fT3, is also implicated in glucose homeostasis. Objective To examine associations of fT3 and the fT3/fT4 ratio with gestational diabetes mellitus (GDM). Design In a case-control study, thyroid markers (fT3, fT4, TSH) were measured and the fT3/fT4 ratio was derived across four visits in pregnancy, including first (gestational weeks 10 to 14) and second (weeks 15 to 26) trimester. Conditional logistic regression adjusting for thyroid autoimmunity status and major GDM risk factors estimated trimester-specific associations of thyroid markers with subsequent GDM risk. Setting Twelve US clinical centers. Participants One hundred seven GDM cases and 214 non-GDM controls from a multiracial pregnancy cohort of 2802 women. Main Outcome Measures GDM diagnosis ascertained from medical records. Results Both fT3 and the fT3/fT4 ratio were positively associated with GDM: adjusted OR (95% CI) comparing the highest vs lowest fT3 quartile was 4.25 (1.67, 10.80) at the first trimester and 3.89 (1.50, 10.10) at the second trimester. Similarly, the corresponding risk estimates for the fT3/fT4 ratio were 8.63 (2.87, 26.00) and 13.60 (3.97, 46.30) at the first and second trimester, respectively. Neither TSH nor fT4 was significantly associated with GDM. Conclusions Higher fT3 levels, potentially resulting from de novo synthesis or increased fT4 to fT3 conversion, may be an indicator of GDM risk starting early in pregnancy.

Original languageEnglish (US)
Pages (from-to)2447-2456
Number of pages10
JournalJournal of Clinical Endocrinology and Metabolism
Issue number7
StatePublished - Jul 1 2018

Bibliographical note

Funding Information:
Financial Support: This work was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development intramural funding as well as by the American Recovery and Reinvestment Act funding (Contracts HHSN275200800013C, HHSN275200800002I, HHSN27500006, HHSN275200800003IC, HHSN275200800014C, HHSN275200800012C, HHSN275200800028C, HHSN275201000009C, and HHSN275201000001Z). W.B. was supported by research grants from the National Institutes of Health (Grant R21HD091458) and the Fraternal Order of Eagles Diabetes Research Center.

Publisher Copyright:
Copyright © 2018 Endocrine Society.


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