Abstract
Objectives. Diabetes mellitus (DM) and hypothyroidism are each associated with increased rate of pregnancy complications. However, their combined morbidity during gestation is poorly studied. Therefore, the aims of this study were to determine the prevalence of the combined morbidity of DM & hypothyroidism and whether it is associated with adverse maternal and neonatal outcome.Study design. This population based retrospective cohort study included 87,213 women who had 232,293 deliveries. All deliveries were divided into the following groups: (1) hypothyroidism & DM (n = 171); (2) hypothyroidism (n = 1502); (3) DM (n = 13,324); and (4) deliveries of women with neither endocrinopathy, who served as a control group (n = 217, 296).Results. The prevalence of DM & hypothyroidism in our population was 0.17%. In comparisons to the other study groups, women with DM & hypothyroidism had higher rates of infertility (p < 0.001), preeclampsia (p < 0.001), chronic hypertension (p < 0.001), preterm birth (p < 0.001), and cesarean deliveries (p < 0.001). In Generalized Estimating Equations (GEE) model, hypothyroidism & DM was an independent risk factor for cesarean section (OR 3.46; 95% CI 2.53–4.75) and for preeclampsia (OR 1.82; 95%CI 1.16–2.84).Conclusion. The combination of DM & hypothyroidism is rare, yet it is associated with higher rate of infertility, cesarean sections, preterm deliveries, and hypertensive disorders of pregnancy than the rest of the population. This dual endocrinological combination is an independent risk factor for preeclampsia and cesarean section. These findings suggest that these patients are at risk for perinatal complications and should be followed and delivered as high risk pregnancies.
Highlights
Diabetes mellitus (DM) and hypothyroidism disorders are among the most common endocrinopathies during pregnancy
All deliveries were divided into the following groups: (1) hypothyroidism & DM (n = 171); (2) hypothyroidism (n = 1502); (3) DM (n = 13,324); and (4) deliveries of women with neither endocrinopathy that served as a control group (n = 217,296)
Three Generalized Estimating Equations (GEE) models were constructed to determine independent risk factors for cesarean section (Table 4), preterm delivery (Table 5) and preeclampsia (Table 6) after adjustment for confounding factors: (1) Hypothyroidism [OR 1.6; 95% CI 1.52–1.68)], DM [OR 1.74; 95% CI 1.52–1.99)] and their interaction term [OR 3.46; 95% CI 2.53–4.75)], were all independent risk factors for cesarean delivery (Table 4). (2) Hypothyroidism, maternal age, infertility treatments, history of preterm birth, infection of amniotic fluid, preterm prelabor rupture of membranes (PROM) and chronic hypertension were all independent risk factors for preterm birth
Summary
Diabetes mellitus (DM) and hypothyroidism disorders are among the most common endocrinopathies during pregnancy. Gestational diabetes mellitus (GDM) and especially pregestational DM, are known as risk factors for pregnancy complications, effecting both the mother and the fetus and include among the rest gestational hypertension, cesarean sections, macrosomic fetuses and shoulder dystocia (Casey et al, 1997; Barahona et al, 2005; Langer et al, 2005). These patients have increased neonatal morbidity including fetal demise, neonatal hypoglycemia, jaundice, polycytemia and hypocalcemia (American Diabetes Association, 2004; Casey et al, 1997; Barahona et al, 2005; Langer et al, 2005). Maternal diabetes is associated with long term implications on the fetus including increase incidence of future obesity and type II diabetes (American Diabetes Association, 2004)
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