ORIGINAL RESEARCH article
Front. Endocrinol.
Sec. Thyroid Endocrinology
Volume 16 - 2025 | doi: 10.3389/fendo.2025.1555409
Association of Maternal Thyroid Function and Gestational Diabetes with Pregnancy Outcomes: A Retrospective Cohort Study
Provisionally accepted
- Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Shanghai, China
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Background: Gestational diabetes mellitus (GDM) and thyroid dysfunction share demographic overlap in at-risk populations, both exerting adverse effects on pregnancy. Their combined influence on pregnancy outcomes and complications requires further investigation through large-scale clinical studies.Objective: To compare trimester-specific thyroid function in GDM population with euthyroid population, and to examine the impact of maternal thyroid function on pregnancy outcomes adjusted for GDM diagnosis status. Methods: The retrospective cohort study involved singleton pregnant women registered between 2013 and 2020 in Shanghai, China. Maternal and infant biometrics were extracted from the electronic system at Shanghai First Maternity and Infant Hospital. Primary statistical methods in study include logistic regression model and parallel mediation analysis.Results: Of the 81,488 pregnancies included, 8,868 were with GDM. Compared to population without GDM, GDM population exhibited lower FT4 and different TSH levels in specific trimesters. Mid-pregnancy thyroid function correlated with risks of preterm birth (for FT4<2.5th percentile while TSH>97.5th, adjusted OR 2.471, 95%CI 1.234−4.478) and fetal overgrowth (for FT4<2.5th percentile, adjusted OR 1.551, 95%CI 1.271–1.874). Late-pregnancy low FT4 was associated with hypertensive disorders (for FT4<2.5th percentile while TSH>97.5th, adjusted OR 3.279, 95%CI 1.221−7.375; for isolated FT4<2.5th percentile, adjusted OR 2.010, 95%CI 1.260−3.057). GDM amplified all these risks. Moreover, maternal ferritin is a primary mediator in thyroid-neonatal weight associations, particularly in late pregnancy (mediation proportion: 22.1%).Conclusion: Study highlighted increased risks of adverse outcomes associated with thyroid dysfunction in GDM pregnancies, underscoring necessity for combined thyroid function and glucose metabolism screening, which facilitates timely interventions to mitigate risks of preterm birth, hypertensive disease, and fetal overgrowth.
Keywords: gestational diabetes mellitus, Hypothyroidism, Birth Weight, hypertensive disorder, Preterm Birth
Received: 04 Jan 2025; Accepted: 16 May 2025.
Copyright: © 2025 Zou, Shen, Yang, Liao and Du. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Qiaoling Du, Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Shanghai, China
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