Effect of thyroid dysfunction and autoimmunity on pregnancy outcomes in low risk population.

PURPOSE: The objective of this study was to assess the effect of thyroid dysfunction and autoimmunity in early pregnancy on adverse pregnancy and neonatal outcome. METHODS: 497 pregnant women between 10 and 12 gestational age were invited who were attending for their first antenatal visit and asked to perform blood tests for thyroid function and antithyroid peroxidase antibodies. A total of 395 women were recruited in the present study. Cases were classified into four groups according to thyroid function and anti-TPO results. The pregnancy outcomes included gestational diabetes mellitus, preeclampsia, preterm delivery, cesarean rate, small for gestational age, low birth weight. RESULTS: 2.5-(OR 2.5, 95% CI 1.06-5.89) and 4.8-(OR 4.85, 95% CI 1.89-12.42) fold increase in preterm delivery was detected in groups with isolated anti-TPO positivity and subclinic hypothyroidism with anti-TPO positivity compared to reference group, respectively. No association was found between thyroid dysfunction and anti-TPO positivity with gestational diabetes, preeclampsia, cesarean rates, low birth weight and small for gestational age neonates. CONCLUSION: Pregnant women with anti-TPO antibody positivity alone or with subclinic hypothyroidism were more likely to experience a spontaneous preterm delivery.

Prediction of gestational diabetes mellitus at first trimester in low-risk pregnancies.

OBJECTIVE: We aimed to assess the relationship among the sex hormone-binding globulin (SHBG), homeostasis model assessment (HOMA), glycosylated hemoglobin (HbA1c), and cholesterol panel values to predict subsequent gestational diabetes mellitus (GDM) in low-risk pregnancies. MATERIALS AND METHODS: Thirty-eight pregnant women with GDM and 295 low-risk pregnant women without GDM were included in this study. Maternal blood samples were obtained during the first trimester examination to determine the SHBG, HbA1c, fasting blood glucose, insulin, thyroid stimulating hormone (TSH), free thyroxine, total cholesterol, triglycerides (TG), high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol (LDL-C) levels. The variables that exhibited statistically significant differences between the groups and independent predictors for GDM were examined using logistic regression analysis. The risk of developing GDM, according to cutoff values, was determined using receiver operating characteristic (ROC) curve analysis. RESULTS: The SHBG, HOMA, LDL, and TG levels were found to be the significant independent markers for GDM [adjusted odds ratio (OR) = 0.991; 95% confidence interval (CI), 0.986-995; OR = 1.56; 95% CI, 1.24-1.98; OR = 1.02; 95% CI, 1.01-1.04; and OR = 1.01; 95% CI, 1.00-1.02, respectively]. The HbA1c, body mass index, and mean arterial pressure values were nonindependent predictors of GDM. The areas under the ROC curve used to determine the predictive accuracy of SHBG, HOMA, TG, and LDL-C for development of GDM were 0.73, 0.75, 0.70, and 0.72, respectively. For a false positive rate of 5% for the prediction of GDM, the values of the sensitivities were 21.1, 26.3, 21.1, and 18.4%, respectively. CONCLUSION: The HOMA, SHBG, TG, and LDL-C levels are independent predictors for subsequent development of GDM in low-risk pregnancies, but they exhibit low sensitivity.

Spot protein/creatinine ratio in preeclampsia as an alternative for 24-hour urine protein.

BACKGROUND: Proteinuria is a major component of preeclampsia. Urine protein measurement after 24-hour urine collection is the traditional standard method for the detection of proteinuria. It is time-consuming. As an alternative, random spot sampling for a urine protein to creatinine (P/C) ratio has been investigated. AIMS: The aim of the study was to determine the diagnostic accuracy of the protein to creatinine ratio (P/C) compared with 24-hour urine collection for the detection of remarkable proteinuria and to evaluate the P/C ratio for different proteinuria ranges in patients with preeclampsia. STUDY DESIGN: Case-control study. METHODS: Two hundred and eleven pregnant women who met the criteria of preeclampsia comprised the study group and fifty three pregnant women were taken as the control group. Spot urine specimens for measuring P/C ratio were obtained taken immediately before 24-hour urine collection. The correlation between the P/C ratio in the spot urine samples and urinary protein excretion in the 24-hour collections was examined using the Spearman correlation test. RESULTS: It was found a good positive correlation between the P/C ratio and 24-hour protein excretion, with a correlation coefficient (r) of 0.758. The best cut-off which gave the maximum area under the curve was 0.45 for 300 mg, 0.9 for 1000 mg, 1.16 for 2000 mg, 1.49 for 3000 mg, 2.28 for 4000 mg and 2.63 for 5000 mg per 24h. A P/C ratio above 0.9 strongly predicts significant proteinuria for more than 1 gram (AUC 0.97, 95% CI: 0.94-0.99 and sensitivity, specificity, positive and negative predictive value of 91%, 95.4%, 95.2%, and 91.2%, respectively). CONCLUSION: The P/C ratio can be used as a screening test as a good predictor for remarkable proteinuria. The P/C ratio seems to be highly predictive for diagnosis to detect proteinuria over one gram and it could be used as a rapid alternative test in preeclamptic patients not to delay implementation treatment.