European thyroid journal · 2026
Low FT4 levels in early pregnancy are associated with higher insulin therapy need in women with gestational diabetes mellitus.
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Jelloul Emna, Lomré Manon, Kleynen Pierre, Sitoris Georgiana, Grabczan Lidia, Veltri Flora, Prasai Madhu, Rozenberg Serge, Poppe Kris G
Аннотация
OBJECTIVE: To compare demographical and thyroid parameters/disorders between a group of women with gestational diabetes mellitus (GDM) treated with diet and lifestyle measures (DiLS) and a group also necessitating insulin therapy (IT). Furthermore, to determine which variables were associated with IT need.
DESIGN/METHODS: Retrospective analysis in a single centre cohort including 1,782 women screened at median 12 (11-14) weeks of pregnancy for thyroid disorders (TSH, free T4 (FT4), and TPOAb) and for GDM with an oral glucose tolerance test at 24-28 weeks. Women with assisted and multiple pregnancies were excluded (n = 85). The diagnosis of GDM was based on the 2013 WHO criteria, and TAI on increased TPOAb levels (≥60 kIU/L). Multivariable regression analyses were applied to identify variables/conditions (thyroxine treatment before or after screening, thyroid parameters (TSH and FT4 levels), and thyroid disorders (subclinical hypothyroidism (SCH) and/or thyroid autoimmunity (TAI)) were associated with IT.
RESULTS: Overall, 328 of the 1,697 women were diagnosed with GDM (19.3%); 54 were treated with IT (16.5%) and 274 only with diet and lifestyle measures (83.5%). After adjustment for confounders, only FT4 levels were associated with IT need (adjusted odds ratio: 0.76; 95% CI: 0.61-0.94; P = 0.011).
CONCLUSION: Lower serum free T4 levels were independently associated with a higher risk for IT need in women with GDM. More research is needed to unravel this association, but insulin resistance is probably a major contributor.
DESIGN/METHODS: Retrospective analysis in a single centre cohort including 1,782 women screened at median 12 (11-14) weeks of pregnancy for thyroid disorders (TSH, free T4 (FT4), and TPOAb) and for GDM with an oral glucose tolerance test at 24-28 weeks. Women with assisted and multiple pregnancies were excluded (n = 85). The diagnosis of GDM was based on the 2013 WHO criteria, and TAI on increased TPOAb levels (≥60 kIU/L). Multivariable regression analyses were applied to identify variables/conditions (thyroxine treatment before or after screening, thyroid parameters (TSH and FT4 levels), and thyroid disorders (subclinical hypothyroidism (SCH) and/or thyroid autoimmunity (TAI)) were associated with IT.
RESULTS: Overall, 328 of the 1,697 women were diagnosed with GDM (19.3%); 54 were treated with IT (16.5%) and 274 only with diet and lifestyle measures (83.5%). After adjustment for confounders, only FT4 levels were associated with IT need (adjusted odds ratio: 0.76; 95% CI: 0.61-0.94; P = 0.011).
CONCLUSION: Lower serum free T4 levels were independently associated with a higher risk for IT need in women with GDM. More research is needed to unravel this association, but insulin resistance is probably a major contributor.