Abstract 181: Screening for thyroid autoimmunity and implications of thyroid dysfunction on pregnancy outcomes among subjects with hyperglycemia in pregnancy- experience from a tertiary care centre in South India

Background: The Indian subcontinent has shown higher prevalence for both thyroid dysfunction and autoimmunity as well as diabetes complicating pregnancy when compared to the Western population. Despite the potential serious implications of this problem, not enough attention has been paid in our country to understand this, and there is an urgent need to explore the same. Aims: To assess the proportion of women with thyroid autoimmunity and thyroid dysfunction in pregnancy complicated by diabetes mellitus and determine association of the same with diabetes in pregnancy and maternal and perinatal outcomes. Methods: We conducted a cross sectional study in which pregnant women with gestational as well as pregestational diabetes were enrolled and the proportion of those with thyroid dysfunction were assessed. Thyroid autoimmunity was evaluated in the same population using anti TPO and anti-thyroglobulin antibodies. The proportion of women with thyroid autoimmunity as well as thyroid dysfunction was calculated and the association of these with gestational and pregestational diabetes was evaluated. Those with thyroid autoimmunity was compared with those without autoimmunity and the association of each group with the presence of diabetes mellitus was evaluated. The same tests were done on pregnant women without diabetes or thyroid disease who served as controls. Results: The mean age of the study population was 26.62 ± 4.34 years. Among the gestational diabetics, the mean gestational age at diagnosis was 28.39 ± 4.69 weeks. The average duration of diabetes among those with pregestational diabetes was 3.10 ± 1.32 years. 40.67% participants had a family history of diabetes and 14% had family history of hypothyroidism. 56% were diagnosed with GDM and the rest had preGDM. Acanthosis nigricans was noted in 63.34% participants and 37.3% had goitre. 26.6% of the study population were diagnosed with hypothyroidism, none had hyperthyroidism. Of these, 45% were newly diagnosed during the current pregnancy.30.95% of those with GDM were noted to have hypothyroidism whereas it was 21.2% in preGDM. The prevalence of anti TPO antibody positivity was assessed in 140 patients which was found to be 9.29% whereas that of anti-thyroglobulin antibody was 3.57%.4.67% participants were noted to have oligohydramnios and 10% had polyhydramnios. 46.6% of those with polyhydramnios were found to have associated hypothyroidism which was statistically significant (P=.01). Maternal complications like gestational hypertension, pre term delivery, post-partum hemorrhage and caesarean section as well as neonatal complications like neonatal jaundice were higher in women with combined endocrinopathy. Conclusion: The prevalence of hypothyroidism in pregnancy complicated by diabetes mellitus is higher than the prevalence in normal pregnancy. About one third of those with gestational diabetes and more than one fifth of those with pregestational diabetes were found to have hypothyroidism in our study. Almost half of patients with polyhydramnios were found to have associated hypothyroidism. Maternal complications and neonatal jaundice were found to be higher among those with combined endocrinopathy. However, the prevalence of thyroid autoimmunity in our study was lower as compared to previously published data which could be because of regional differences in iodine sufficiency or other unrecognised endocrine disruptors which could be at play. Nevertheless, our study emphasises the fact that women with diabetes in pregnancy should receive early and periodic screening for thyroid dysfunction in pregnancy.