A Cause for Pregnant Pause

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Some women with type 1 diabetes will need additional insulin during their pregnancy and a new blood test can reveal one reason why.

The test looks for TPO-Abs antibodies, predictors of hypothyroidism. Hypothyroidism is characterized by a decrease in thyroid hormone production, and symptoms include a slower metabolic rate, weight gain and lethargy.

According to an article in October’s Diabetes Care, pregnant type 1 women who test positive for the antibodies before becoming pregnant have a far greater risk of developing hypothyroidism and suffering from poor glucose control during their pregnancy. They may also need higher doses of insulin during the second and third trimesters of their pregnancies say researchers Luisa Fernandez-Soto, MD, Amalia Gonzalez, MD, et. al.

TPO-Abs antibodies are produced in the body when thyroid trouble in present, and the detection of the antibodies before becoming pregnant can predict which patients will need more insulin during pregnancy and which patients may develop thyroid problems.

In the study, forty-two percent of the women who tested positive for TPO-Abs before they got pregnant later developed hypothyroidism and were treated with thyroid hormone replacement therapy. Also, the younger the woman was when she developed diabetes, the more likely she was to develop thyroid disease.

Other studies have shown that women with high TPO-Abs levels have a higher risk of losing a baby or having a baby with diminished cognitive development. TPO-Abs women who develop hypothyroidism also have higher HbA1c and poor metabolic control, even after thyroid treatment. Poor glycemic control also increases the risk of complications during pregnancy.

Researchers advise type 1 women undergo pre-pregnancy screening for the antibodies and be closely monitored during and after the pregnancy if results are positive.

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