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Beibei Zhu, Yan Han, Fen Deng, Kun Huang, Shuangqin Yan, Jiahu Hao, Peng Zhu, and Fangbiao Tao

Objectives: Compared with other thyroid markers, fewer studies explored the associations between triiodothyronine (T3) and T3/free thyroxine (fT4) and glucose abnormality during pregnancy. Thus, we aimed to: (1) examine the associations of T3 and T3/fT4 with glucose metabolism indicators; and (2) evaluate, in the first trimester, the performance of the two markers as predictors of gestational diabetes mellitus (GDM) risk.

Methods: Longitudinal data from 2723 individuals, consisting of three repeated measurements of T3 and fT4, from the Man’anshan birth cohort study (MABC), China, were analyzed using a time-specific generalized estimating equation (GEE). The receiver operating characteristic curve (ROC) - area under the curve (AUC) and Hosmer-Lemeshow goodness of fit test were used to assess the discrimination and calibration of prediction models.

Results: T3 and T3/fT4 presented stable associations with the level of fasting glucose, glucose at 1h/2h across pregnancy. T3 and T3/fT4 in both the first and second trimesters were positively associated with the risk of GDM, with the larger magnitude of association observed in the second trimester (Odds ratio (OR) = 2.50, 95%CI = 1.95, 3.21 for T3; OR = 1.09, 95%CI = 1.07, 1.12 for T3/fT4). T3 ((AUC) = 0.726, 95%CI = 0.698, 0.754) and T3/fT4 (AUC = 0.724, 95%CI = 0.696, 0.753) in the first trimester could improve the performance of the predicting model; however, the overall performance is not good.

Conclusion: Significant and stable associations of T3, T3/fT4 and glucose metabolism indicators were documented. Both T3 and T3/fT4 improve the performance of the GDM predictive model.