Over the last few decades, thyroid cancer incidence has had a significant increase. Despite well-known genetic and epigenetic factors (radiation, overdiagnosis, already existing benign thyroid tumors), the effect of air pollution on its incidence and mortality has not yet been fully elucidated. In this study, air pollution data from 27 EU member states is used in order to analyze its association with thyroid cancer incidence, and mortality and socioeconomic factors are examined as confounders. This ecological study used age standardized thyroid cancer incidence and mortality rates per 100,000 people for the year 2012 from 27 EU member states, collected from the International Agency for Research on Cancer, World Health Organization and European Cancer. Data regarding mean air pollutant mass concentrations for 1992, 2002 and 2012 was collected from the European Environment Agency. Data analysis was carried out using Prism 5.0 and SPSS v.20. Multiple regression analysis showed a statistically significant positive association between thyroid cancer incidence in men and the environmental 2012 masse of Benzo (k) Fluoranthene (r² = 0.2142, p = 0.042) and HexaChlorocycloHexane (r² = 0.9993, p = 0.0166). Additionally, a statistically significant positive association was observed between the thyroid cancer mortality rate in men and the 1992 environmental concentrations of Hg (r² = 0.1704, p = 0.043). Data indicates that some air pollutants may have an effect on increased thyroid cancer incidence and mortality, at least in men. However, causal relationships cannot be fully supported via ecological studies, and this article only focuses on the EU and uses only three distinct time periods.

Background/Objectives: As the incidence of diabetes mellitus (DM) is increasing rapidly worldwide, it is anticipated that an increasing number of women will enter pregnancy with pregestational diabetes mellitus (PGDM) in the future. Compelling evidence suggests that hyperglycemia in pregnancy is related to multiple adverse perinatal outcomes. This systematic review and meta-analysis aims to assess and quantify the association of PGDM with a range of adverse perinatal outcomes, providing a comprehensive understanding of its impact on pregnancy. Methods: The data sources of this systematic review and meta-analysis were Medline/PubMed, Scopus and Cochrane Library (January 1999 to August 2023), complemented by hand-searching for additional references. Observational studies reporting perinatal outcomes of pregnancies with PGDM diagnosed before pregnancy versus control pregnancies were eligible for inclusion. A systematic review and meta-analysis were conducted as per the PRISMA guidelines. Pooled estimate odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to determine the risk of adverse pregnancy outcomes between PGDM and control pregnancies. Results: The systematic search of the literature yielded 81 observational studies meeting inclusion criteria and in total, 137,237,640 pregnancies were included in the analysis. A total of 19 adverse perinatal outcomes were assessed, revealing a significant association with PGDM. In pregnancies with PGDM there was an increased risk of adverse perinatal outcomes, including gestational hypertension (OR 3.16, 95% CI 2.65–3.77), preeclampsia (OR 4.46, 95% CI 3.94–5.05), preterm delivery (OR 3.46, 95% CI 3.06–3.91), cesarean delivery (OR 3.12, 95% CI 2.81–3.47), induction of labor (OR 2.92, 95% CI 2.35–3.63), macrosomia (OR 2.23, 95% CI 1.76–2.83), LGA neonates (OR 3.95, 95% CI 3.47–4.49), low 5-min Apgar score (OR 2.49, 95% CI 2.07–2.99), shoulder dystocia (OR 3.05, 95% CI 2.07–4.50), birth trauma (OR 1.40, 95% CI 1.22–1.62), polyhydramnios (OR 5.06, 95% CI 4.33–5.91), oligohydramnios (OR 1.61, 95% CI 1.19–2.17), neonatal hyperbilirubinemia (OR 3.45, 95% CI 2.51–4.74), neonatal hypoglycemia (OR 19.19, 95% CI 2.78–132.61), neonatal intensive care unit (NICU) admission (OR 4.54, 95% CI 3.87–5.34), congenital malformations (OR 2.44, 95% CI 1.96–3.04), stillbirth (OR 2.87, 95% CI 2.27–3.63) and perinatal mortality (OR 2.94, 95% CI 2.18–3.98). Subgroup analyses indicated a higher risk of neonatal hypoglycemia, stillbirth and perinatal mortality in T1DM pregnancies compared with T2DM pregnancies. Conclusions: This study provides a robust synthesis of evidence underlying the strong association between PGDM and several adverse perinatal outcomes. Early detection, optimal glycemic control during the periconceptional and pregnancy periods, and proper antenatal care are critical to mitigate these risks.

Background/Objectives: Gestational diabetes mellitus (GDM) is a common pregnancy complication, and maternal diet before conception may be an important modifiable risk factor. This study aimed to investigate the association between maternal pre-pregnancy energy and macronutrient intake and the risk of GDM. Methods: Data from the BORN2020 cohort in Northern Greece were used. Women were recruited at their first trimester prenatal visit (11–13 weeks of gestation) and provided detailed dietary data via a validated food frequency questionnaire (FFQ), reflecting intake in the six months prior to conception. Weighted Quantile Sum (WQS) regression models were applied to assess the joint effects of food-derived macronutrient mixtures on GDM risk. Analyses were adjusted for parity, maternal age, pre-pregnancy BMI, thyroid disorders, smoking, energy intake, and physical activity. Results: In total, 797 women were included in the analyses. In normal-BMI women, higher pre-pregnancy intake of energy (aOR = 81.16, 95% CI: 4.55–1447.46), total carbohydrates (aOR = 50.66, 95% CI: 3.59–715.04), total fat (aOR = 9.35, 95% CI: 1.17–74.54), and total protein (aOR = 11.06, 95% CI: 1.14–107.09) were significantly associated with increased odds of GDM. The main contributing foods were energy-dense and processed items such as puff pastry, processed meats, potatoes, refined grains, and dairy products. In contrast, dietary fiber, vegetable protein, and animal protein were not significantly associated with GDM risk. Among overweight and obese women, none of the macronutrient or energy mixtures showed significant associations. Conclusions: For women of normal weight, a pre-conception diet high in energy and macronutrients from processed foods is a significant predictor of GDM risk. This association was not found in overweight or obese women, highlighting a critical window for targeted nutritional intervention for normal-weight individuals before pregnancy.

Background/Objectives: Pre-conception health behaviors may influence the risk of gestational diabetes mellitus (GDM), but evidence on the joint effects of physical activity (PA) and dietary patterns remains limited. This study investigated the associations between pre-conception PA and GDM risk and explored their interaction with adherence to a Mediterranean diet (MD). Methods: This analysis used data from the BORN2020 cohort, which included pregnant women in Greece (2020–2022). Pre-conception PA was assessed using the International Physical Activity Questionnaire-Short Form (IPAQ-SF), expressed as the metabolic equivalent of task (MET)-min/week and categorized into quartiles. Adherence to the MD was assessed via the Trichopoulou score and then grouped into tertiles. Multivariable logistic regression models were computed, accounting for sociodemographic and clinical covariates, including sedentary time and post-lunch nap frequency. Results: In total, 524 women were included and 13.9% (n = 73) were diagnosed with GDM. Women who developed GDM were significantly older (mean age 34.41 vs. 31.98 years, p < 0.0001), were more likely to be >35 years old (46.6% vs. 26.6%, p < 0.001), had higher pre-pregnancy BMI (median 24.6 vs. 22.7 kg/m², p = 0.014), and were more likely to be obese (23.3% vs. 11.8%, p = 0.012). No significant association was observed between total pre-conception PA and GDM risk. Compared to the lowest PA quartile, women in the medium (aOR = 0.80, 95% CI: 0.45–1.40), high (aOR = 1.12, 95% CI: 0.52–2.39), and very high (aOR = 1.10, 95% CI: 0.50–2.38) PA quartiles showed no significant differences in GDM risk. PA, when modeled as a continuous variable, showed no significant trend (aOR = 0.99, 95% CI: 0.99–1.00; p-trend = 0.61). A joint analysis of PA and MD adherence also yielded no significant associations overall. However, in very small BMI-stratified subgroups, a low level of PA combined with very high MD adherence in normal-weight women was associated with increased GDM risk (aOR = 14.06, 95% CI: 1.55–165.54, p = 0.022), while in obese women, very high levels of PA and medium MD adherence showed a potentially protective effect (aOR = 0.006, 95% CI: 8.43 × 10⁻⁶–0.42, p = 0.048). These subgroup findings require cautious interpretation, due to the limited size of the sample set and wide confidence intervals. Conclusions: In this cohort, pre-conception PA, either alone or in combination with MD adherence, was not a reliable predictor of GDM. While our subgroup signals are hypothesis-generating, they do not yet support changes to clinical risk stratification. Future large-scale and interventional studies should investigate combined lifestyle interventions before conception to clarify the potential synergistic effects on GDM prevention.

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Background and Objectives: Many diagnostic methods exist for identifying thyroid malignancy, but most of them resemble an odyssey, as the journey from palpating a nodule to receiving a definitive diagnose is often long and costly. The aim of the present study is to investigate the role of Sestamibi scintigraphy in the characterization of cytological indeterminate thyroid nodules. Materials and Methods: A focused literature review was conducted, emphasizing the comparison between Fine Needle Aspiration Biopsy (FNAB), the main diagnostic method for thyroid cancer, and Sestamibi. Results: It is widely accepted that Sestamibi is the primary alternative for patients with non-diagnostic FNAB. As shown in the literature, Sestamibi has a high negative predictive value in excluding thyroid malignancy. Conclusions: Much like Odysseus’ adventurous 10-year journey returning to Ithaca, the path to diagnosing thyroid cancer is not straightforward. Molecular imaging with 99mTc-Sestamibi may serve as a valuable adjunct in evaluating thyroid nodules with inconclusive cytological findings.