Introduction: Thyroid dysfunction and gestational diabetes (GDM) are the two most common endocrine disorders that can be observed during pregnancy. Thyroid function abnormalities can be associated with insulin resistance (IR) and changes in carbohydrate metabolism. In patients with type 1 diabetes, thyroid function is usually evaluated to rule out abnormalities within a second autoimmune disease. Patients with type 2 diabetes are tested for thyroid function in view of the associated weight gain, IR, and changes in metabolism. The question arises: Should we also look for thyroid dysfunction in patients with gestational diabetes? The aim of the study was to determine whether there are abnormalities in thyroid hormone levels in pregnant women with gestational diabetes. Material and methods: A monocentric, retrospective study of the Dr Shterev Hospital electronic database was performed. We analysed the medical records of 662 pregnant women, divided in two groups — 412 with GDM and 250 with normal glucose tolerance, who gave birth in the period 2017–2019. Gestational diabetes mellitus in the study group was diagnosed with a 2-h, 75-g oral glucose tolerance test (OGTT) using the International Federation of Gynaecology and Obstetrics (FIGO) and American Diabetes Association (ADA) criteria. We analysed the mean serum concentrations of thyroid-stimulating hormone (TSH); free thyroxine (FT4), free triiodothyronine (FT3), FT3:FT4 ratio, fasting plasma glucose, age and body mass index in both groups. The groups were compared using the Mann-Whitney U-test. Results: In patients who developed GDM, significantly higher concentrations of TSH (p < 0.0001) and FT3 (p < 0.0001), lower concentrations of FT4 (p < 0.0001), and higher FT3:FT4 ratios (p < 0.0001) were found. Conclusion: The results of this pilot retrospective series reveal that high-normal to high concentration of TSH and low-normal to low concentration of FT4 as well as high FT3:Ft4 ratio could indicate increased risk of development of GDM. Introduction: Thyroid dysfunction and gestational diabetes (GDM) are the two most common endocrine disorders that can be observed during pregnancy. Thyroid function abnormalities can be associated with insulin resistance (IR) and changes in carbohydrate metabolism. In patients with type 1 diabetes, thyroid function is usually evaluated to rule out abnormalities within a second autoimmune disease. Patients with type 2 diabetes are tested for thyroid function in view of the associated weight gain, IR, and changes in metabolism. The question arises: Should we also look for thyroid dysfunction in patients with gestational diabetes? The aim of the study was to determine whether there are abnormalities in thyroid hormone levels in pregnant women with gestational diabetes. Material and methods: A monocentric, retrospective study of the Dr Shterev Hospital electronic database was performed. We analysed the medical records of 662 pregnant women, divided in two groups — 412 with GDM and 250 with normal glucose tolerance, who gave birth in the period 2017–2019. Gestational diabetes mellitus in the study group was diagnosed with a 2-h, 75-g oral glucose tolerance test (OGTT) using the International Federation of Gynaecology and Obstetrics (FIGO) and American Diabetes Association (ADA) criteria. We analysed the mean serum concentrations of thyroid-stimulating hormone (TSH); free thyroxine (FT4), free triiodothyronine (FT3), FT3:FT4 ratio, fasting plasma glucose, age and body mass index in both groups. The groups were compared using the Mann-Whitney U-test. Results: In patients who developed GDM, significantly higher concentrations of TSH (p < 0.0001) and FT3 (p < 0.0001), lower concentrations of FT4 (p < 0.0001), and higher FT3:FT4 ratios (p < 0.0001) were found. Conclusion: The results of this pilot retrospective series reveal that high-normal to high concentration of TSH and low-normal to low concentration of FT4 as well as high FT3:Ft4 ratio could indicate increased risk of development of GDM.

Gestational diabetes mellitus (GDM) is one of the most common pregnancy complications and one of the main causes of adverse pregnancy outcomes. An early diagnosis of GDM is of fundamental importance in clinical practice. However, the major professional organizations recommend universal screening for GDM, using a 75 g oral glucose tolerance test at 24–28 weeks of gestation. A selective screening at an early stage of pregnancy is recommended only if there are maternal risk factors for diabetes. As a result, the GDM diagnosis is often delayed and established after the appearance of complications. The manifestation of GDM is directly related to insulin resistance, which is closely associated with endothelial dysfunction. The placenta, the placental peptides and hormones play a pivotal role in the manifestation and progression of insulin resistance during pregnancy. Recently, the placental growth factor (PlGF) and plasma-associated protein-A (PAPP-A), have been shown to significantly affect both insulin sensitivity and endothelial function. The principal function of PAPP-A appears to be the cleavage of circulating insulin-like growth factor binding protein-4 while PlGF has been shown to play a central role in the development and maturation of the placental vascular system and circulation. On one hand, these factors are widely used as early predictors (11–13 weeks of gestation) of complications during pregnancy, such as preeclampsia and fetal aneuploidies, in most countries. On the other hand, there is increasing evidence for their predictive role in the development of carbohydrate disorders, but some studies are rather controversial. Therefore, this review aims to summarize the available literature about the potential of serum levels of PlGF and PAPP-A as early predictors in the diagnosis of GDM.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), may lead to thyroid disorders, including both thyrotoxicosis and suppression of thyroid function. The aim of the present study was to assess the post-COVID-19 effects on thyroid function in patients without history of thyroid disease after complete recovery from mild-to-moderate COVID-19. Thyroid function tests [thyroid-stimulating hormone (TSH), free thyroxine (fT4), antithyroid antibodies] were performed on 113 patients (median age of 43.0 years; 31.0% male) two months after initial SARS-CoV-2 infection. TSH and fT4 were determined again one month later in this observational, prospective study. Thyroid dysfunction was registered in 61.1% of the patients (78.3% subclinical hypothyroidism, 13% subclinical hyperthyroidism and 8.7% overt hypothyroidism) two months after COVID-19. Moderate rather than mild manifestation of COVID-19 was significantly associated with a higher risk of thyroid dysfunction (OR 5.33; 95% CI: 1.70–16.69, p = 0.002), presence of thyroglobulin antibodies and need for levothyroxine therapy. At the follow-up, the subclinical hypothyroidism persisted in 28.3% of the subjects. Moreover, the TSH level was significantly reduced in comparison to the second month after the initial COVID-19 infection in all the patients (p < 0.001), but not in those with subclinical hypothyroidism and without hormone replacement therapy. Our findings indicate that COVID-19 could have long-term, negative effects on thyroid function. Therefore, thyroid function testing should be included in the follow-up algorithm of COVID-19 survivors.

The number of overweight and obese people has dramatically risen in the last two decades and has become one of the most serious health concerns. This study aimed to assess the use of food supplements as aids in reducing body weight and different approaches for weight management practised by Bulgarian adults. A cross-sectional, questionnaire-based online survey was conducted between December 2019 and February 2020. A total of 508 adults completed the survey. According to study participants, the Internet was the most used source of weight reduction information (66.9%). One hundred and seventy-two adults (33.9%) have sought weight-loss advice from a personal trainer/fitness instructor, and only 12.6% (n = 64) have consulted with a physician. More than half of the respondents (n = 288, 56.7%) reported food supplement use to maintain weight. The majority of the consumers were female (76.4%, p < 0.001) and adults with higher education (89.9%, p < 0.001). The main reasons for food supplement intake were individual research on the Internet (43%), advice from a personal trainer/fitness instructor (23.6%), and a recommendation from a healthcare provider (22.2%). With the increasing rates of overweight and obesity, food supplements are becoming a popular weight-loss approach, which is confirmed by our findings.

Objectives: Gestational diabetes mellitus (GDM) is one of the most common pregnancy complications. The universal screening for GDM is usually performed between 24-28 weeks’ gestation. This often delays the diagnosis and could increase the risk of adverse pregnancy outcomes. Some of the biochemical placental markers — pregnancy associated plasma protein A (PAPP-A) and free-β human chorionic gonadotropin (hCG), probably could provide a diagnostic value for GDM. The aim of our study was to assess if PAPP-A and hCG values were different among pregnant women with and without GDM and respectively, to tested their place in the early GDM screening. Material and methods: We conducted a retrospective, case-control study by reviewing the clinical database records of 662 pregnant women. The analysis includes the data for a two-year period. The patients included in the observation were divided into two groups — GDM group (n = 412) and Euglycemic group (n = 250). Early screening for GDМ between 9–12 weeks’ gestation was performed in 173 of the women in the interventional group due to: registered fasting plasma glucose (FPG) above 5.1 mmol/L, obesity, macrosomia in previous pregnancies or family history for diabetes mellitus. The remaining 239 women underwent universal screening at 24–28 weeks’ gestation. Mean serum levels of PAPP-A, hCG, FPG, and body mass index (BMI) were measured between 10–13 gestational weeks. Serum levels of PAPP-A and hCG are presented as multiples of the normal median (MoM), adjusted by maternal baseline characteristics and demographics. Results: In patients who developed GDM during pregnancy, compared with the control group, we have found significantly lower MoM values of PAPP-A (p < 0.0001), higher levels of FPG (р < 0.0001) and higher BMI (р < 0.0001). Median hCG MoM was similar in both group of pregnant women. Conclusion: Our findings suggest that low-normal to low reference range values of PAPP-A might be associated with higher risk for GDM. PAAP-A levels can be used as an additional factor to recommend early screening for GDM. Objectives: Gestational diabetes mellitus (GDM) is one of the most common pregnancy complications. The universal screening for GDM is usually performed between 24-28 weeks’ gestation. This often delays the diagnosis and could increase the risk of adverse pregnancy outcomes. Some of the biochemical placental markers — pregnancy associated plasma protein A (PAPP-A) and free-β human chorionic gonadotropin (hCG), probably could provide a diagnostic value for GDM. The aim of our study was to assess if PAPP-A and hCG values were different among pregnant women with and without GDM and respectively, to tested their place in the early GDM screening. Material and methods: We conducted a retrospective, case-control study by reviewing the clinical database records of 662 pregnant women. The analysis includes the data for a two-year period. The patients included in the observation were divided into two groups — GDM group (n = 412) and Euglycemic group (n = 250). Early screening for GDМ between 9–12 weeks’ gestation was performed in 173 of the women in the interventional group due to: registered fasting plasma glucose (FPG) above 5.1 mmol/L, obesity, macrosomia in previous pregnancies or family history for diabetes mellitus. The remaining 239 women underwent universal screening at 24–28 weeks’ gestation. Mean serum levels of PAPP-A, hCG, FPG, and body mass index (BMI) were measured between 10–13 gestational weeks. Serum levels of PAPP-A and hCG are presented as multiples of the normal median (MoM), adjusted by maternal baseline characteristics and demographics. Results: In patients who developed GDM during pregnancy, compared with the control group, we have found significantly lower MoM values of PAPP-A (p < 0.0001), higher levels of FPG (р < 0.0001) and higher BMI (р < 0.0001). Median hCG MoM was similar in both group of pregnant women. Conclusion: Our findings suggest that low-normal to low reference range values of PAPP-A might be associated with higher risk for GDM. PAAP-A levels can be used as an additional factor to recommend early screening for GDM.