{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T17:28:21Z","timestamp":1793726901676,"version":"4.6.1"},"reference-count":44,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2022,8,26]],"date-time":"2022-08-26T00:00:00Z","timestamp":1661472000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Belgian National Lottery"},{"name":"Academic studies of UZ Leuven"},{"name":"Yvonne and Jacques Fran\u00e7ois-de Meurs of the King Boudewijn Foundation"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Aim: To determine the association between thyroid function and the risk of developing gestational diabetes mellitus (GDM) and adverse pregnancy outcomes. Methods: This case\u2013control study was a sub-analysis of the BEDIP-N study, in which 199 GDM women were matched for age and body mass index with 398 controls. Thyroid-stimulating hormone (TSH), free thyroxine (fT4), free triiodothyronine (fT3), and thyroid peroxidase (TPO) antibodies were measured at 6\u201314 weeks and 26\u201328 weeks during pregnancy. TSH and fT4 were also measured in early postpartum in GDM women. Results: The fT3-to-fT4 ratio at 26\u201328 weeks was positively associated with GDM risk with an adjusted odds ratio (aOR for smoking, education, parity, ethnicity, gestational weight gain, and (family) history of diabetes or GDM) of 2.12 (95% CI 1.07; 4.23), comparing the highest with the lowest tertile. Higher fT3 levels and a higher fT3-to-fT4 ratio were associated with a less favorable metabolic profile with higher BMI and more insulin resistance during pregnancy and postpartum. Women in the upper fT3 tertile and the upper fT3-to-fT4 ratio had a higher rate of preeclampsia [4.6% (10) vs. 1.0% (2), p = 0.040, and 4.4% (9) vs. 0.5% (1), p = 0.020], gestational hypertension [8.3% (18) vs. 3.1% (6), p = 0.034 and 8.9% (18) vs. 2.0% (4), p = 0.003], and caesarean sections [29.4% (63) vs. 16.1% (31), p = 0.002 and 32.2% (65) vs. 12.7% (25), p &lt; 0.001]. Conclusion: A higher fT3-to-fT4 ratio late into pregnancy was associated with GDM, adverse pregnancy outcomes, and an adverse metabolic profile in early postpartum.<\/jats:p>","DOI":"10.3390\/jcm11175016","type":"journal-article","created":{"date-parts":[[2022,8,29]],"date-time":"2022-08-29T03:34:56Z","timestamp":1661744096000},"page":"5016","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Higher Thyroid fT3-to-fT4 Ratio Is Associated with Gestational Diabetes Mellitus and Adverse Pregnancy Outcomes"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3686-0355","authenticated-orcid":false,"given":"Lore","family":"Raets","sequence":"first","affiliation":[{"name":"Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Herestraat 49, 3000 Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6846-9452","authenticated-orcid":false,"given":"Caro","family":"Minschart","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Herestraat 49, 3000 Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0529-7256","authenticated-orcid":false,"given":"Annick","family":"Van den Bruel","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, AZ St Jan Brugge, Ruddershove 10, 8000 Brugge, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmelien","family":"Van den Bogaert","sequence":"additional","affiliation":[{"name":"Department of Medicine, Katholieke Universiteit Leuven, Herestraat 49, 3000 Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Van Crombrugge","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, OLV-Ziekenhuis Aalst-Asse-Ninove, Moorselbaan 164, 9300 Aalst, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolien","family":"Moyson","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Herestraat 49, 3000 Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johan","family":"Verhaeghe","sequence":"additional","affiliation":[{"name":"Department of Obstetrics & Gynecology, UZ Gasthuisberg, Katholieke Universiteit Leuven, Herestraat 49, 3000 Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofie","family":"Vandeginste","sequence":"additional","affiliation":[{"name":"Department of Obstetrics & Gynecology, OLV-Ziekenhuis Aalst-Asse-Ninove, Moorselbaan 164, 9300 Aalst, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hilde","family":"Verlaenen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics & Gynecology, OLV-Ziekenhuis Aalst-Asse-Ninove, Moorselbaan 164, 9300 Aalst, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Vercammen","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Imelda Ziekenhuis, Imeldalaan 9, 2820 Bonheiden, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toon","family":"Maes","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Imelda Ziekenhuis, Imeldalaan 9, 2820 Bonheiden, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Els","family":"Dufraimont","sequence":"additional","affiliation":[{"name":"Department of Obstetrics & Gynecology, Imelda Ziekenhuis, Imeldalaan 9, 2820 Bonheiden, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nele","family":"Roggen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics & Gynecology, Imelda Ziekenhuis, Imeldalaan 9, 2820 Bonheiden, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christophe","family":"De Block","sequence":"additional","affiliation":[{"name":"Department of Endocrinology-Diabetology-Metabolism, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yves","family":"Jacquemyn","sequence":"additional","affiliation":[{"name":"Department of Obstetrics & Gynecology, Antwerp University Hospital (UZA), Drie Eikenstraat 655, 2650 Edegem, Belgium"},{"name":"Antwerp Surgical Training, Anatomy and Research Centre, Global Health Institute GHI, Antwerp University (UA), 2000 Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farah","family":"Mekahli","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Kliniek St-Jan Brussel, Kruidtuinlaan 32, 1000 Brussel, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katrien","family":"De Clippel","sequence":"additional","affiliation":[{"name":"Department of Obstetrics & Gynecology, Kliniek St-Jan Brussel, Kruidtuinlaan 32, 1000 Brussel, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Loccufier","sequence":"additional","affiliation":[{"name":"Department of Obstetrics & Gynecology, Kliniek St-Jan Brussel, Kruidtuinlaan 32, 1000 Brussel, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annouschka","family":"Laenen","sequence":"additional","affiliation":[{"name":"Center of Biostatics and Statistical Bioinformatics, Katholieke Universiteit Leuven, Kapucijnenvoer 35 Bloc D, Box 7001, 3000 Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7837-4684","authenticated-orcid":false,"given":"Roland","family":"Devlieger","sequence":"additional","affiliation":[{"name":"Department of Obstetrics & Gynecology, UZ Gasthuisberg, Katholieke Universiteit Leuven, Herestraat 49, 3000 Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chantal","family":"Mathieu","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Herestraat 49, 3000 Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4153-4757","authenticated-orcid":false,"given":"Brigitte","family":"Decallonne","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Herestraat 49, 3000 Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3325-0263","authenticated-orcid":false,"given":"Katrien","family":"Benhalima","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Herestraat 49, 3000 Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,8,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1056\/NEJM199102213240805","article-title":"Maturation of the secretion of thyroid hormone and thyroid-stimulating hormone in the fetus","volume":"324","author":"Nicolaides","year":"1991","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"101431","DOI":"10.1016\/j.beem.2020.101431","article-title":"Interpretation of thyroid function tests during pregnancy","volume":"34","author":"Visser","year":"2020","journal-title":"Best Pract. Res. Clin. Endocrinol. Metab."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1210\/er.2009-0041","article-title":"Thyroid function and human reproductive health","volume":"31","author":"Krassas","year":"2010","journal-title":"Endocr. Rev."},{"key":"ref_4","first-page":"703","article-title":"Maternal subclinical hypothyroidsm and gestational diabetes mellitus: A meta-analysis","volume":"20","author":"Toulis","year":"2014","journal-title":"Endocr. Pract. Off. J. Am. Coll. Endocrinol. Am. Assoc. Clin. Endocrinol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2447","DOI":"10.1210\/jc.2017-02442","article-title":"A Longitudinal Study of Thyroid Markers Across Pregnancy and the Risk of Gestational Diabetes","volume":"103","author":"Rawal","year":"2018","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"American Diabetes Association (2019). 14. Management of Diabetes in Pregnancy: Standards of Medical Care in Diabetes\u20142019. Diabetes Care, 42, S165\u2013S172.","DOI":"10.2337\/dc19-S014"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1097\/AOG.0b013e318250aeeb","article-title":"Relationship of subclinical thyroid disease to the incidence of gestational diabetes","volume":"119","author":"Tudela","year":"2012","journal-title":"Obs. Gynecol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1007\/s00404-009-1105-1","article-title":"Overt and subclinical thyroid dysfunction among Indian pregnant women and its effect on maternal and fetal outcome","volume":"281","author":"Sahu","year":"2010","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1007\/s12020-016-1022-6","article-title":"Maternal TSH level and TPOAb status in early pregnancy and their relationship to the risk of gestational diabetes mellitus","volume":"54","author":"Ying","year":"2016","journal-title":"Endocrine"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1679","DOI":"10.1111\/dme.14106","article-title":"Higher thyroid-stimulating hormone levels in the first trimester are associated with gestational diabetes in a Chinese population","volume":"36","author":"Leng","year":"2019","journal-title":"Diabet. Med. A J. Br. Diabet. Assoc."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"636","DOI":"10.3389\/fendo.2020.00636","article-title":"Incidence and Risk Factors of Gestational Diabetes Mellitus: A Prospective Cohort Study in Qingdao, China","volume":"11","author":"Li","year":"2020","journal-title":"Front. Endocrinol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e3441","DOI":"10.1002\/dmrr.3441","article-title":"A longitudinal study of thyroid markers during pregnancy and the risk of gestational diabetes mellitus and post-partum glucose metabolism","volume":"37","author":"Tang","year":"2021","journal-title":"Diabetes\/Metab. Res. Rev."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"806256","DOI":"10.3389\/fendo.2022.806256","article-title":"Increased Central and Peripheral Thyroid Resistance Indices During the First Half of Gestation Were Associated With Lowered Risk of Gestational Diabetes\u2014Analyses Based on Huizhou Birth Cohort in South China","volume":"13","author":"Liu","year":"2022","journal-title":"Front. Endocrinol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1186\/1471-2393-14-226","article-title":"The Belgian Diabetes in Pregnancy Study (BEDIP-N), a multi-centric prospective cohort study on screening for diabetes in pregnancy and gestational diabetes: Methodology and design","volume":"14","author":"Benhalima","year":"2014","journal-title":"BMC Pregnancy Childbirth"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e111","DOI":"10.2337\/dc18-0556","article-title":"The sensitivity and specificity of the glucose challenge test in a universal two-step screening strategy for gestational diabetes mellitus using the 2013 world health organization criteria","volume":"41","author":"Benhalima","year":"2018","journal-title":"Diabetes Care"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Benhalima, K., Van Crombrugge, P., Moyson, C., Verhaeghe, J., Vandeginste, S., Verlaenen, H., Vercammen, C., Maes, T., Dufraimont, E., and De Block, C. (2018). A Modified Two-Step Screening Strategy for Gestational Diabetes Mellitus Based on the 2013 WHO Criteria by Combining the Glucose Challenge Test and Clinical Risk Factors. J. Clin. Med., 7.","DOI":"10.3390\/jcm7100351"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2118","DOI":"10.1007\/s00125-019-4961-7","article-title":"Characteristics and pregnancy outcomes across gestational diabetes mellitus subtypes based on insulin resistance","volume":"62","author":"Benhalima","year":"2019","journal-title":"Diabetologia"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1007\/s00592-019-01469-5","article-title":"Estimating the risk of gestational diabetes mellitus based on the 2013 WHO criteria: A prediction model based on clinical and biochemical variables in early pregnancy","volume":"57","author":"Benhalima","year":"2020","journal-title":"Acta Diabetol."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"American Diabetes Association (2020). 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes\u20142020. Diabetes Care, 43, S14.","DOI":"10.2337\/dc20-S002"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"World Health Organization (2014). Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy: A World Health Organization Guideline. Diabetes Res. Clin. Pract., 103, 341\u2013363.","DOI":"10.1016\/j.diabres.2013.10.012"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1007\/BF00280883","article-title":"Homeostasis model assessment: Insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man","volume":"28","author":"Matthews","year":"1985","journal-title":"Diabetologia"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1462","DOI":"10.2337\/diacare.22.9.1462","article-title":"Insulin sensitivity indices obtained from oral glucose tolerance testing: Comparison with the euglycemic insulin clamp","volume":"22","author":"Matsuda","year":"1999","journal-title":"Diabetes Care"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s00125-002-1009-0","article-title":"The relative contributions of insulin resistance and beta-cell dysfunction to the pathophysiology of Type 2 diabetes","volume":"46","author":"Kahn","year":"2003","journal-title":"Diabetologia"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1602","DOI":"10.2337\/diacare.24.9.1602","article-title":"Clinically useful estimates of insulin sensitivity during pregnancy: Validation studies in women with normal glucose tolerance and gestational diabetes mellitus","volume":"24","author":"Kirwan","year":"2001","journal-title":"Diabetes Care"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1198","DOI":"10.1111\/j.1464-5491.2009.02841.x","article-title":"Evaluation of proposed oral disposition index measures in relation to the actual disposition index","volume":"26","author":"Retnakaran","year":"2009","journal-title":"Diabet. Med. A J. Br. Diabet. Assoc."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1","DOI":"10.2143\/TVG.56.1.5000625","article-title":"Standaarden van geboortegewicht-voor-zwangerschapsduur voor de Vlaamse boreling","volume":"56","author":"Bekaert","year":"2000","journal-title":"Tijdschr. Voor Geneeskd."},{"key":"ref_27","unstructured":"Rasmussen, K.M., and Yaktine, A.L. (2009). The National Academies Collection: Reports funded by National Institutes of Health. Weight Gain during Pregnancy: Reexamining the Guidelines, National Academy of Sciences."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e804","DOI":"10.1210\/clinem\/dgab637","article-title":"A prospective study of early-pregnancy thyroid markers, lipid species, and risk of gestational diabetes mellitus","volume":"107","author":"Wang","year":"2021","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"4237","DOI":"10.1210\/jc.2016-1506","article-title":"Low Thyroid Hormone in Early Pregnancy Is Associated with an Increased Risk of Gestational Diabetes Mellitus","volume":"101","author":"Yang","year":"2016","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Zhang, Y., Dai, X., Yang, S., Zhang, C., Han, M., Huang, H.F., and Fan, J. (2017). Maternal low thyroxin levels are associated with adverse pregnancy outcomes in a Chinese population. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0178100"},{"key":"ref_31","first-page":"3857","article-title":"The placenta in fetal thyroid hormone delivery: From normal physiology to adaptive mechanisms in complicated pregnancies","volume":"33","author":"Eerdekens","year":"2020","journal-title":"J. Matern.-Fetal Neonatal Med. Off. J. Eur. Assoc. Perinat. Med. Fed. Asia Ocean. Perinat. Soc. Int. Soc. Perinat. Obs."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"3717","DOI":"10.1210\/jc.2011-1784","article-title":"Lower Free Thyroxin Associates with a Less Favorable Metabolic Phenotype in Healthy Pregnant Women","volume":"96","author":"Bassols","year":"2011","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"890","DOI":"10.1111\/cen.12384","article-title":"Different levels of thyroid hormones between impaired fasting glucose and impaired glucose tolerance: Free T3 affects the prevalence of impaired fasting glucose and impaired glucose tolerance in opposite ways","volume":"80","author":"Su","year":"2014","journal-title":"Clin. Endocrinol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1089\/thy.2013.0314","article-title":"Triiodothyronine and Free Thyroxine Levels are Differentially Associated with Metabolic Profile and Adiposity-Related Cardiovascular Risk Markers in Euthyroid Middle-Aged Subjects","volume":"24","author":"Roef","year":"2014","journal-title":"Thyroid Off. J. Am. Thyroid Assoc."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"880","DOI":"10.2337\/diabetes.51.3.880","article-title":"Association between a novel variant of the human type 2 deiodinase gene Thr92Ala and insulin resistance: Evidence of interaction with the Trp64Arg variant of the beta-3-adrenergic receptor","volume":"51","author":"Mentuccia","year":"2002","journal-title":"Diabetes"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"14107","DOI":"10.1038\/srep14107","article-title":"Gene expression profiling of pre-eclamptic placentae by RNA sequencing","volume":"5","author":"Kaartokallio","year":"2015","journal-title":"Sci. Rep."},{"key":"ref_37","first-page":"206","article-title":"Adipose Tissue and Skeletal Muscle Expression of Genes Associated with Thyroid Hormone Action in Obesity and Insulin Resistance","volume":"32","author":"Stefanowicz","year":"2021","journal-title":"Thyroid Off. J. Am. Thyroid Assoc."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1152\/physrev.00030.2013","article-title":"Thyroid hormone regulation of metabolism","volume":"94","author":"Mullur","year":"2014","journal-title":"Physiol. Rev."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1530\/EJE-15-0866","article-title":"Maternal hypothyroxinaemia in pregnancy is associated with obesity and adverse maternal metabolic parameters","volume":"174","author":"Knight","year":"2016","journal-title":"Eur. J. Endocrinol."},{"key":"ref_40","first-page":"819","article-title":"Association of Thyroid Function During Pregnancy With the Risk of Pre-eclampsia and Gestational Diabetes Mellitus","volume":"27","author":"Wang","year":"2021","journal-title":"Endocr. Pract. Off. J. Am. Coll. Endocrinol. Am. Assoc. Clin. Endocrinol."},{"key":"ref_41","first-page":"e2021010","article-title":"Long term outcomes of infants born by mothers with thyroid dysfunction during pregnancy","volume":"92","author":"Lucaccioni","year":"2020","journal-title":"Acta Bio-Med. Atenei Parm."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Mahadik, K., Choudhary, P., and Roy, P.K. (2020). Study of thyroid function in pregnancy, its feto-maternal outcome; a prospective observational study. BMC Pregnancy Childbirth, 20.","DOI":"10.1186\/s12884-020-03448-z"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"5853","DOI":"10.1210\/jc.2019-00390","article-title":"Association Between Maternal Thyroid Hormones and Birth Weight at Early and Late Pregnancy","volume":"104","author":"Zhang","year":"2019","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1097\/01.AOG.0000152345.99421.22","article-title":"Subclinical Hypothyroidism and Pregnancy Outcomes","volume":"105","author":"Casey","year":"2005","journal-title":"Obs. Gynecol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/17\/5016\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:15:56Z","timestamp":1760141756000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/17\/5016"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,26]]},"references-count":44,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2022,9]]}},"alternative-id":["jcm11175016"],"URL":"https:\/\/doi.org\/10.3390\/jcm11175016","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,26]]}}}