Mild gestational hyperglycaemia as a risk factor for metabolic syndrome in pregnancy and adverse perinatal outcomes (original) (raw)
Diabetology & Metabolic Syndrome, 2015
Background: To evaluate the association between fasting glucose levels in women throughout pregnancy and the occurrence of gestational diabetes mellitus (GDM) and other pregnancy complications, macrosomia, and cesarean delivery. Methods: An analytical cross-sectional study with 829 healthy pregnant women receiving health care at a public maternity unit in Rio de Janeiro between 1999 and 2008. The dependent variables assessed in the study were: GDM (was confirmed when two or more values were above the glucose curve using 100 g glucose), complications, mode of delivery and birth weight. Macrosomia was defined as a birth weight of >4000 g. The independent variables assessed were: maternal fasting glucose per trimester as a continuous variable, divided into three categories, socio-demographic data on the mothers. The level of statistical significance was set at 5%. Results: The mean fasting glucose levels of the women who had GDM were higher in the second trimester than for those who had no pregnancy complications (90.5 mg/dL vs. 78.5 mg/dL, p = 0.000). Higher mean fasting glucose levels were also found in the third trimester for women who developed GDM than for those with no pregnancy complications (90 mg/dL vs. 77.8 mg/dL, p = 0.016). Women who had a cesarean delivery had higher fasting glucose levels in the second (80.4 mg/dL vs. 78 mg/dL, post hoc = 0.034) and third (80.4 mg/dL and 77.1 mg/dL; post hoc = 0.005) trimesters than women who had a normal delivery. Also, higher fasting glucose levels were found in the second semester for women whose infants had macrosomia than for women whose newborns were normal weight (86.2 mg/dL and 78.8 mg/dL; post hoc = 0.003). The chance of develop GDM was higher for the women with glucose levels in the 90-94 mg/dL range in the second trimester (OR = 7.2; 95% CI = 2.33-22.24) than for the women whose glucose levels were in the <80 mg/dL and 80-90 mg/dL ranges. Conclusion: Second and third trimester fasting glucose levels below the cutoff values for the diagnosis of GDM are associated with an increased risk of pregnancy complications. The dependent variables assessed in the study were: GDM (present/absent), complications, mode of delivery (normal, forceps, cesarean), and birth weight.
Journal of Maternal-fetal & Neonatal Medicine, 2015
Objective: We aimed to compare maternal characteristics and dysglycemia after delivery in women with gestational diabetes mellitus (GDM) according to pregnancy being multiple (MP) or singleton (SP). The hypothesis was that women with GDM and MP would have a milder glycemic abnormality before and after pregnancy than those with SP. Methods: We performed a cohort study of 2908 women giving birth between 1986 and 2009. Logistic regression was performed to discriminate between MP and SP after anamnestic prepregnancy characteristics. Kaplan-Meier and Cox regression analyses were performed to assess if MP was independently associated with both impaired fasting glucose (IFG)/impaired glucose tolerance (IGT) and diabetes after delivery. Results: Family history of diabetes was the only independent anamnestic pre-pregnancy characteristic discriminating MP versus SP, OR 2.04 (95% CI 1.12, 3.70, p 0.019). The median time to progress to IFG/IGT was 7.52 years in SP (95% CI 6.92, 8.13) and 7.41 in MP (95% CI 3.84, 10.98), ns and the progression to DM did not differ. In addition, MP was not associated to IFG/IGT or to DM in the Cox regression analysis. Conclusions: In this cohort of women with GDM, those with MP did not demonstrate a lesser degree of dysglycemia after controlling for other pregnancy characteristics and pregnancyindependent factors.
The association of impaired gestational glucose tolerance with maternal and fetal outcomes
Clinical and Experimental Obstetrics & Gynecology, 2016
The aim of the present study was to examine the associations of gestational diabetes mellitus (GDM) and impaired glucose tolerance (IGT) with maternal and fetal outcomes.A total of 200 pregnant women were included in this cross-sectional study. A 50-gram oral glucose challenge test (GCT) was performed between 24 and 28 weeks of gestation, followed by glucose tolerance test (OGTT) with 100 grams of oral glucose in those with an abnormal one-hour test result. The following were not significantly different between groups. Preterm labour (PL), pregnancy induced hypertension(PIH), pre-eclampsia, polyhydramnios, and macrosomia. However, a significant increase was noted in the fetal birth weight as well as in number of cesarean deliveries among GDM subjects. Neonatal outcomes were also similar between the two groups. In conclusion, the present results suggest that single high glucose readings in OGTT may be as important as a diagnosis of GDM in terms of fetomaternal complication risk.
Diabetic Medicine, 2020
What's new? While different metabolic phenotypes have been shown to predict adverse pregnancy outcomes in women with gestational diabetes mellitus (GDM) detected at 24-28 weeks' gestation (late GDM), no studies have been performed in women with GDM diagnosed prior to 20 weeks' gestation (early GDM). Early GDM was predominantly related to having an above-median insulin resistance level alone, which increased the risk of having larger babies and of caesarean section. Women with below-median insulin secretion alone, as well as those with both impairments, had similar pregnancy outcomes compared with those who had normal glucose tolerance. Differentiation of women by underlying metabolic physiology might facilitate management decisions for women with early GDM.
International Journal of Diabetes Mellitus, 2010
Objective: We prospectively evaluated differences in fasting-and oral glucose tolerance test (OGTT)derived indices of insulin action in Caucasian (Cau) and African-American (AA) pregnant women and compared them with obstetric outcomes. Study design: IRB-approved prospective study in 171 pregnant women undergoing a 3-h OGTT. Mathematical modeling was used to evaluate insulin response, insulin activity and glucose tolerance in fasting and postglucose ingestion state. Insulin sensitivity indices derived from fasting (HOMA-IR) and glucosestimulated values (SIOGTT) were compared. An insulin sensitivity-secretion index (IS-SI) was calculated from the product of the SIOGTT and early-phase insulin secretion. Results: Forty-nine patients had gestational diabetes (GDM), 28 had gestational impaired glucose tolerance (GIGT) and 94 had normal glucose tolerance after an abnormal glucose challenge test (NGT-abnGCT). Insulin sensitivity was lowest in women with GDM. In all groups, pregnant AA women were significantly more insulin resistant than Cau women, based on both HOMA-IR and SIOGTT, but had enhanced insulin secretion compared to their Cau counterparts. The mean IS-SI progressively improved for all women from GDM to GIGT to NGT-abnGCT. Women with NGT-abnGCT had a higher prevalence of large-for-gestational age (LGA) newborns and significantly higher cesarean section rate. Discussion: Insulin measures along with glucose determinations during OGTT testing in pregnant women at risk for diabetes provide valuable information that varies according to race. We observed that pregnant women with a lesser degree of glucose tolerance abnormality during pregnancy who receive no intervention have a higher risk for LGA infants and significantly increased C-section rate (ClinicalTrials.gov number, NCT006874791).
Outcomes of pregnancies affected by impaired glucose tolerance
Diabetes Research and Clinical Practice, 2007
Objective: Gestational diabetes mellitus (GDM) is associated with an increase in both maternal and neonatal morbidity. There remains uncertainty, however, about the diagnostic criteria for GDM. We compared pregnancy outcomes across three groups of women, with the aim of establishing a threshold for diagnosis of GDM at our institution. Methods: Women with a glucose tolerance test (GTT) were identified on the hospital's pathology database. Those women with a singleton pregnancy, in whom a GTT had demonstrated a fasting value 5.5 mmol/L, 2-h blood sugar !7.8 mmol/L and who confined 34 weeks gestation were eligible for inclusion. Outcomes were collected from the medical records and obstetric database. These women were managed with either diet modification, regular endocrinologist review and standard antenatal care if the GTT met ADA criteria (n = 265, TREATED), or standard antenatal care alone if the GTT did not fulfil ADA criteria (n = 213, UNTREATED). A third group comprised of women with normal GTT who received identical treatment to the untreated group (n = 197, COMPARISON). Statistical analysis was conducted with x 2 and ANOVA. Results: In women with untreated GDM, there was significantly more macrosomia, shoulder dystocia, and preeclampsia, compared with the comparison group. These rates were similar between the treated and comparison groups. There were no significant differences in induction of labour, caesarean section rates, or gestational age at delivery between the groups. Conclusion: Untreated GDM is associated with larger babies and more birth trauma. We recommend the diagnosis of GDM be made with fasting glucose !5.5 mmol/L and/or 2 h !7.8 mmol/L on 75 g GTT.
Impact of gestational diabetes mellitus on maternal & fetal outcome
2016
Background: Women with GDM are at increased risk for adverse obstetric and perinatal outcome. Hence, it is imperative that an early detection and management of the disease is done to ensure better maternal and fetal outcomes. Aims: To determine the incidence of gestational diabetes mellitus using single step diagnostic test at our centre and to evaluate the maternal & fetal outcome and complications. Materials and Methods: This study was carried out in 200 patients attending the antenatal outdoor. These patients were given 75 g oral glucose irrespective of the meals and their plasma glucose was estimated at 2 h. Patients with plasma glucose values > 140 mg/dl were labelled as GDM. All GDM patients were followed up and treated with diet and/or insulin therapy till delivery to know maternal and fetal outcomes. Results: The prevalence of GDM in this study was 13.5%. Maternal and fetal complications in the GDM group were much higher than non-GDM group. Polyhydromnios, oligohydromnios, Hypertension, were the common maternal complications, while fetal distress, NICU admission, macrosomia and stillbirths occurred in the fetuses. Conclusion: GDM as a disease entity adversely affects maternal and fetal outcomes. This also builds a strong case for following DIPSI guidelines in diagnosis and management of GDM.
Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics, 2016
Objective The aims of the study were to evaluate, after pregnancy, the glycemic status of women with history of gestational diabetes mellitus (GDM) and to identify clinical variables associated with the development of type 2 diabetes mellitus (T2DM), impaired fasting glucose (IFG), and impaired glucose tolerance (IGT). Methods Retrospective cohort of 279 women with GDM who were reevaluated with an oral glucose tolerance test (OGTT) after pregnancy. Characteristics of the index pregnancy were analyzed as risk factors for the future development of prediabetes (IFG or IGT), and T2DM. Results: T2DM was diagnosed in 34 (12.2%) patients, IFG in 58 (20.8%), and IGT in 35 (12.5%). Women with postpartum T2DM showed more frequently a family history of T2DM, higher pre-pregnancy body mass index (BMI), lower gestational age, higher fasting and 2-hour plasma glucose levels on the OGTT at the diagnosis of GDM, higher levels of hemoglobin A1c, and a more frequent insulin requirement during pregnancy. Paternal history of T2DM (odds ratio [OR] ¼ 5.67; 95% confidence interval [95%CI] ¼ 1.64-19.59; p ¼ 0.006), first trimester fasting glucose value (OR ¼ 1.07; 95%CI ¼ 1.03-1.11; p ¼ 0.001), and insulin treatment during pregnancy (OR ¼ 15.92; 95%CI ¼ 5.54-45.71; p < 0.001) were significant independent risk factors for the development of T2DM. Conclusion A high rate of abnormal glucose tolerance was found in women with previous GDM. Family history of T2DM, higher pre-pregnancy BMI, early onset of GDM, higher glucose levels, and insulin requirement during pregnancy were important risk factors for the early identification of women at high risk of developing T2DM. These findings may be useful for developing preventive strategies.
Perinatal outcome in diabetic mothers with relation to glycemic control during pregnancy
The Professional Medical Journal
Objective: To determine the frequency of perinatal outcomes (macrosomia, large for gestational age, birth asphyxia) in pregnant diabetic women with low and high plasma glucose levels between 36-40 weeks. Study Design: Cross-sectional study. Setting: Department of Obstetrics & Gynaecology, DHQ Hospital, Lodhran. Period: 2017 to 2019. Material & Methods: Total 285 diabetic women of age 25-40 years with singleton pregnancy of gestational age 36-40 weeks were selected. Patients with multiple pregnancies, GDM, renal disease and hypertension were excluded. Plasma glucose levels (fasting & 2 hour post-prandial) measured and mean values (fasting + postprandial/2) calculated. The mean values falling between 100-139 mg/dl were taken as low plasma glucose level where as ≥140 mg/dl noted as high plasma glucose level. The perinatal outcomes (macrosomia, large for gestational age, birth asphyxia) were assessed at the time of delivery. Results: Mean age was 29.44 ± 6.01 years. Mean plasma glucose ...