Abstract MP70: Pre-pregnancy Beta Cell Compensation for Insulin Resistance Associated With Subsequent Gestational Diabetes Mellitus: The CARDIA Study

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Erica P Gunderson ◽  
Amy Krefman ◽  
Cora E Lewis ◽  
Janet Catov ◽  
Norrina B Allen

Hypothesis: Gestational diabetes mellitus (GDM) is a disorder of glucose metabolism during pregnancy characterized by pancreatic beta cell dysfunction and greater insulin resistance, but it is unclear whether dysfunction exists before pregnancy. The disposition index (DI) is a physiologic measure of beta cell compensation for insulin resistance strongly predictive of future diabetes. This prospective study evaluates whether a clinical approximation of DI before pregnancy is associated with risk of GDM. Methods: This analysis included 696 women (45% black, 55% white) enrolled in the CARDIA Study, a U.S. multi-center prospective cohort of young adults aged 18-30 at baseline (1985-86) who gave birth at least once during 30 years of follow up, reported GDM status and had fasting glucose and insulin measured before one or more post-baseline births. DI was defined as HOMA-B divided by HOMA-IR using standard formulas. Multinomial logistic regression models estimated odds ratios (OR) and 95%CI for GDM among pre-pregnancy DI tertiles (low, moderate, high) and fully adjusted for time to birth, race, age, parity, BMI, lifestyle behaviors and family history of diabetes, and also stratified by pre-pregnancy BMI. Results: 9% of women reported GDM (64/696) for 794 births. 55% of GDM and 30% of non-GDM were categorized as low DI. Low pre-pregnancy DI compared to moderate DI was associated with higher fully adjusted odds of GDM (OR=2.71, 95%CI:1.37-5.35) in the entire sample. In models stratified by pre-pregnancy BMI, low DI was associated with 4-fold higher odds of GDM among Overweight/Obese (OR=4.22, 95%CI: 1.35-13.91) and somewhat attenuated higher odds of GDM among Normal BMI (OR=1.94, 95%CI: 0.78–4.86); Table 1. Only family history of diabetes was strongly associated with GDM independent of DI. Conclusions: Inadequate beta cell compensation is present before pregnancy and discriminates greatest risk of GDM among high BMI, and may identify higher risk among women of normal BMI.

Author(s):  
Poojita Tummala ◽  
Munikrishna M. ◽  
Kiranmayee P.

Background: Gestational diabetes mellitus (GDM) is carbohydrate intolerance at the onset of pregnancy which induces pathological short term or long term outcomes for both mother and baby. The aim of the present study was to know the prevalence of GDM in pregnant women who were attending the antenatal care (ANC) center at a tertiary care hospital in Kolar, Karnataka, India.Methods: This prospective study was conducted in Department of Obstetrics and Gynecology, Sri Devaraj Urs Medical College, a constituent of Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India. The duration of the study was two months. In this study, 108 pregnant women above 24 weeks of gestation were screened for GDM by oral glucose tolerance test. Fasting 2 milli liter blood was collected and were given 75 grams of glucose in 200 milli liters of water and asked to drink within 5 minutes. Again 2 milli liters venous blood was collected after 1 hour and 2 hours from all participants. Plasma sample was used for the estimation of glucose by glucose oxidase and peroxidase (GOD-POD) method.Results: Out of 108, 12 women (11.1%) were diagnosed with GDM. The prevalence rate was higher in the age group of 26-30 years (41.6%).  Among 12 diabetic women, five (47.2%) exercised regularly and seven (58.3%) did not doing exercise. Out of 12 GDM subjects, eight of them had family history of diabetes in first degree relatives; among which one was hypertensive and five were suffering from thyroid problems.Conclusions: In the present study, the prevalence of GDM was found to be 11.1%. Prevalence of GDM might be influenced by increasing age, pre pregnancy weight, family history of diabetes, past history of pregnancy complications, status of literacy and exercise.


2021 ◽  
Author(s):  
Peilin Ouyang ◽  
You Yiping ◽  
Jia Xiaozhou ◽  
Yang Liqin

Abstract Women with polycystic ovary syndrome are prone to develop gestational diabetes mellitus, a disease which may have significant impact on the postpartum health of both mother and infant. We performed a retrospective cohort study to develop and test a model that could predict gestational diabetes mellitus in the first trimester in women with polycystic ovary syndrome. Our study included 520 pregnant women who were referred to the obstetrics department between December 2017 and March 2020 with a diagnosis of polycystic ovary syndrome. Of these women, 171 were diagnosed with gestational diabetes mellitus in the second trimester. Univariate analysis revealed that in the first trimester, parity, family history of diabetes, age, body mass index (BMI), testosterone, low density lipoprotein cholesterol, triglyceride(TG), total cholesterol(TC), fasting plasma glucose(FPG), Hemoglobin A1c (HbA1C), diastolic blood pressure(DBP),and insulin levels were predictive factors of gestational diabetes mellitus (P<0.05). Logistic analysis revealed that TG, age, HbA1C, Insulin, TC, BMI and family history of diabetes were independent risk factors for gestational diabetes mellitus. The area under the ROC curve of the gestational diabetes mellitus risk prediction model was 0.917 in this retrospective analysis, demonstrating the great ability to predict. The sensitivity and specificity of the prediction model were 0.814 and 0.871, respectively. The Hosmer–Lemeshow test also showed a good fit to the test.


2016 ◽  
Vol 23 (01) ◽  
pp. 015-019
Author(s):  
Afsheen Qazi ◽  
Amin Fahim ◽  
Aneela Qureshi3 ◽  
Mazhar ul Haque

Objectives: The present study was designed to find the importance of properscreening and early diagnosis of gestational diabetes mellitus. Study Design: A prospective/descriptive study Place of Study: tertiary care hospital Hyderabad. Duration of Study: fromSeptember 2014 to November 2014. Materials and Methods: A total of 168 pregnant femalesbetween the ages of 20-40 years & in their 24th to 28th week of gestation were enrolled for thestudy. Oral Glucose Tolerance Test of all the participants was done after an overnight fasting of10-12 hours. All the participants were given 75gm of glucose per 100 ml of distilled water. Theblood samples were collected after two hours time for serum glucose levels. Results: Mostof the participants were below 26 years of age 47(27.9%) with the mean age of 30.2±5.83years. However the highest prevalence of GDM was observed in age group 31-35 years (36%).Among the 25 cases of gestational diabetes mellitus the highest number of patients with GDMwere multipara (40%) followed by parity of 3-4 gravida (32%). Twenty seven women (16%)women had family history of diabetes mellitus. Among these 12/27 (44.4%) women were foundwith GDM, compared to 15/141 (10.6%) who have no family history of diabetes mellitus. Total14 (8.33%) women were found obese, out of these 8 (57%) women had GDM while only 6(42.8%) women had no GDM. Conclusion: The prevalence of GDM in the present study isfound to be 14.8%. A prevalence of GDM was higher in the elderly multiparous females whowere overweight and had family history of diabetes mellitus.


Biomedicine ◽  
2020 ◽  
Vol 39 (3) ◽  
pp. 497-502
Author(s):  
Mary Chandrika A. ◽  
B. Shanthi

Introduction and Aim: The most common non-communicable disease affecting large population is type 2 diabetes mellitus. This metabolic disorder is characterized by hyperglycemia with disturbances of carbohydrate, fat and protein metabolism. The causes of diabetes mellitus can vary greatly but always include either defects in insulin secretion of the pancreas or the cells of the body not responding properly to the insulin produced or in both at some point in the course of the disease. Materials and Methods: 200 participants who were divided into two groups, non-diabetics with and without family history of diabetes were involved in this study. The outcomes of fasting plasma glucose, postprandial plasma glucose, glycated hemoglobin, fasting plasma insulin, serum c-peptide, HOMA -IR, HOMA-B were compared between both the groups. Results: All these parameters were significantly correlated between the groups with the level of significance p<0.05%. Non-diabetic off-springs of type 2 diabetes were found to have hyperinsulinemia, increased level of serum c-peptide level, moderate insulin resistance and pancreatic beta cell dysfunction than non-diabetics without the family history of diabetes. The fasting hyperinsulinemia, known to reflect decreased insulin sensitivity constitute the strongest independent predictor of type 2 diabetes. Conclusion: The above findings show that insulin resistance is the primary abnormality in type 2 Diabetes Mellitus.


Author(s):  
Shaymaa Hasan Abbas ◽  
Sura Abbas Khdair

Introduction: Gestational diabetes mellitus (GDM) is one of the most common medical problems occurred during pregnancy. GDM increase the chance for developing type 2 diabetes meletus by seven times. The overall prevalence of GDM in pregnancy is 1-14% according to the American Diabetes Association. Material and Methods: a self-administered questionnaire was used to collect data. The information was collected from pregnant women with gestational DM to assess some maternal risk factors and compare blood glucose level according to different treatment types for GDM. Results: The present study reported that (40.38%) of GDM patients have advanced age (≥35 yrs.). First pregnancy was a risk factors for GDM and it was reported by (9.62%). History of HT and GDM during prior pregnancies were reported by (11.54%) and (% 34.62) respectively. Hypertension or preeclampsia in the current pregnancy was reported by (3.85%). Positive family history of diabetes was associated with (26.92%) GDM patients. All Patients of the present study reported no previous PCOS and smoking history. Also in this study, 44 patients out of 52 GDM patients use medications to control the glucose intolerance, while other patients control it by diet. There were no statistical differences found between treatment groups in term of blood glucose control. Conclusion: Age, history of GDM in the previous pregnancies and family history of diabetes mellitus were identifiable as a risk factors for GDM and their effect were significant in this study while the effect of other risk factors were non-significant. No statistical differences found between treatment groups in term of blood glucose level control and no group achieved the glycemic target.


2009 ◽  
Vol 2009 ◽  
pp. 1-6 ◽  
Author(s):  
M. Clapperton ◽  
J. Jarvis ◽  
K. Mungrue

Objective. To investigate the incidence of Gestational Diabetes Mellitus at the Mt. Hope Women's Hospital and to describe its epidemiological pattern.Design. A retrospective observational study (Jan 2005 to Dec 2007).Setting. A teaching hospital of The University of the West Indies.Population/Sample. Pregnant women who gave birth.Methods. A sample size of 720. The variables analyzed were: age, ethnicity, BMI of mother, family history of diabetes; history of GDM, obstetric history, birth weight and APGAR score of infant.Main Outcome Measures. (1) Incidence of cases of GDM. (2) Impact of the measured variable. Chi-squares, odds ratios and logistic regression were performed.Results. The incidence of GDM was 4.31% (95% C.I. 2.31%, 6.31%). The proportion of GDM patients for the years 2005, 2006, and 2007 were 1.67%, 4.58%, and 6.67%, respectively. Age, Obesity Ethnicity, Family history of diabetes and a history of GDM were determined risk factors. Associations between GDM and (1) Mode of Delivery and (2) APGAR score of the baby were found.Discussion & Conclusion. There was an apparent increase in the incidence of GDM. Additional studies should be conducted to measure the occurrence of GDM in Trinidad and Tobago. Efforts to promote public awareness and a healthy lifestyle should be made to reverse this trend.


2017 ◽  
Vol 4 (1) ◽  
pp. 112 ◽  
Author(s):  
Maxima Anand ◽  
Manan Anand ◽  
Devinder Singh Mahajan

Background: Diabetes is estimated to complicate 2-5% of all pregnancies of which 90% of those are detected during pregnancy i.e. gestational diabetes mellitus (GDM) and the rest are overt or pregestational i.e. either Type 1 or Type 2. According to ADA, approximately 7% of all pregnancies are complicated by GDM resulting in more than 2,00,000 cases annually. The aim was to study the incidence of GDM among pregnant women between 24 to 28 weeks of gestation, to evaluate and compare the occurrence of risk factors e.g.; family history of diabetes, prematurity, history of foetal loss and congenital anomaly associated with diabetes in pregnancy.Methods: 50gm of glucose, glucose challenge test (GCT) was given to women coming for antenatal check-up between 24 to 28 weeks of gestation irrespective of presence or absence of risk factors for GDM.1 hour glucose levels were checked. Patients with glucose levels more than 130mg/dl were subjected to 100gm of oral glucose tolerance test (OGTT) according to Carpenter and Coustan modification of the National Diabetes Data. Data was compiled and statistically analysed.Results: In this study it was observed that 20 (women had raised GCT, 11 (5.3%) women developed GDM out of 206 women. All GDM patients have one or more risk factors. Age >25 years (63.6%) fetal loss (36.3%), BMI (33.3%) are common risk factors followed by family history of diabetes (27.3%).Conclusions: Family history of diabetes and past history of congenital anomalies are statistically significant in GDM group as compared to non GDM.


Author(s):  
Manouchehr Iranparvar-Alamdari ◽  
Hosein Ghorbani Behrooz ◽  
Mostafa Alidousti

<p class="abstract"><strong>Background:</strong> Gestational diabetes is the most common metabolic disorder during pregnancy and postpartum thyroiditis is a destructive thyroiditis that can cause serious complications for the mother and her child. The purpose of this study was to determine the prevalence of postpartum thyroiditis in women with gestational diabetes.</p><p class="abstract"><strong>Methods:</strong> In this cross-sectional study, 86 cases satisfy inclusion criteria and gestational diabetes mellitus (GDM) and were evaluated for postpartum thyroiditis with thyroid stimulating hormone (TSH), T4, anti-TPO, T3RU tests. The groups with and without thyroiditis were compared and data was analyzed by statistical methods.</p><p class="abstract"><strong>Results:</strong> There were 17 patients (19.8%) with postpartum thyroiditis, of whom 4 patients (23.5%) had hyperthyroidism, 9 patients (52.9%) were in the age group of 21 to 30 years, and 9 patients (52.9%) had a family history of diabetes.  Five patients (29.4%) with high anti-TPO level (P=0.022) and mean TSH and anti-TPO respectively, 2.8 (4.8) and 17.2 (35.9).</p><p><strong>Conclusions:</strong> The results showed that higher level of anti TPO titer and family history of diabetes can be associated with a higher rate of postpartum thyroiditis, so it is recommended that postpartum thyroiditis to be examined in women with gestational diabetes who have these mentioned items.</p>


Author(s):  
Nirav K. Nimavat ◽  
Roma S. Dadwani ◽  
Girija P. Kartha

Background: Prevalence of gestational diabetes mellitus (GDM) vary widely depending on the region of the country, dietary habits, and socio-economic status. This study was undertaken to determine the prevalence of GDM and risk factors associated with it, in women attending an antenatal care (ANC) clinic at urban health training center in Rajkot city, Gujarat.Methods: This study enrolled women, with estimated gestational age between 24 and 28 week, attending UHC in Rajkot. After informing, women who consented to participate were given a standardized 75 g oral glucose tolerance test (OGTT). A proforma containing general information on demographic characteristics, socio-economic status, education level, parity, family history of diabetes and/or hypertension was filled up. Diabetes in pregnancy study group India (DIPSI) criteria for 75 g 2-h OGTT was used for diagnosing GDM.Results: Total of 366 women participated in the study and GDM was diagnosed in 36 (9.8%) women. Age, parity, BMI, family history of DM and hypertension were accessed and found to be not significant. History of hypertension in previous pregnancy was statistically significant with occurrence of GDM in present pregnancy.Conclusions: The prevalence of GDM was found to be 9.8 per cent in a UHC, Rajkot. Appropriate interventions are required for control of GDM and modifications of risk factors. 


2021 ◽  
Vol 17 (37) ◽  
pp. 48-56
Author(s):  
Yuli Puspita DEVI ◽  
Rumaisah ABDILLAH ◽  
Muthmainnah MUTHMAINNAH

Background: Gestational Diabetes Mellitus (GDM) is a glucose tolerance disorder that first appears during pregnancy. GDM can cause a variety of obstetric and perinatal complications for pregnant women and their fetuses. The prevalence of GDM in the city of Surabaya in 2015 amounted to 2.29%, increasing to 3.88% in 2018. Aim: The purpose of this study was to analyze the determinants (family history of diabetes mellitus, BMI, history of birth weight, parity, and the age of the pregnant woman) that influence the GDM. Methods: This research is an analytical study with an observational approach. The research design was carried out using a case-control study. In this study, the number of samples was 36 people, 6 cases, and 30 people as controls, and were taken randomly. The data source obtained from secondary data (medical records of pregnant women) at Mulyorejo Health Center Surabaya. The analysis used in this study was a simple logistic regression test. Results and Discussion: The result showed an effect of a family history of diabetes mellitus (p = 0.035) on the incidence of GDM. Parity was a potential variable (p = 0.077) on the incidence of GDM. Meanwhile, BMI, history of birth weight, and mother's age did not affect the incidence of GDM. Conclusion: Pregnant women with a family history of diabetes who are not balanced with maintaining a good lifestyle can experience complications of developing GDM.


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