The Utility of Glycated Hemoglobin, Determined in the Second Trimester of Pregnancy, in Diagnosing Gestational Diabetes

Abstract Background and Aims: Gestational diabetes (GD) identifies a pregnancy with high obstetrical risk due to the possible complications that may appear and which are associated with significant perinatal mortality and morbidity. The role of HbA1c in diagnosing GD is still debatable. Our aim was to evaluate the clinical utility of HbA1c assessed in the second trimester of pregnancy (before performing the oral glucose tolerance test - OGTT) in establishing the macrosomia risk, and also for diagnosing GD. Material and methods: This was an observational study on a group of 165 pregnant women followed from the first trimester of pregnancy in whom we measured HbA1c in the second trimester, before running an OGTT with 100 grams of glucose and who delivered at term (37 - 41 weeks of pregnancy). Finally, HbA1c and OGTT were performed only in 132 women, these being the subjects of our study. Results: The average value of HbA1c was 4.85±1.23%. HbA1c was higher in the group having gestational diabetes (6.58±0.74%) in comparison to the group not having GD (4.52±0,80%). The Receiver Operating Characteristic (ROC) curve for HbA1c determined in the second trimester, for diagnosis of GD, has an area under the curve (AUC) of 0.939. Conclusions: HbA1c value could be considered as a sensitive and specific predictive factor in appreciating the macrosomia risk and could be set as an extra criterion in GD diagnosis.

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The Effects of Hyperemesis Gravidarum on the Oral Glucose Tolerance Test Values and Gestational Diabetes

Prague Medical Report ◽

10.14712/23362936.2021.26 ◽

2021 ◽

Vol 122 (4) ◽

pp. 285-293

Author(s):

Burak Bayraktar ◽

Meric Balikoglu ◽

Miyase Gizem Bayraktar ◽

Ahkam Goksel Kanmaz

Keyword(s):

Blood Glucose ◽

Gestational Diabetes ◽

Glucose Tolerance Test ◽

Hyperemesis Gravidarum ◽

First Trimester ◽

Tolerance Test ◽

Control Group ◽

Oral Glucose ◽

Second Trimester ◽

Oral Glucose Tolerance

This study is aimed at determination whether pregnant women who develop hyperemesis gravidarum in the first trimester have a tendency to develop gestational diabetes mellitus (GDM). It is also aimed at identification of effects of hyperemesis gravidarum and GDM on prenatal and neonatal status in case they were detected together. Hyperemesis gravidarum diagnose was based on the following signs and symptoms. To diagnose GDM, first trimester fasting blood glucose measurement and subsequent blood glucose monitoring and 75-g oral glucose tolerance test (OGTT) were performed in the second trimester. A total of 949 singleton pregnant women (95 with and 852 without hyperemesis gravidarum) who met our criteria were included in the study. In the first trimester, plasma blood glucose and positive GDM screening were found to be significantly higher in the hyperemesis gravidarum group compared to the control group (p=0.042 and p<0.001, respectively). However, actual GDM cases were similar between both groups. The positive predictive value was significantly lower in the hyperemesis gravidarum group (28.5% vs. 72.7%, p=0.003). In the second trimester, the prevalence of GDM was 6.6% in the hyperemesis gravidarum group and 7.3% in the control group, with no significant difference (p=0.218) between-groups. In this study, hyperemesis gravidarum was found to cause changes in maternal metabolism in the first trimester of pregnancy due to limited calorie intake and fasting; in the presence of hyperemesis gravidarum, it should be known that the positive predictive value of first trimester gestational diabetes screening may decrease and the diagnosis of pseudo-GDM may increase.

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First trimester prediction of maternal glycemic status

Journal of Perinatal Medicine ◽

10.1515/jpm-2014-0149 ◽

2015 ◽

Vol 43 (3) ◽

Cited By ~ 8

Author(s):

Rinat Gabbay-Benziv ◽

Lauren E. Doyle ◽

Miriam Blitzer ◽

Ahmet A. Baschat

Keyword(s):

Risk Score ◽

Predictive Value ◽

Challenge Test ◽

Area Under The Curve ◽

First Trimester ◽

Tolerance Test ◽

Oral Glucose ◽

Operating Characteristics ◽

Maternal Characteristics ◽

Predictive Algorithm

AbstractTo predict gestational diabetes mellitus (GDM) or normoglycemic status using first trimester maternal characteristics.We used data from a prospective cohort study. First trimester maternal characteristics were compared between women with and without GDM. Association of these variables with sugar values at glucose challenge test (GCT) and subsequent GDM was tested to identify key parameters. A predictive algorithm for GDM was developed and receiver operating characteristics (ROC) statistics was used to derive the optimal risk score. We defined normoglycemic state, when GCT and all four sugar values at oral glucose tolerance test, whenever obtained, were normal. Using same statistical approach, we developed an algorithm to predict the normoglycemic state.Maternal age, race, prior GDM, first trimester BMI, and systolic blood pressure (SBP) were all significantly associated with GDM. Age, BMI, and SBP were also associated with GCT values. The logistic regression analysis constructed equation and the calculated risk score yielded sensitivity, specificity, positive predictive value, and negative predictive value of 85%, 62%, 13.8%, and 98.3% for a cut-off value of 0.042, respectively (ROC-AUC – area under the curve 0.819, CI – confidence interval 0.769–0.868). The model constructed for normoglycemia prediction demonstrated lower performance (ROC-AUC 0.707, CI 0.668–0.746).GDM prediction can be achieved during the first trimester encounter by integration of maternal characteristics and basic measurements while normoglycemic status prediction is less effective.

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Elevated Midtrimester Triglycerides as a Biomarker for Postpartum Hyperglycemia in Gestational Diabetes

Journal of Diabetes Research ◽

10.1155/2020/3950652 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Mengyu Lai ◽

Fang Fang ◽

Yuhang Ma ◽

Jiaying Yang ◽

Jingjing Huang ◽

...

Keyword(s):

Gestational Diabetes ◽

Tolerance Test ◽

Oral Glucose ◽

Second Trimester ◽

Lipid Levels ◽

Severe Insulin Resistance ◽

Abnormal Glucose Metabolism ◽

Previous Gestational Diabetes Mellitus ◽

Hba1c Levels ◽

Previous Gestational Diabetes

Background. Whether elevated triglyceride (TG) levels during pregnancy were a biomarker for postpartum abnormal glucose metabolism (AGM) in women with previous gestational diabetes mellitus (GDM) remained unknown. The aim of this study was to investigate the association between TG levels during the second trimester and postpartum AGM in GDM women. Methods. This was a retrospective cohort study including 513 GDM women. A 75 g oral glucose tolerance test (OGTT) was performed, and lipid levels were determined during pregnancy and the postpartum period. GDM patients were categorized into tertiles according to their TG levels at 24–28 weeks of gestation (TG<2.14 mmol/L, TG: 2.14–2.89 mmol/L, and TG>2.89 mmol/L). A logistic regression model was used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs). Results. During pregnancy, women in the high TG tertile showed higher HbA1c levels (5.47±0.58% versus 5.28±0.49%, p=0.006), higher total cholesterol (TC) levels (5.85±1.23 mmol/L versus 5.15±0.97 mmol/L, p=0.026), and higher HOMA-IR (2.36 (1.62-3.45) versus 1.49 (0.97-2.33), p<0.001) than the participants in the low TG tertile. After delivery, the prevalence rates of AGM based on above tertiles of TG levels during pregnancy were 26.90%, 33.33%, and 43.27%, respectively (p=0.006). High TG tertile during the second trimester was associated with the presence of postpartum AGM (adjusted OR: 2.001, 95% CI: 1.054-3.800, p=0.034). Conclusions. The elevated midtrimester TG levels were not only accompanied by higher glucose and lipid levels and more severe insulin resistance at the time of the measurement but were a biomarker for postpartum AGM as well.

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First trimester secreted Frizzled-Related Protein 4 and other adipokine serum concentrations in women developing gestational diabetes mellitus

PLoS ONE ◽

10.1371/journal.pone.0242423 ◽

2020 ◽

Vol 15 (11) ◽

pp. e0242423

Author(s):

Joost H. N. Schuitemaker ◽

Rik H. J. Beernink ◽

Arie Franx ◽

Thomas I. F. H. Cremers ◽

Maria P. H. Koster

Keyword(s):

Logistic Regression ◽

Gestational Diabetes ◽

Gestational Age ◽

Area Under The Curve ◽

First Trimester ◽

Multivariate Logistic Regression Model ◽

Control Group ◽

Related Protein ◽

Serum Samples ◽

First Trimester Of Pregnancy

Background The aim of this study was to evaluate whether soluble frizzled-related protein 4 (sFRP4) concentration in the first trimester of pregnancy is individually, or in combination with Leptin, Chemerin and/or Adiponectin, associated with the development of gestational diabetes (GDM). Methods In a nested case-control study, 50 women with GDM who spontaneously conceived and delivered a live-born infant were matched with a total of 100 uncomplicated singleton control pregnancies based on body mass index (± 2 kg/m2), gestational age at sampling (exact day) and maternal age (± 2 years). In serum samples, obtained between 70–90 days gestational age, sFRP4, Chemerin, Leptin and Adiponectin concentrations were determined by ELISA. Statistical comparisons were performed using univariate and multi-variate logistic regression analysis after logarithmic transformation of the concentrations. Discrimination of the models was assessed by the area under the curve (AUC). Results First trimester sFRP4 concentrations were significantly increased in GDM cases (2.04 vs 1.93 ng/ml; p<0.05), just as Chemerin (3.19 vs 3.15 ng/ml; p<0.05) and Leptin (1.44 vs 1.32 ng/ml; p<0.01). Adiponectin concentrations were significantly decreased (2.83 vs 2.94 ng/ml; p<0.01) in GDM cases. Further analysis only showed a weak, though significant, correlation of sFRP4 with Chemerin (R2 = 0.124; p<0.001) and Leptin (R2 = 0.145; p<0.001), and Chemerin with Leptin (R2 = 0.282; p<0.001) in the control group. In a multivariate logistic regression model of these four markers, only Adiponectin showed to be significantly associated with GDM (odds ratio 0.12, 95%CI 0.02–0.68). The AUC of this model was 0.699 (95%CI 0.605–0.793). Conclusion In the first trimester of pregnancy, a multi-marker model with sFRP4, Leptin, Chemerin and Adiponectin is associated with the development of GDM. Therefore, this panel seems to be an interesting candidate to further evaluate for prediction of GDM in a prospective study.

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The Influence of First Trimester Maternal Glucose on Fetal Growth and Possible Implications in Pregnancy Evolution

Romanian Journal of Diabetes Nutrition and Metabolic Diseases ◽

10.2478/rjdnmd-2013-0018 ◽

2013 ◽

Vol 20 (2) ◽

pp. 141-148

Author(s):

Monica Vereş ◽

Szidonia Lacziko ◽

Aurel Babeş

Keyword(s):

Birth Weight ◽

Area Under The Curve ◽

First Trimester ◽

Tolerance Test ◽

Fetal Macrosomia ◽

Control Group ◽

Oral Glucose ◽

Third Trimester ◽

Maternal Characteristics ◽

Fetal Birth Weight

AbstractBackground and Aims: Maternal hyperglycemia during the first trimester of pregnancy is frequently associated with the appearance of maternal and fetal complications. The aim of our study was to analyze the influence of the first trimester blood glucose on the glycemic values from the second and third trimester and on fetal birth weight. Material and method: We performed an observational study on a group of 46 pregnant women who finally delivered on due date. We determined glycemia values in the first and third trimester of pregnancy while an Oral Glucose Tolerance Test (OGTT) was performed during the second trimester (24 - 28 weeks of pregnancy). We divided the pregnancies in two groups: with normal glucose or hyperglycemia during the first trimester. Finally we analyzed the influence of first trimester hyperglycemia on different maternal characteristics and on fetal birth weight. Results: Third trimester glycemia was significantly increased in women with first trimester hyperglycemia in comparison with the control group (p= 0.04) but no effect of the last on OGTT values was recorded. The ROC curve for the influence of first trimester glycemia on fetal macrosomia had an Area Under the Curve (AUC) of 0.551. Conclusions: Firsttrimester glycemia has a low diagnostic accuracy in the appreciation of fetal macrosomia risk.

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Is improvement in the Healthy Food Intake Index (HFII) related to a lower risk for gestational diabetes?

British Journal Of Nutrition ◽

10.1017/s0007114517001015 ◽

2017 ◽

Vol 117 (8) ◽

pp. 1103-1109 ◽

Cited By ~ 1

Author(s):

Jelena Meinilä ◽

Anita Valkama ◽

Saila B. Koivusalo ◽

Beata Stach-Lempinen ◽

Kristiina Rönö ◽

...

Keyword(s):

Food Intake ◽

Gestational Diabetes ◽

Lower Risk ◽

First Trimester ◽

Tolerance Test ◽

Healthy Food ◽

Oral Glucose ◽

Fat Percentage ◽

Exact Test ◽

The Mean

AbstractThe aim was to analyse whether changes in the Healthy Food Intake Index (HFII) during pregnancy are related to gestational diabetes (GDM) risk. The 251 pregnant women participating had a pre-pregnancy BMI≥30 kg/m2 and/or a history of GDM. A 75 g oral glucose tolerance test (OGTT) was performed during the first and second trimesters of pregnancy for assessment of GDM. A normal OGTT result at first trimester was an inclusion criterion for the study. FFQ collected at first and second trimesters served for calculating the HFII. A higher HFII score reflects higher adherence to the Nordic Nutrition Recommendations (NNR) (score range 0–17). Statistical methods included Student’s t test, Mann–Whitney U test, Fisher’s exact test and linear and logistic regression analyses. The mean HFII at first trimester was 10·1 (95 % CI 9·7, 10·4) points, and the mean change from the first to the second trimester was 0·35 (95 % CI 0·09, 0·62) points. The range of the HFII changes varied from –7 to 7. The odds for GDM decreased with higher HFII change (adjusted OR 0·83 per one unit increase in HFII; 95 % CI 0·69, 0·99; P=0·043). In the analysis of the association between HFII-sub-indices and GDM, odds for GDM decreased with higher HFII-Fat change (fat percentage of milk and cheese, type of spread and cooking fats) but it was not significant in a fully adjusted model (P=0·058). Dietary changes towards the NNR during pregnancy seem to be related to a lower risk for GDM.

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Mid-Pregnancy Fructosamine Measurement—Predictive Value for Gestational Diabetes and Association with Postpartum Glycemic Indices

Nutrients ◽

10.3390/nu10122003 ◽

2018 ◽

Vol 10 (12) ◽

pp. 2003 ◽

Cited By ~ 1

Author(s):

Véronique Gingras ◽

Sheryl Rifas-Shiman ◽

Karen Switkowski ◽

Emily Oken ◽

Marie-France Hivert

Keyword(s):

Gestational Diabetes ◽

Glucose Tolerance ◽

Predictive Value ◽

Glycated Hemoglobin ◽

Characteristic Curve ◽

Challenge Test ◽

Tolerance Test ◽

Oral Glucose ◽

Second Trimester ◽

Glycemic Indices

Screening for gestational diabetes mellitus (GDM) during pregnancy is cumbersome. Measurement of plasma fructosamine may help simplify the first step of detecting GDM. We aimed to assess the predictive value of mid-pregnancy fructosamine for GDM, and its association with postpartum glycemic indices. Among 1488 women from Project Viva (mean ± SD: 32.1 ± 5.0 years old; pre-pregnancy body mass index 24.7 ± 5.3 kg/m2), we measured second trimester fructosamine and assessed gestational glucose tolerance with a 50 g glucose challenge test (GCT) followed, if abnormal, by a 100 g oral glucose tolerance test (OGTT). Approximately 3 years postpartum (median 3.2 years; SD 0.4 years), we measured maternal glycated hemoglobin (n = 450) and estimated insulin resistance (HOMA-IR; n = 132) from fasting blood samples. Higher glucose levels 1 h post 50 g GCT were associated with higher fructosamine levels (Pearson’s r = 0.06; p = 0.02). However, fructosamine ≥222 µmol/L (median) had a sensitivity of 54.8% and specificity of 48.6% to detect GDM (area under the receiver operating characteristic curve = 0.52); other fructosamine thresholds did not show better predictive characteristics. Fructosamine was also weakly associated with 3-year postpartum glycated hemoglobin (per 1 SD increment: adjusted β = 0.03 95% CI [0.00, 0.05] %) and HOMA-IR (per 1 SD increment: adjusted % difference 15.7, 95% CI [3.7, 29.0] %). Second trimester fructosamine is a poor predictor of gestational glucose tolerance and postpartum glycemic indices.

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Comparing the first trimester and second trimester fifty grams oral glucose tolerance test values in gestational diabetes mellitus

Zeynep Kamil Medical Journal ◽

10.14744/zkmj.2021.48278 ◽

2021 ◽

pp. 1-9

Author(s):

Hasan Turan

Keyword(s):

Risk Factors ◽

Pregnant Women ◽

Plasma Glucose ◽

Early Period ◽

First Trimester ◽

Tolerance Test ◽

Oral Glucose ◽

Second Trimester ◽

Glucose Levels ◽

History Of

Objective: The present study aimed to assess the results of pregnant women who have been applied a 50 g oral glucose tolerance test (OGTT) in the first and second trimesters and investigate this method’s role in the diagnosis of gestational diabetes mellitus (GDM) and risk factors associated with this disease. Material and Methods: This retrospective study was performed on 153 pregnant women who were admitted to our hospital’s antenatal clinics between March 2011 and August 2011. Fifty grams OGTT was applied to the same pregnant women both in the 1st trimester (between 8th and 14th weeks) and second trimester (between 24th and 28th weeks); values of the test results were then compared. A 100 g OGTT di- agnostic test was performed on those with a 50 g OGTT value of ≥140 mg/dl in both trimesters. The study patients were divided into two groups as non-GDM and GDM based on venous plasma glucose values measured 1 h after 50 g of oral glucose load given. The non-GDM group consisted of those with plasma glucose levels <140 mg/ dl and plasma glucose levels between 140 mg/dl and 200mg/dl, GDM group plasma glucose levels ≥200 mg/dl. First trimester and second-trimester OGTT values and possible risk factors for GDM (age, gravida, parity, number of abortions, smoking, a previous GDM history, etc.) were compared between non-GDM and GDM groups. Results: GDM, diagnosed in 4.5% (7) in the first trimester (between 8th and 14th weeks) and 6.5% (10) second trimester, was detected in 11% (17) of 153 pregnant women in the present study. GDM, diagnosed in 41.2% (7 patients) in the first trimester and 58.8% (10 patients) second trimester, was found with a higher rate in pregnant women over 30 years (p=0.000 <0.05). The mean fasting blood glucose (FBG) level was 96 mg/dl in the GDM group and 83 mg/dl in the non-GDM group, with a statistically sig- nificant difference, which existed (p<0.05). The mean 50 g OGTT value was 170 mg/ dl in pregnant women diagnosed with GDM in the first trimester, and it was 140 mg/dl in those diagnosed in the second trimester, with this difference was considered statis- tically different (p<0.05). Age, parity, a family history of DM, FBG, a previous GDM his- tory, gravida, a previous macrosomia history, and a previous history of preeclampsia were determined as risk factors that significantly increase the risk of GDM (p<0.05). The half of patients was diagnosed with GDM in the early period of pregnancy. In the present study, 41.2% of cases were diagnosed in the first trimester and 58.8% in the second trimester. In general, the patients diagnosed in the first trimester were those being under risk in terms of GDM. According to the present study, it is recommended that the pregnant women should be scanned for GDM in the early period. Conclusion: With screening tests to be applied to risky groups in early pregnancy, a significant number of cases with GDM recently be detected on time. Thereby, mater- nal and fetal morbidity and mortality rates might be considerably reduced thanks to providing proper treatments and regular monitoring. Furthermore, for obtaining spe- cific data concerning the factors with potential influence on the risk of GDM, further studies on this topic need to be performed.

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