Plasma glycated CD59 predicts postpartum glucose intolerance after gestational diabetes

2021 ◽  
Author(s):  
Katrien Benhalima ◽  
Diane D Ma ◽  
Annouschka Laenen ◽  
Chantal Mathieu ◽  
Jose A Halperin
Keyword(s):  
Gestational Diabetes ◽  
Glucose Intolerance ◽  
Predictive Value ◽  
Characteristic Curve ◽  
Ethnic Origin ◽  
Tolerance Test ◽  
Blood Levels ◽  
Oral Glucose ◽  
Normal Glucose ◽  
Glucose Tolerant

Aims: To assess whether in women with gestational diabetes mellitus (GDM), postpartum plasma glycated CD59 (pGCD59) levels predict conversion to glucose intolerance diagnosed with an oral glucose tolerance test (OGTT). Methods: Blood levels of pGCD59 were measured in a case-control study of 105 women with GDM who underwent a 75g OGTT three months postpartum. The 35 postpartum glucose intolerant cases were individually matched for age, BMI, ethnic origin and parity with 70 women with GDM but normal postpartum OGTT (controls). The GDM cohort (105) was also matched with 105 normal glucose tolerant women during pregnancy. pGCD59 was measured by ELISA in standard peptide units (SPU). Results: Mean pGCD59 postpartum was significantly higher in cases than in controls (1.5 ± 0.6 SPU vs. 1.0 ±0.6 SPU, p<0.001). The area under the receiving operating characteristic curve (AUC) in cases versus controls was 0.72 (95% CI 0.62-0.83) for postpartum pGCD59 and 0.50 (95% CI 0.36-0.61) for postpartum HbA1c. A 0.5-unit increase in postpartum pGCD59 was associated with an OR of 3.3 (95% CI 1.82-6.16, p<0.001) for glucose intolerance postpartum. A pGCD59 cut-off postpartum of 0.9 SPU had a sensitivity of 85.7% (95% CI 69.7-95.2%), specificity of 47.8% (95% CI 35.6-60.2%), positive predictive value of 45.4% (95% CI 33.1-58.2%) and negative predictive value of 86.8% (95% CI 71.9-95.6%). pGCD59 in pregnancy was a poor predictor for glucose intolerance postpartum [AUC of 0.61 (95% CI 0.50-0.72)]. Conclusions: pGCD59 might identify women at low risk for glucose intolerance postpartum and could help to avoid an OGTT.

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

Nutrients ◽  
2018 ◽  
Vol 10 (12) ◽  
pp. 2003 ◽  
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.

scholarly journals Risk Factors for Pregnancy Complications and Postpartum Glucose Intolerance in Women With Gestational Diabetes Mellitus

2020 ◽  
Author(s):  
Naohisa Masuko ◽  
Kenji Tanimura ◽  
Nobue Kojima ◽  
Hitomi Imafuku ◽  
Masashi Deguchi ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Glucose Intolerance ◽  
Pregnancy Complications ◽  
Glucose Tolerance Test ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Hba1c Levels

Abstract This prospective cohort study aimed to evaluate the risk factors for pregnancy complications and postpartum glucose intolerance (GI) in women with gestational diabetes mellitus (GDM). A total of 140 women with GDM were enrolled. Of these, 115 underwent a 75-g oral glucose tolerance test (OGTT) at 12 weeks after delivery. Clinical factors and parameters in the antepartum 75-g OGTT associated with pregnancy complications and postpartum GI were evaluated. Women with GDM experienced pregnancy complications, including hypertensive disorders of pregnancy (HDP, n=19), preterm delivery (PD, n=17), heavy-for-date (HFD, n=19), and light-for-date (LFD, n=12), and 22 of the 115 women with GDM developed postpartum GI. The univariate and multivariable logistic regression analyses revealed the following risk factors: histories of hypertension (odds ratio [OR], 23.8; 95% confidence interval [CI], 4.2–134.7; p<0.01) for HDP; histories of hypertension (OR, 9.8; 95% CI, 2.5–38.9; p<0.01) for PD; HbA1c levels (OR, 7.6; 95% CI, 1.5–37.9; p<0.05) for HFD; and oral deposition index (DI) (OR, 0.1; 95% CI, 0.02–0.7; p<0.01) for postpartum GI. Higher HbA1c levels and lower oral DI on the antepartum 75-g OGTT may be useful markers for identifying GDM women who are at high risk for HFD and postpartum GI, respectively.

scholarly journals Comparison of Birth Outcomes by Gestational Diabetes Screening Criteria

2018 ◽  
Vol 08 (04) ◽  
pp. e280-e288 ◽  
Author(s):  
Esa Davis ◽  
Christina Scifres ◽  
Kaleab Abebe ◽  
Tina Costacou ◽  
Diane Comer ◽  
...  
Keyword(s):  
Gestational Diabetes ◽  
Birth Outcomes ◽  
International Association ◽  
Challenge Test ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Singleton Pregnancy ◽  
Screening Criteria ◽  
Iadpsg Criteria ◽  
Normal Glucose

Objectives This study is to examine the association between different diagnostic criteria for gestational diabetes mellitus (GDM) and adverse birth outcomes. Study Design A retrospective cohort study of 5,937 women with a singleton pregnancy was conducted, who completed GDM screening between 24 to 32 weeks gestational age. Four nonoverlapping groups of women defined as: 1) Normal: glucose challenge test (GCT) <130 mg/dL, 2) elevated GCT + normal oral glucose tolerance test (OGTT): abnormal 1 hour GCT + normal 3 hour OGTT, 3) GDM/International Association of Diabetes in Pregnancy Study Group (IADPSG): abnormal 3 hour OGTT by the IADPSG criteria, and 4) GDM/Carpenter-Coustan (CC): diagnosis per CC criteria. We used logistic regression to examine the association between GDM group classification and main outcome of macrosomia and secondary birth outcomes. Results Prevalences were GDM/CC 4.6%, GDM/IADPSG 3.0, and 7.6% overall. GDM/IADPSG group was associated with increased macrosomia (adj OR [odd ratio] 1.87; 95% CI [confidence interval]: 1.08–3.25; p = 0.02), while GDM/CC group was associated with increased preterm birth (adj OR 1.75; 95% CI: 1.05–2.80; p = 0.03). Conclusion Little difference in birth outcomes was found between the two criteria, GDM/CC and GDM/IADPSG. Randomized controlled trials are needed to clarify the risks and benefits of these screening paradigms before their incorporation into clinical practice.

scholarly journals Gestational Diabetes: Comparison of Random and Fasting Plasma Glucose as Modalities of Screening

EMJ Diabetes ◽  
2020 ◽  
pp. 110-117
Author(s):  
Chibuike F. Chukwunyere ◽  
David O. Awonuga ◽  
Olubiyi F. Adesina ◽  
Ifeoma C. Udenze
Keyword(s):  
Gestational Diabetes ◽  
Plasma Glucose ◽  
Predictive Value ◽  
Gold Standard ◽  
Glucose Tolerance Test ◽  
Area Under The Curve ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Oral Glucose Tolerance ◽  
Pregnant Females

Objective: Gestational diabetes is glucose intolerance of varying severity with onset in the index pregnancy. This study aimed to compare fasting plasma glucose (FPG) with random plasma glucose (RPG) among pregnant females as methods of screening for gestational diabetes. Methods: A cross-sectional study of 100 pregnant females selected to have screening for gestational diabetes between gestational ages of 24 and 28 weeks using RPG and FPG. All the subjects had 75 g oral glucose tolerance test as the gold standard. Venous plasma glucose assay was performed using glucose oxidase method. Results: The prevalence of gestational diabetes was 29% using FPG cut-off ≥5.1 mmol/L and 6% using RPG cut-off ≥7.8 mmol/L. The RPG cut-off ≥11.1 mmol/L gave the lowest prevalence rate of 2%, while 75 g oral glucose tolerance test (gold standard test) gave the highest prevalence rate of 30%. RPG cut-off ≥7.8 mmol/L revealed a positive-predictive value of 66.7%, negative-predictive value of 72.3%, and area under the curve of 0.845 compared with FPG level at threshold of 5.1 mmol/L, which gave positive-predictive value of 93.1%, negative-predictive value of 95.8%, and area under the curve 0.920. Conclusion: This study revealed that FPG threshold of 5.1 mmol/L alone performed excellently as a screening test.

scholarly journals ENDOCRINOLOGY OF PREGNANCY: Gestational diabetes mellitus: definition, aetiological and clinical aspects

2016 ◽  
Vol 174 (2) ◽  
pp. R43-R51 ◽  
Author(s):  
Baz Baz ◽  
Jean-Pierre Riveline ◽  
Jean-François Gautier
Keyword(s):  
Gestational Diabetes ◽  
Normal Pregnancy ◽  
Tolerance Test ◽  
Clinical Aspects ◽  
Oral Glucose ◽  
Glucose Levels ◽  
Risk Alleles ◽  
Before And After ◽  
Normal Glucose ◽  
Adverse Pregnancy

Gestational diabetes (GDM) is defined as a glucose intolerance resulting in hyperglycaemia of variable severity with onset during pregnancy. This review aims to revisit the pathogenesis and aetiology of GDM in order to better understand its clinical presentation and outcomes. During normal pregnancy, insulin sensitivity declines with advancing gestation. These modifications are due to placental factors, progesterone and estrogen. In a physiological situation, a compensatory increase in insulin secretion maintains a normal glucose homeostasis. GDM occurs if pancreatic β-cells are unable to face the increased insulin demand during pregnancy. GDM is most commonly a forerunner of type 2 diabetes (T2D) – the most prevalent form of diabetes. These women share similar characteristics with predisposed subjects to T2D: insulin resistance before and after pregnancy, and carry more T2D risk alleles. Auto-immune and monogenic diabetes are more rare aetiologies of GDM. Adverse pregnancy outcomes of GDM are mainly related to macrosomia caused by fetal hyperinsulinism in response to high glucose levels coming from maternal hyperglycaemia. Screening recommendations and diagnosis criteria of GDM have been recently updated. High risk patients should be screened as early as possible using fasting plasma glucose, and if normal, at 24–28 weeks of gestation using 75 g oral glucose tolerance test. The treatment of GDM is based on education with trained nurses and dieticians, and if necessary insulin therapy.

scholarly journals Predictors of postpartum glucose intolerance in women with gestational diabetes mellitus: a prospective cohort study in Ethiopia based on the updated diagnostic criteria

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e036882
Author(s):  
Achenef Asmamaw Muche ◽  
Oladapo O Olayemi ◽  
Yigzaw Kebede Gete
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Glucose Intolerance ◽  
Plasma Glucose ◽  
Fasting Plasma Glucose ◽  
Tolerance Test ◽  
Multivariable Logistic Regression Analysis ◽  
Oral Glucose ◽  
Fasting Plasma

ObjectivesTo identify the incidence of postpartum glucose intolerance and develop a prediction model based on antenatal characteristics to predict postpartum glucose intolerance.DesignProspective cohort study.SettingGondar town public health facilities in Northwest Ethiopia.ParticipantsWomen who had gestational diabetes mellitus were advised to undergo postpartum oral glucose tolerance test at 6–12 weeks of delivery.Main outcomePostpartum glucose intolerance.Data analysisPredictors of postpartum glucose intolerance were identified using multivariable logistic regression analysis. The discriminative power of the predictor variables for postpartum glucose intolerance and the model accuracy were computed by area under the receiver operating characteristic curve and estimated by area under the curve (AUC) with 95% CI.ResultsA total of 112 (85.5%) women with gestational diabetes mellitus returned and completed the postpartum oral glucose tolerance test. The incidence of postpartum glucose intolerance was 21.4% (95% CI14.3 to 28.4), inclusive of 18.7% pre-diabetes and 2.7% diabetes. Multivariable logistic regression analysis revealed that advanced maternal age, high fasting plasma glucose level at diagnosis, overweight and/or obesity, and antenatal depression were predictors of postpartum glucose intolerance. The AUC of the final reduced model to predict postpartum glucose intolerance was 0.884 (95% CI 0.822 to 0.937). Fasting plasma glucose at diagnosis of gestational diabetes mellitus (AUC=0.736, 95% CI0.616 to 0.845) and overweight and/or obesity (AUC=0.718, 95% CI 0.614 to 0.814) were better predictors of postpartum glucose intolerance. Moreover, the AUC for the combined predictors of fasting plasma glucose at diagnosis and mid-upper arm circumference was 0.822 (95% CI 0.722 to 0.907), which was the best predictor.ConclusionsThe incidence of postpartum glucose intolerance was high among women with gestational diabetes mellitus. Antenatal predictors modestly predicted postpartum glucose intolerance. The findings suggest ongoing glucose screening is indicated for all women with gestational diabetes mellitus.

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