Prospective study of maternal outcomes in primigravida with gestational diabetes mellitus in a tertiary care centre Venjaramood, Thiruvananthapuram

Background: The prevalence of Gestational diabetes mellitus (GDM) is on the rise. Understanding the various outcomes of it is essential to face this challenge. The aim of the study was to understand the maternal outcomes of GDM in primigravida and to compare the maternal outcomes in primigravida with GDM and without GDM.Methods: This prospective study was conducted in the department of obstetrics and gynaecology at Sree Gokulam Medical College and Research Foundation, Venjaramood, Thiruvananthapuram, on 180 primigravida mothers,90 with and 90 without gestational diabetes. GDM was diagnosed with IADPSG criteria using 75 g Oral glucose tolerance test (OGTT).Results: A total of 180 primigravida with singleton gestation, 90 with GDM and 90 without GDM were followed from pregnancy to delivery after fulfilling criteria during study period. 65.6% GDM mothers had good compliance with Medical nutrition therapy (MNT) and exercise. 88.8% of GDM mothers required induction of labour, 13.3% had pregnancy induced hypertension, 12.2% had vulvovaginal candidiasis and 10% had postpartum hemorrhage. Thus, women with GDM on MNT or MNT with insulin had a higher risk of adverse maternal outcomes but was comparable to normoglycemic mothers if they had good compliance to MNT or insulin.Conclusions: Women with GDM had a higher but comparable risk of adverse maternal outcomes as compared to normoglycemic pregnant mothers, if they strictly adhere to MNT with or without insulin reflecting the importance of good treatment compliance.

Do Pregnancy Outcomes of Women With False-Positive Early Gestational Diabetes Mellitus Differ From Those of Women With Normal Glucose Tolerance?

Background: To investigate whether false-positive early gestational diabetes mellitus (GDM) women can be managed similarly as normal glucose tolerance (NGT) women.Methods: This retrospective study was conducted at a tertiary care center in Japan. Pregnancy and neonate outcomes of 117 singleton pregnancies with false-positive early GDM and 1774 singleton pregnancies with NGT who delivered after 22 weeks of gestation were compared. GDM was diagnosed according to the IADPSG criteria (patients having one or more of the following: fasting plasma glucose ≥ 92 mg/dL and a 75 g oral glucose tolerance test (OGTT) value ≥180 mg/dL at 1 h, or ≥153 mg/dL at 2 h). Pregnant women diagnosed with GDM in early pregnancy who did not meet the diagnostic criteria on the second OGTT were defined as having false-positive early GDM. Women with false-positive early GDM did not receive any therapeutic intervention during gestation.Results: Maternal age, pre-pregnancy BMI, and gestational weight gain were significantly higher in the false-positive GDM group than the NGT group. No significant differences were found in pregnancy outcomes, including gestational age, birth weight, large for gestational age rate, and cesarean delivery rate. Except for neonatal hypoglycemia rate, no significant differences were found in neonatal outcomes.Conclusions: There were no clinically significant differences between early GDM false-positive women exhibiting GDM patterns only during early pregnancy and NGT women. False-positive early GDM women can be managed similarly as NGT women, suggesting that WHO diagnostic guidelines, applying the IADPSG criteria during early pregnancy, need revision.

The correlation between the prevalence of gestational diabetes mellitus and maternal age in Southern China

Objectives The present study aimed to survey the prevalence of gestational diabetes mellitus (GDM) in Southern China and further to analyze the correlation between the prevalence of GDM and maternal age. Methods A retrospective cross-sectional study was carried out at the Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, China between January and April 2020. Oral glucose tolerance tests (OGTT) was performed, using a 75 g glucose load and venous samples were drawn at 0 h, 1 h and 2 h at 24–28 weeks of gestation. GDM was diagnosed by International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. Results The prevalence of GDM was 14.87% by IADPSG criteria. The incidence of GDM outcome increased and plasma glucose levels remained high among the age subgroups (<20, 20–24, 25–29, 30–34, 35–39, ≥40 years old) in pregnant women. Moreover, the levels of plasma glucose levels after OGTT kept rising among the pregnant women with non-gestational diabetes mellitus (non-GDM). Furthermore, pregnant women were inclined to have abnormal plasma glucose values at 1 h and 2 h than initial fasting plasma glucose (FPG) after OGTT as the age increased. Conclusions Our findings demonstrate that the incidence of GDM outcome and plasma glucose levels increase as the maternal age increase.

Comparative epidemiology of gestational diabetes in ethnic Chinese from Shanghai birth cohort and growing up in Singapore towards healthy outcomes cohort

Background Gestational diabetes mellitus (GDM) has been associated with adverse health outcomes for mothers and offspring. Prevalence of GDM differs by country/region due to ethnicity, lifestyle and diagnostic criteria. We compared GDM rates and risk factors in two Asian cohorts using the 1999 WHO and the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. Methods The Shanghai Birth Cohort (SBC) and the Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort are prospective birth cohorts. Information on sociodemographic characteristics and medical history were collected from interviewer-administered questionnaires. Participants underwent a 2-h 75-g oral glucose tolerance test at 24–28 weeks gestation. Logistic regressions were performed. Results Using the 1999 WHO criteria, the prevalence of GDM was higher in GUSTO (20.8%) compared to SBC (16.6%) (p = 0.046). Family history of hypertension and alcohol consumption were associated with higher odds of GDM in SBC than in GUSTO cohort while obesity was associated with higher odds of GDM in GUSTO. Using the IADPSG criteria, the prevalence of GDM was 14.3% in SBC versus 12.0% in GUSTO. A history of GDM was associated with higher odds of GDM in GUSTO than in SBC, while being overweight, alcohol consumption and family history of diabetes were associated with higher odds of GDM in SBC. Conclusions We observed several differential risk factors of GDM among ethnic Chinese women living in Shanghai and Singapore. These findings might be due to heterogeneity of GDM reflected in diagnostic criteria as well as in unmeasured genetic, lifestyle and environmental factors.

ADCY5, CAPN10 and JAZF1 Gene Polymorphisms and Placental Expression in Women with Gestational Diabetes

Gestational diabetes mellitus (GDM) is carbohydrate intolerance that occurs during pregnancy. This disease may lead to various maternal and neonatal complications; therefore, early diagnosis is very important. Because of the similarity in pathogenesis of type 2 diabetes and GDM, the genetic variants associated with type 2 diabetes are commonly investigated in GDM. The aim of the present study was to examine the associations between the polymorphisms in the ADCY5 (rs11708067, rs2877716), CAPN10 (rs2975760, rs3792267), and JAZF1 (rs864745) genes and GDM as well as to determine the expression of these genes in the placenta. This study included 272 pregnant women with GDM and 348 pregnant women with normal glucose tolerance. The diagnosis of GDM was based on a 75 g oral glucose tolerance test (OGTT) at 24–28 weeks gestation, according to International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. There were no statistically significant differences in the distribution of the ADCY5 gene (rs11708067, rs2877716) and CAPN10 gene (rs2975760, rs3792267) polymorphisms between pregnant women with normal carbohydrate tolerance and pregnant women with GDM. We have shown a lower frequency of JAZF1 gene rs864745 C allele carriers among women with GDM CC + CT vs. TT (OR = 0.60, 95% CI = 0.41–0.87, p = 0.006), and C vs. T (OR = 0.75, 95% CI = 0.60–0.95, p = 0.014). In addition, ADCY5 and JAZF1 gene expression was statistically significantly increased in the placentas of women with GDM compared with that of healthy women. The expression of the CAPN10 gene did not differ significantly between women with and without GDM. Our results indicate increased expression of JAZF1 and ADCY5 genes in the placentas of women with GDM as well as a protective effect of the C allele of the JAZF1 rs864745 gene polymorphism on the development of GDM in pregnant women.

Oral Glucose Tolerance Test Results in Pregnancy Can Be Used to Individualize the Risk of Future Maternal Type 2 Diabetes Mellitus in Women With Gestational Diabetes Mellitus

OBJECTIVE: We aimed to quantify the risk of future maternal T2DM in women with GDM based on the type and number of abnormal 75g-OGTT values and the diagnostic criteria used for the diagnosis of GDM. <p>RESEARCH DESIGN AND METHODS: We conducted a population-based retrospective cohort study of all nulliparous women with a live singleton birth who underwent testing for GDM using a 75g-OGTT in Ontario, Canada (2007-2017). We estimated the incidence rates (per 1000 person years), overall risk (expressed as adjusted hazard ratio [aHR]), and risk at 5-year post the index pregnancy of future maternal T2DM. Estimates were stratified by the type and number of abnormal OGTT values, as well as by the diagnostic criteria for GDM (Diabetes Canada vs. IADPSG criteria). </p> <p>RESULTS: A total of 55,361 women met the study criteria. The median duration of follow-up was 4.4 (IQR 2.8-6.3, maximum 10.3) years. Using women without GDM as reference (incidence rate 2.18 per 1000py), women with GDM were at an increased risk of future T2DM, with the risk being higher for the Diabetes Canada compared with the IADPSG criteria (incidence rate 18.74 [95%-CI 17.58-19.90] vs. 14.07 [95%-CI 13.24-14.91] per 1000py, respectively). The risk of future maternal T2DM increased with the number of abnormal OGTT values, and was highest for women with 3 abnormal values (incidence rate 49.93 per 1000py; aHR 24.57 [95%-CI 21.26-28.39]). The risk of future T2DM was also affected by the type of OGTT abnormality: women with an abnormal fasting value had the greatest risk while women with an abnormal 2-hour value had the lowest risk for future T2DM (aHR 14.09 [95%-CI 12.46-15.93) vs. 9.22 [95%-CI 8.19-10.37]), respectively). <a></a><a>Similar findings to those described above were observed when the risk of T2DM at a fixed time point of 5-years post the index pregnancy was considered as the outcome of interest</a>.</p> <p>CONCLUSION: In women with GDM, individualized information regarding the future risk of T2DM can be provided based on the type and number of abnormal OGTT values, as well as the diagnostic criteria used for the diagnosis of GDM. </p>

Oral Glucose Tolerance Test Results in Pregnancy Can Be Used to Individualize the Risk of Future Maternal Type 2 Diabetes Mellitus in Women With Gestational Diabetes Mellitus

OBJECTIVE: We aimed to quantify the risk of future maternal T2DM in women with GDM based on the type and number of abnormal 75g-OGTT values and the diagnostic criteria used for the diagnosis of GDM. <p>RESEARCH DESIGN AND METHODS: We conducted a population-based retrospective cohort study of all nulliparous women with a live singleton birth who underwent testing for GDM using a 75g-OGTT in Ontario, Canada (2007-2017). We estimated the incidence rates (per 1000 person years), overall risk (expressed as adjusted hazard ratio [aHR]), and risk at 5-year post the index pregnancy of future maternal T2DM. Estimates were stratified by the type and number of abnormal OGTT values, as well as by the diagnostic criteria for GDM (Diabetes Canada vs. IADPSG criteria). </p> <p>RESULTS: A total of 55,361 women met the study criteria. The median duration of follow-up was 4.4 (IQR 2.8-6.3, maximum 10.3) years. Using women without GDM as reference (incidence rate 2.18 per 1000py), women with GDM were at an increased risk of future T2DM, with the risk being higher for the Diabetes Canada compared with the IADPSG criteria (incidence rate 18.74 [95%-CI 17.58-19.90] vs. 14.07 [95%-CI 13.24-14.91] per 1000py, respectively). The risk of future maternal T2DM increased with the number of abnormal OGTT values, and was highest for women with 3 abnormal values (incidence rate 49.93 per 1000py; aHR 24.57 [95%-CI 21.26-28.39]). The risk of future T2DM was also affected by the type of OGTT abnormality: women with an abnormal fasting value had the greatest risk while women with an abnormal 2-hour value had the lowest risk for future T2DM (aHR 14.09 [95%-CI 12.46-15.93) vs. 9.22 [95%-CI 8.19-10.37]), respectively). <a></a><a>Similar findings to those described above were observed when the risk of T2DM at a fixed time point of 5-years post the index pregnancy was considered as the outcome of interest</a>.</p> <p>CONCLUSION: In women with GDM, individualized information regarding the future risk of T2DM can be provided based on the type and number of abnormal OGTT values, as well as the diagnostic criteria used for the diagnosis of GDM. </p>

Comparison of Pregnancy Outcomes Using Different Gestational Diabetes Diagnostic Criteria and Treatment Thresholds in Multiethnic Communities between Two Tertiary Centres in Australian and New Zealand: Do They Make a Difference?

Introduction: Australia, but not New Zealand (NZ), has adopted the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria to diagnose gestational diabetes (GDM). We compared pregnancy outcomes using these different diagnostic approaches. Method: Prospective data of women with GDM were collected from one NZ (NZ) and one Australian (Aus) hospital between 2007–2018. Aus screening criteria with 2-step risk-based 50 g Glucose Challenge Testing (GCT) followed by 75 g-oral glucose tolerance testing (OGTT): fasting ≥ 5.5, 2-h ≥ 8.0 mmol/L (ADIPS98) changed to a universal OGTT and fasting ≥5.1, 1-h ≥ 10, 2-h ≥ 8.5 mmol/L (IADPSG). NZ used GCT followed by OGTT with fasting ≥ 5.5, 2-h ≥ 9.0 mmol/L (NZSSD); in 2015 adopted a booking HbA1c (NZMOH). Primary outcome was a composite of macrosomia, perinatal death, preterm delivery, neonatal hypoglycaemia, and phototherapy. An Aus subset positive using NZSSD was also defined. RESULTS: The composite outcome odds ratio compared to IADPSG (1788 pregnancies) was higher for NZMOH (934 pregnancies) 2.227 (95%CI: 1.84–2.68), NZSSD (1344 pregnancies) 2.19 (1.83–2.61), and ADIPS98 (3452 pregnancies) 1.91 (1.66–2.20). Composite outcomes were similar between the Aus subset and NZ. Conclusions: The IADPSG diagnostic criteria were associated with the lowest rate of composite outcomes. Earlier NZ screening with HbA1c was not associated with a change in adverse pregnancy outcomes.

Interventions for gestational diabetes: impact of assisted reproduction

Background: This study was to assess whether assisted conception acts as a predictor for insulin therapy in gestational diabetes (GDM) treatment. The secondary aim of this study was to analyse the type of interventions that aided control of blood glucose. The role of ART as a risk factor that increases the risk of insulin therapy in GDM remains elusive. Many studies have established the increased association of GDM with ART conceptions. Factors like advanced maternal age, polycystic ovarian syndrome or obesity that increase GDM risk also contribute to subfertility. Increased level of Hb A1C, elevated FBS values are considered as risk factors for antenatal insulin therapy in women with GDM. This study was to assess if assisted reproduction is an independent variable associated with insulin therapy.Methods: In this retrospective study, GDM was diagnosed by fasting blood sugar and 2 hours postprandial or 75 gms OGTT based on IADPSG criteria with FBS >90, 2hr >140. Among the 121 GDM mothers, 42 women were ART conceptions and 79 were spontaneous conceptions. The entire study population (121) was divided into 3 groups based on the treatment required. Diet and lifestyle modifications only, diet and life style modifications with OHA and OHA with or without insulin therapy. The demographic, clinical, biochemical data were compared between groups. Details were obtained from case notes and entered in an excel sheet and SSPS software was used for statistical analysis. Inclusion criteria was all GDM pregnancies in the study period (4 years; January 2014 to December 2017) for whom case notes were available. Exclusion criteria was women with diabetes prior to pregnancy, those who moved elsewhere for delivery and multiple gestations.Results: There was no difference in the insulin requirement between ART conception and spontaneous conceptions. Out of 121 women, 34 women (28%) required diet and life style management, 38 women required OHA (31%), 49 women required insulin (40%). 73% of women who were managed with diet were spontaneous conceptions. Preterm labor was the commonest complication encountered (17%). ART women had more number of perinatal complications, in all treatment groups.Conclusions: ART was not a predictor for insulin therapy in this study group. The largest group of intervention for GDM was with insulin, 40%. Perinatal complications were seen more in ART mothers with GDM compared with spontaneous conceptions. Spontaneous conceptions women had more percentage of management with diet and life style modifications.