Early Diagnosis of Gestational Diabetes Mellitus in Patients With Elevated Body Mass Index [300

Abstract

INTRODUCTION: Increased body mass index (BMI, calculated as weight (kg)/[height (m)]2) in a pregnant patient can put her at risk of gestational diabetes mellitus (GDM) by altering her insulin resistance early in pregnancy. The objective of this study was to determine a one-step test for GDM as early as 16 weeks of gestation in patients with increased BMI, thus minimizing fetal and maternal complications. METHODS: Between February 2008 and February 2012, 200 pregnant patients with BMI greater than 25 were registered for this prospective double-blind randomized study. Group A received 50 g glucola and group B received 100 g at 16 weeks of gestation. Patients who had impaired glucose tolerance (130–139 mg) received counseling about exercise and diet and those who had abnormal glucola (greater than 140 mg) also received a consult with perinatologists. Student's t test, χ2 test, and statistical analyses were run using SPSS 21. RESULTS: A total of 176 patients completed (A=89, B=87) glucola at 16 weeks of gestation. Impaired glucose tolerance was noted in 11 patients (A=6.7%, B=5.7%). Abnormal glucose tolerance was noted in 37 patients (A=12.3%, B=29.8%). Additionally 30 new cases of impaired glucose tolerance were diagnosed at 28 weeks of gestation with 50 g glucose (A=12.2%, B=4.4%). The data demonstrated that there was no statistically significant difference in weight gain, hemoglobin, hematocrit, platelet, blood pressure, mode of delivery or fetal weight between patient groups who had abnormal glucose screening test and received counseling and those who had normal glucose screening. CONCLUSION: This study showed that diagnosing impaired glucose tolerance in early pregnancy in patients with elevated BMI and providing them counseling helped to prevent GDM complications. A one-step test using a 100-g glucola test in early pregnancy in patients with elevated BMI is promising.