Abstract
Gestational diabetes mellitus (GDM) starts during pregnancy and can increase the risk of adverse pregnancy outcomes, as well as be the cause of a number of diseases in the years after birth in both the mother and the fetus. The aim is to study in the Bulgarian population of pregnant women the relationship between hyperglycemia during pregnancy and some factors – arterial hypertension (AH), previous macrosomic baby weighing 4.5 kg or above, hirsutism. Material: A cross-sectional multicenter population-based study which included 547 pregnant women, with average age 30.49±5,12 years was conducted in 84 settlements in Bulgaria. Methods: A questionnaire was completed, blood pressure was measured (Guideline of ESC/ESH, 2018), BMI was calculated. A two-hour, 75 g oral glucose tolerance test (OGTT) was performed. Glucose was quantitatively determined using enzymatic reference method with hexokinase (Roche reagent) on Cobas e501 analyzer. The statistical analysis was performed using standard SPSS 13.0 for Windows. Results: The incidence of Hyperglycemia for the whole group of pregnant women was 14.4% (79/547), up to 24 gestational week (g.w.) it was 5.3% (29/547) and after 24 g.w. - 9.1% (50/547), P < 0.01. Of all screened pregnant women, 2.4% (13/547) developed AH during the current pregnancy. Hyperglycemia was found in 38.5% (5/13) of the women with AH and in 13.9% (74/534) of the women without AH, P < 0.028. In 3.29% of the pregnant women (18/547) a macrosomic baby weighing 4.5 kg or above was found in a previous pregnancy. Hyperglycemia was present in 38.9% (7/18) of women who gave birth to a large fetus against 13.6% (72/529) of women who gave birth to a fetus under 4 kg, P < 0.008. Hirsutism was reported in 7.9% (43/547) of the studied pregnant women. Hirsutism is twice as common in pregnant women with Hyperglycemia - 13.9% (11/79) versus hirsutism in those with Normoglycemia - 6.8% (32/468), P < 0.049. There was a significant correlation between Hyperglycemia and gestational age (P < 0.006), previous fetal birth over 4 kg (P < 0.03), AH during the current pregnancy (P < 0.01), presence of hirsutism (P < 0.03). Conclusion: A good knowledge of all risk factors associated with the development of glucose intolerance and GDM could play an important role in the early diagnosis of this common disorder during pregnancy.
Highlights
Hyperglycemia is one of the most common conditions during pregnancy [1]
The aim of the present study was to investigate the relationship between Hyperglycemia during pregnancy and the sequence of pregnancy, arterial hypertension, large fetus over 4 kg at birth, hirsutism, reproductive problems or adverse outcome of previous pregnancies among the Bulgarian population of pregnant women
For the period up to 24 g.w. no significant dynamics is observed in this frequency, but after 24 g.w. the incidence of Hyperglycemia increased from 9.4% in the first pregnancy to 31.6% in the fourth (NS), Table 2
Summary
Hyperglycemia is one of the most common conditions during pregnancy [1]. According to classification of the International Federation of Gynecology and Obstetrics – FIGO [2] and the World Health Organization – WHO [3], hyperglycemia detected for the first time during pregnancy may be related to: 1) Diabetes in Pregnancy (DIP) – Diabetes diagnosed for the first time during pregnancy according to generally accepted population diagnostic criteria for diabetes (standard oGTT 75 g glucose): fasting plasma glucose ≥ 7.0 mmol / L or 2nd hour plasma glucose ≥ 11.1 mmol / L or HbA1c ≥ 48 mmol / mol or ≥ 6.5% and 2) Gestational diabetes (GDM) – hyperglycemia above the diagnostic threshold for International Journal of Diabetes and Endocrinology 2021; 6(2): 69-75 gestational diabetes (standard oGTT 75 g glucose): fasting plasma glucose 5.1 - 6.9 mmol / L, 1st hour plasma glucose ≥ 10.0 mmol / L, 2nd hour plasma glucose 8.5 - 11.0 mmol / L [2, 3]. As early as 2015, the National Institute for Health and Care Excellence-NICE [4] published criteria for diagnosing GDM: plasma fasting blood glucose (FBG) ≥ 5.6 mmol / L or plasma blood glucose at 120 minutes ≥ 7.8 mmol / L. The NICE Recommendations include instructions for establishing of pregnancy up to 10-16 gestational week (g.w.) to perform oral glucose tolerance test (oGTT) for detection of undiagnosed diabetes. GDM started during pregnancy, and it is clear that it did not exist before pregnancy [5]
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