Abstract
In this study we aimed to explore the significance of glycemic control during gestational diabetes mellitus (GDM) pregnancy in predicting recurrence as this is unknown. A retrospective population-based cohort study of women with first diagnosed GDM pregnancy was conducted. A total of 426 women with 4,226 glucose charts were obtained. Daily glucose values were collected from the glucose charts. Non-parametric (LOWESS) regression was used to present the glucose measurements along the gestational weeks. The analyses revealed that the 2-hour postprandial levels among women with GDM recurrence were substantially higher throughout gestation (PR = 1.89 [95% CI: 1.33, 2.73] for every 20 mg/dl increase). In a multivariable log-binomial regression, the mean postprandial glucose was significantly associated with GDM recurrence (p = 0.017) after adjusting for maternal age, family history of diabetes, insulin use, and inter-pregnancy interval (PR = 1.04 [95% CI: 1.01, 1.07]). The study conclusion is that tighter postprandial glycemic control should be considered. Future studies should explore tighter cutoffs of the 2-hour postprandial glucose.
Highlights
Women diagnosed with gestational diabetes mellitus (GDM) are at increased risk for a variety of adverse birth outcomes[1,2,3]
A total of 426 women (Fig. 1) were included in the analysis, including 257 women (60%) that had GDM recurrence, and the statistical power increased to 95%
Aside from the 3-hour oral glucose tolerance test (OGTT) glucose levels, HbA1c, neonatal birth weight, and the mean daily overall and preprandial glucose levels, all of the examined risk factors were significantly associated with GDM recurrence
Summary
Women diagnosed with gestational diabetes mellitus (GDM) are at increased risk for a variety of adverse birth outcomes[1,2,3]. Several studies have examined the relevance of OGTT levels as risk factors[9,10,11,12,13,14,15,16,17] where the mean values of the OGTT results among women with and without GDM recurrence were compared; except for the 3-hour post glucose load results, the OGTT results were consistently significant. No study has examined the accuracy of the OGTT levels in predicting GDM recurrence, or presented cutoff values for an increased risk for GDM recurrence. The main objective of the current study was to explore the association and accuracy of the glucose levels during the third trimester in predicting GDM recurrence. The OGTT significance and accuracy were examined
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