Abnormal Oral Glucose Tolerance Test Values Research Articles

Associations between OGTT results during pregnancy and offspring TSH levels: a birth cohort study

BackgroundLimited evidence exists regarding the association between gestational diabetes mellitus (GDM) and elevated levels of thyroid-stimulating hormone (TSH) in newborns. Therefore, this study aimed to investigate the potential risk of elevated TSH levels in infants exposed to maternal GDM, considering the type and number of abnormal values obtained from the 75-gram oral glucose tolerance test (OGTT).MethodsA population-based, prospective birth cohort study was conducted in Wuhan, China. The study included women who underwent GDM screening using a 75-g OGTT. Neonatal TSH levels were measured via a time-resolved immunofluorescence assay. We estimated and stratified the overall risk (adjusted Risk Ratio [RR]) of elevated TSH levels (defined as TSH > 10 mIU/L or > 20 mIU/L) in offspring based on the type and number of abnormal OGTT values.ResultsOut of 15,236 eligible mother-offspring pairs, 11.5% (1,753) of mothers were diagnosed with GDM. Offspring born to women diagnosed with GDM demonstrated a statistically significant elevation in TSH levels when compared to offspring of non-GDM mothers, with a mean difference of 0.20 [95% CI: 0.04–0.36]. The incidence of elevated TSH levels (TSH > 10 mIU/L) in offspring of non-GDM women was 6.3 per 1,000 live births. Newborns exposed to mothers with three abnormal OGTT values displayed an almost five-fold increased risk of elevated TSH levels (adjusted RR 4.77 [95% CI 1.64–13.96]). Maternal fasting blood glucose was independently and positively correlated with neonatal TSH levels and elevated TSH status (TSH > 20 mIU/L).ConclusionsFor newborns of women with GDM, personalized risk assessment for elevated TSH levels can be predicated on the type and number of abnormal OGTT values. Furthermore, fasting blood glucose emerges as a critical predictive marker for elevated neonatal TSH status.

Future diabetes risk can be predicted by the number of abnormal oral glucose tolerance test values during pregnancy.

To quantify the future risk of type 2 diabetes (T2D) in women with gestational diabetes (GD) based on baseline metabolic characteristics and the number of abnormal values during a 3-hour 100-g oral glucose tolerance test (OGTT). We conducted a population-based retrospective cohort study of 10 023 pregnant women who underwent testing for GD in a large health maintenance organization in Israel using a 100-g OGTT. Glucose values were obtained at four time points, 0, 60, 120 and 180 minutes. We identified 9939 women who met the study criteria. Median follow-up was 3.25 (interquartile range 1.5-5.1; maximum 10.1) years. Using women without GD as reference, women with GD were at an increased risk of future T2D (hazard ratio [HR] 5.33 [95% confidence interval {CI} 3.86-7.34]). This risk increased with a greater number of abnormal OGTT values, with the highest risk seen in women with four abnormal values (HR 16.67 [95% CI 7.94-35.01]). In a multivariate model, a higher number of abnormal values, Arab ethnicity, higher body mass index, triglycerides and prepregnancy glucose were significantly associated with increased risk. Future T2D risk was also affected by the type of OGTT abnormality; an abnormal fasting value had the greatest risk, whereas an abnormal 3-hour value had the lowest risk (HR 3.61 [95% CI 2.42-5.38] vs. 1.50 [95% CI 0.93-2.43], respectively). GD isa heterogenous disease, with varying degrees of glucose intolerance and subsequent T2D risk. Targeting interventions to womenat the highest risk may help to improve postpartum adherence and effective long-term follow-up strategies.

Gestational Glucose Intolerance and Birth Weight-Related Complications.

To evaluate the risks of large-for-gestational-age birth weight (LGA) and birth weight-related complications in pregnant individuals with gestational glucose intolerance, an abnormal screening glucose loading test result without meeting gestational diabetes mellitus (GDM) criteria. In a retrospective cohort study of 46,989 individuals with singleton pregnancies who delivered after 28 weeks of gestation, those with glucose loading test results less than 140 mg/dL were classified as having normal glucose tolerance. Those with glucose loading test results of 140 mg/dL or higher and fewer than two abnormal values on a 3-hour 100-g oral glucose tolerance test (OGTT) were classified as having gestational glucose intolerance. Those with two or more abnormal OGTT values were classified as having GDM. We hypothesized that gestational glucose intolerance would be associated with higher odds of LGA (birth weight greater than the 90th percentile for gestational age and sex). We used generalized estimating equations to examine the odds of LGA in pregnant individuals with gestational glucose intolerance compared with those with normal glucose tolerance, after adjustment for age, body mass index, parity, health insurance, race and ethnicity, and marital status. In addition, we investigated differences in birth weight-related adverse pregnancy outcomes. Large for gestational age was present in 7.8% of 39,685 pregnant individuals with normal glucose tolerance, 9.5% of 4,155 pregnant individuals with gestational glucose intolerance and normal OGTT, 14.5% of 1,438 pregnant individuals with gestational glucose intolerance and one abnormal OGTT value, and 16.0% of 1,711 pregnant individuals with GDM. The adjusted odds of LGA were higher in pregnant individuals with gestational glucose intolerance than in those with normal glucose tolerance overall (adjusted odds ratio [aOR] 1.35, 95% CI 1.23-1.49, P<.001). When compared separately with pregnant individuals with normal glucose tolerance, those with either gestational glucose intolerance subtype had higher adjusted LGA odds (gestational glucose intolerance with normal OGTT aOR 1.21, 95% CI 1.08-1.35, P<.001; gestational glucose intolerance with one abnormal OGTT value aOR 1.77, 95% CI 1.52-2.08, P<.001). The odds of birth weight-related adverse outcomes (including cesarean delivery, severe perineal lacerations, and shoulder dystocia or clavicular fracture) were higher in pregnant individuals with gestational glucose intolerance with one abnormal OGTT value than in those with normal glucose tolerance. Gestational glucose intolerance in pregnancy is associated with birth weight-related adverse pregnancy outcomes. Glucose lowering should be investigated as a strategy for lowering the risk of these outcomes in this group.

Prevalence of abnormal glucose values and gestational diabetes mellitus among pregnant women in Xi’an from 2015 to 2021

BackgroundPregnant women with gestational diabetes mellitus (GDM) often have an increased risk of adverse pregnancy outcomes. The purpose of this study was to explore the prevalence and characteristics of GDM in Xi’an from 2015 to 2021 since the implementation of China’s “Two-Child policy” and to provide a clinical basis for the management of GDM.MethodsWe analyzed the oral glucose tolerance test (OGTT) results of 152,836 pregnant women who underwent routine prenatal examination at the Northwest Women and Children’s Hospital from 2015 to 2021. Additionally, we analyzed the GDM prevalence and characteristics.ResultsThe prevalence of GDM in the Xi’an urban area was 24.66% and exhibited an increasing trend annually (χ2 for trend = 43.922, p < 0.001) and with age (χ2 for trend = 2527.000, p < 0.001). Consistent with this, the proportion of pregnant women aged 18–25 and 26–30 years decreased significantly with the annual growth (χ2 for trend = 183.279, p < 0.001 and χ2 for trend = 33.192, p < 0.001, respectively). The proportion of pregnant women aged 31–35 and 36–42 years increased gradually annually (χ2 for trend = 134.436, p < 0.001and χ2 for trend = 44.403, p < 0.001, respectively). Of the pregnant women diagnosed with GDM, 71.15% (65.05–74.95%) had abnormal fasting plasma glucose (FPG) values. The highest percentage of patients had a single abnormal OGTT value (68.31%; 65.77–70.61%), followed by two (20.52%; 18.79–22.55%) and three (11.17%; 10.11–11.85%) abnormal values (FPG and 1-h and 2-h plasma glucose (PG).ConclusionThe prevalence of GDM among pregnant women in Xi’an region was high, and it had a increasing trend over the period from 2015 to 2021. Notably, the proportion of elder pregnant women, aged 31–42 years, presented a significant rise after the implementation of the universal two-child policy. On the basis of the high incidence of GDM among elder pregnant women and the high rate of abnormal OGTT values (numbe ≥ 2) in pregnant women diagnosed with GDM, the management of GDM should be intensified, and relevant departments should pay more attention to pregnant women of advanced age.

Glucose intolerance in pregnancy and risk of early-onset type 2 diabetes: a population-based cohort study

The risk of type 2 diabetes among women with glucose intolerance during pregnancy that does not meet gestational diabetes criteria requires further investigation. We aimed to explore the associations between various degrees of gestational glucose intolerance and the risk of type 2 diabetes in young adulthood. For this population-based cohort study, the national Israeli conscription database was linked to Maccabi Healthcare Services (MHS), the second-largest state-mandated health provider in Israel. We included 177 241 women who underwent a pre-recruitment evaluation at adolescence (age 16-20 years), 1 year before mandatory military service, and later underwent, from Jan 1, 2001, to Dec 31, 2019, two-step gestational diabetes screening with a 50 g glucose challenge test (GCT) based on a threshold of 140 mg/dL (7·8 mmol/L), followed as needed by a 100 g oral glucose tolerance test (OGTT). Abnormal OGTT values were defined according to the Carpenter-Coustan thresholds: 95 mg/dL (5·3 mmol/L) or higher in the fasting state; 180 mg/dL (10·0 mmol/L) or higher at 1 h; 155 mg/dL (8·6 mmol/L) or higher at 2 h; and 140 mg/dL (7·8 mmol/L) or higher at 3 h. The primary outcome was incident type 2 diabetes in the MHS diabetes registry. Cox proportional hazards models were applied to estimate adjusted hazard ratios (HRs) with 95% CIs for incident type 2 diabetes. During a cumulative follow-up of 1 882 647 person-years, and with a median follow-up of 10·8 (IQR 5·2-16·4) years, 1262 women were diagnosed with type 2 diabetes. Crude incidence rates of type 2 diabetes were 2·6 (95% CI 2·4-2·9) per 10 000 person-years in women with gestational normoglycaemia, 8·9 (7·4-10·6) per 10 000 person-years in women with an abnormal GCT and normal OGTT, 26·1 (22·4-30·1) per 10 000 person-years in women with one abnormal OGTT value (in the fasting state or 1 h, 2 h, or 3 h post-challenge), and 71·9 (66·0-78·3) per 10 000 person-years in women with gestational diabetes. After adjustment for sociodemographic characteristics, adolescent BMI, and age at gestational screening, the risk of type 2 diabetes was higher, compared to the gestational normoglycaemia group, in women with an abnormal GCT and normal OGTT (adjusted hazard ratio [HR] 3·39 [95% CI 2·77-4·16]; p<0·0001), in women with one abnormal OGTT value (9·11 [7·64-10·86]; p<0·0001), and in women with gestational diabetes (24·84 [21·78-28·34]; p<0·0001). The risk of type 2 diabetes was modestly increased in women with isolated elevated fasting glucose (adjusted HR 11·81 [95% CI 8·58-16·25]; p<0·0001), and in women with gestational diabetes and an abnormal fasting glucose (38·02 [32·41-44·61]; p<0·0001). Gestational glucose intolerance, including conditions not meeting gestational diabetes criteria of the two-step strategy, confers a high risk of type 2 diabetes in young adulthood. These conditions should be recognised as risk factors for type 2 diabetes, especially among women with abnormal fasting glucose concentrations during pregnancy. None.

Gestational Glucose Intolerance and Risk of Future Diabetes.

Pregnant individuals are universally screened for gestational diabetes mellitus (GDM). Gestational glucose intolerance (GGI) (an abnormal initial GDM screening test without a GDM diagnosis) is not a recognized diabetes risk factor. We tested for an association between GGI and diabetes after pregnancy. We conducted a retrospective cohort study of individuals followed for prenatal and primary care. We defined GGI as an abnormal screening glucose-loading test result at ≥24 weeks' gestation with an oral glucose tolerance test (OGTT) that did not meet GDM criteria. The primary outcome was incident diabetes. We used Cox proportional hazards models with time-varying exposures and covariates to compare incident diabetes risk in individuals with GGI and normal glucose tolerance. Among 16,836 individuals, there were 20,359 pregnancies with normal glucose tolerance, 2,943 with GGI, and 909 with GDM. Over a median of 8.4 years of follow-up, 428 individuals developed diabetes. Individuals with GGI had increased diabetes risk compared to those with normal glucose tolerance in pregnancy (adjusted hazard ratio [aHR] 2.01 [95% CI 1.54-2.62], P < 0.001). Diabetes risk increased with the number of abnormal OGTT values (zero, aHR 1.54 [1.09-2.16], P = 0.01; one, aHR 2.97 [2.07-4.27], P < 0.001; GDM, aHR 8.26 [6.49-10.51], P < 0.001 for each compared with normal glucose tolerance). The fraction of cases of diabetes 10 years after delivery attributable to GGI and GDM was 8.5% and 28.1%, respectively. GGI confers an increased risk of future diabetes. Routinely available clinical data identify an unrecognized group who may benefit from enhanced diabetes screening and prevention.

Association of pre-pregnancy low-carbohydrate diet with maternal oral glucose tolerance test levels in gestational diabetes.

BackgroundLimited evidence exists on the correlation between the pre-pregnancy low-carbohydrate (LC) diet and maternal oral glucose tolerance test (OGTT) levels during pregnancy. Our aim was to compare the differences in maternal OGTT levels among women who had been diagnosed with gestational diabetes mellitus (GDM) during pregnancy and adopted different dietary patterns in the pre-pregnancy period.MethodsA case–control study was conducted in 20 women with GDM who adhering to an LC diet (carbohydrate intake < 130 g/d) during pre-conception (LC/GDM,cases). Control subjects, who were matched in a 4:1 ratio, were 80 women with GDM and conventional diet (Con/GDM,control), and 80 women with conventional diet but without GDM (Con/Healthy,control). Women diagnosed with GDM using 75-g OGTT between 24 and 28 weeks of gestation. We used unadjusted raw data to compare the dietary composition data and biomarkers of the three study groups.ResultsThe average pre-conception BMI in each group suggested a similar body size from the three study groups(19.12 ± 2.00 LC/GDM, 19.65 ± 2.32 Con/GDM, 19.53 ± 2.30 Con/Healthy; P = 0.647). Compared with the Con/GDM group, the OGTT-1 h and OGTT-2 h values in LC/GDM group were significantly higher (10.36 ± 1.28 mmol/L vs. 9.75 ± 0.98 mmol/L; 9.12 ± 0.98 mmol/L vs. 8.29 ± 1.06 mmol/L). Furthermore, the percentage of women who had more than one abnormal OGTT value (OGTT-1 h and OGTT-2 h) was 40% in the LC/GDM group, which was significantly higher than in the Con/GDM group (16.3%).ConclusionsWe observed a relationship between the pre-pregnancy LC diet and more detrimental OGTT values in patients with GDM. This finding warrants further studies to understand the effect of pre-pregnancy LC diet practice on maternal glucose tolerance.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12884-022-05059-2.

Glucose Intolerance in Pregnancy and Offspring Obesity in Late Adolescence.

Gestational hyperglycemia is associated with deleterious neonatal outcomes, but long-term risks for offspring obesity are less clear. We estimated the odds for offspring adolescent overweight and obesity among mothers with gestational glucose intolerance. In a mother-offspring historical cohort, the Israel military conscription data set was linked to a large health maintenance organization. Included were women who were evaluated at adolescence and underwent two-step gestational diabetes screening (mean age, 31 years) with a 50-g glucose challenge test (GCT), followed by a 100-g oral glucose tolerance test (OGTT) if the result was abnormal. Glucose tolerance categories included gestational normoglycemia, abnormal GCT with normal OGTT, impaired glucose tolerance (IGT; one abnormal OGTT value), and gestational diabetes. The primary outcome was offspring overweight/obesity (BMI ≥85th percentile) at adolescence, measured prior to military conscription. Logistic regression models were applied. Of 33,482 mother-offspring pairs, overweight and obesity were observed in 6,516 offspring. Across increasing categories of pregnancy glycemia, the proportions of offspring with adolescent overweight/obesity increased: normoglycemia, 19%; abnormal GCT with normal OGTT, 22%; gestational IGT, 24%; and gestational diabetes, 25% (P < 0.0001). Corresponding odds ratios after adjustment for the mother's late adolescent characteristics (sociodemographic confounders and BMI) and pregnancy age were 1.2 (95% CI 1.1-1.4), 1.3 (1.2-1.5), and 1.4 (1.3-1.6), respectively. Further adjustment for offspring birth weight percentile and sociodemographic variables did not materially change results. Associations were more pronounced with increasing obesity severity. Gestational glucose intolerance, including categories not meeting the gestational diabetes threshold, was associated with increased odds for offspring overweight/obesity at late adolescence.

1042-P: Large-for-Gestational-Age Birthweight in Gestational Glucose Intolerance

Background: Treatment of gestational diabetes (GDM) reduces the risk of large for gestational age (LGA) birthweight and associated complications in infants. Pregnant people with gestational glucose intolerance (GGI, abnormal glucose loading test (GLT) without GDM) usually remain untreated. We examined the risk of LGA among women with GGI in a large cohort. Methods: In a retrospective cohort study of 44,628 singleton pregnancies delivered at an academic center at &amp;gt;28 weeks' gestation, pregnancies with a GLT &amp;gt;140 mg/dl and either a normal 3-hour 100-gram oral glucose tolerance test (OGTT) or one abnormal OGTT value were classified as GGI, and those with 2 abnormal OGTT values as GDM. We used generalized estimating equations for logistic regression to examine the risk of LGA (birthweight &amp;gt;90th percentile for gestational age) in GGI versus normal glucose tolerance (NGT, GLT &amp;lt;140 mg/dl) pregnancies after adjustment for age, gender, 1st trimester BMI, parity, insurance, race/ethnicity, and marital status. A second model adjusted for gestational weight gain (GWG) . Results: LGA was present in 7.7% of 36,964 pregnancies with NGT, 9.6% of 4357 with GGI and normal OGTT, 14.3% of 15with GGI and one abnormal OGTT value, and 14.5% of 1800 with GDM. The odds of LGA were higher in GGI than NGT pregnancies (adjusted OR 1.4 [1.3-1.5], p&amp;lt;0.001) . When compared separately with NGT, both types of GGI had elevated odds of LGA: normal OGTT adjusted OR 1.2 [1.1-1.4], p&amp;lt;0.001, one abnormal OGTT value adjusted OR 1.8 [1.5-2.1], p&amp;lt;0.001. The latter was similar to that in GDM compared to NGT: adjusted OR 1.8 [1.5-2.0], p&amp;lt;0.001. Increased odds of LGA were also present for GGI/GDM groups after GWG adjustment: normal OGTT OR 1.3 [1.2-1.5] p&amp;lt;0.001, 1 abnormal OGTT value OR 1.8 [1.5-2.1] p&amp;lt;0.0GDM OR 2.2 [1.9-2.5] p&amp;lt;0.001. Conclusion: Infants of untreated people with GGI have increased risk of LGA birthweight. The risk of LGA in GGI pregnancies with one abnormal OGTT value was similar to that in GDM in a clinical setting where only GDM was treated. Disclosure J.Maya: None. D.J.Selen: None. T.Thaweethai: None. S.Hsu: None. C.Yu: None. K.James: None. A.Kaimal: None. M.Hivert: Advisory Panel; American Heart Association, Research Support; American Diabetes Association. C.E.Powe: None. Funding MGH (Physician Scientist Development Award and Claflin Distinguished Scholar's Award)

1048-P: Glucose Intolerance in Pregnancy and Offspring Obesity in Late Adolescence

Objective: Gestational hyperglycemia is associated with deleterious neonatal outcomes, but long-term risks for offspring obesity are less clear. We estimated the odds for offspring adolescent overweight and obesity among mothers with gestational glucose intolerance. Methods: In a mother-offspring, historical cohort, the Israel military conscription dataset was linked to a large health maintenance organization. Included were women who were evaluated at adolescence and performed two-step gestational diabetes screening (mean age, 31 years) with a 50-g glucose challenge test (GCT) , followed by a 100-g oral glucose tolerance test (OGTT) if abnormal. Glucose tolerance categories included gestational normoglycemia, abnormal GCT with normal OGTT, impaired glucose tolerance (IGT; one abnormal OGTT value) , and gestational diabetes. The primary outcome was offspring overweight/obesity (BMI≥85th percentile) at adolescence, measured prior to military conscription. Logistic regression models were applied. Results: Of 33,482 mother-offspring pairs, overweight and obesity were observed in 6,516 offspring. Across increasing categories of pregnancy glycemia, the proportions of offspring with adolescent overweight/obesity increased: normoglycemia, 19%; abnormal GCT with normal OGTT, 22%; gestational IGT, 24%; and gestational diabetes, 25%, P&amp;lt;0·0001. Corresponding odds ratios after adjustment for mother's late-adolescent characteristics (sociodemographic confounders and BMI) and pregnancy age were 1.2 (95%CI, 1.1-1.4) , 1.3 (95%CI, 1.2-1.5) , and 1.4 (95%CI, 1.3-1.6) , respectively. Further adjustment for offspring birth weight percentile and sociodemographic variables did not materially change results. Associations were more pronounced with increasing obesity severity. Conclusions: Gestational glucose intolerance, including categories not meeting the gestational diabetes threshold, were associated with increased odds for offspring overweight/obesity at late adolescence. Disclosure C.D.Bendor: None. Y.Lebenthal: Advisory Panel; Lilly, Novo Nordisk, Research Support; Novo Nordisk, Pfizer Inc., Speaker's Bureau; Pfizer Inc. A.Afek: None. G.Chodick: None. G.Twig: None. A.Bardugo: None. R.Rotem: None. E.Derazne: None. H.C.Gerstein: Advisory Panel; Abbott, Eli Lilly and Company, Hanmi Pharm. Co., Ltd., Novo Nordisk, Pfizer Inc., Sanofi, Viatris Inc., Consultant; Kowa Company, Ltd., Other Relationship; DKSH, Eli Lilly and Company, Sanofi, Zuellig Pharma Holdings Pte. Ltd., Research Support; AstraZeneca, Eli Lilly and Company, Merck &amp; Co., Inc., Novo Nordisk, Sanofi. D.Tzur: None. O.Pinhas-hamiel: Advisory Panel; Novo Nordisk, Speaker's Bureau; Pfizer Inc. A.M.Tsur: None. T.Cukierman-yaffe: Research Support; European Association for the Study of Diabetes, Medtronic, Merck Sharp &amp; Dohme Corp., Novo Nordisk, Speaker's Bureau; AstraZeneca, Eli Lilly and Company, Medtronic, Merck Sharp &amp; Dohme Corp., Novo Nordisk, Sanofi.

Clinical implications of the 100-g oral glucose tolerance test in the third trimester.

The clinical implications of gestational diabetes mellitus (GDM) diagnosed in the third trimester are not well established and controversy continues regarding the performance of diagnostic tests beyond 28-week gestation. This study aimed to evaluate the incidence of abnormal third trimester oral glucose tolerance test (OGTT) results in women at high risk and to compare the obstetric and neonatal outcomes with those of women with normal OGTT results. The study included 372 women who completed late (>29weeks) 100-g OGTT due to suspected fetal macrosomia, polyhydramnios or a personal risk factor for GDM, diagnosed according to the Carpenter & Coustan criteria. Women withonly one abnormal OGTT value were diagnosed with GDM by abnormal glucose follow-up and analyzed separately. Obstetric and neonatal outcomes were compared between the GDM and the non-GDM groups. GDM was diagnosed in 85/372 (22%) women, including 35 (59.3%) women with one abnormal OGTT value who were later diagnosed with GDM. Of 200 women who had a normal 1-h 50-g glucose challenge test at 24-28weeks, late GDM was diagnosed in 33 (16.5%). Seventy-six (89.5%) of those with GDM were treated by dietary therapy and 9 (10.5%) by pharmacological therapy. Among women with GDM, large-for-gestational-age fetuses, labor induction and elective cesarean section were more prevalent than for those without GDM. Significant differences were not found between the groups in macrosomia and neonatal outcomes. The performance of OGTT in women with risk factors during the third trimester should be considered following further prospective trials.

Risk of gestational diabetes recurrence and the development of type 2 diabetes among women with a history of gestational diabetes and risk factors: a study among 18 clinical centers in China.

Background:Gestational diabetes mellitus (GDM) brings health issues for both mothers and offspring, and GDM prevention is as important as GDM management. It was shown that a history of GDM was significantly associated with a higher maternal risk for GDM recurrence. The incidence of GDM recurrence was unclear because of the incidence of second-child was low before 2016 in China. We aim to investigate the prevalence of GDM recurrence and its associated high-risk factors which may be useful for the prediction of GDM recurrence in China.Methods:A retrospective study was conducted which enrolled participants who underwent regular prenatal examination and delivered twice in the same hospital of 18 research centers. All participants were enrolled from January 2018 to October 2018, where they delivered the second baby during this period. A total of 6204 women were enrolled in this study, and 1002 women with a history of GDM were analyzed further. All participants enrolled in the study had an oral glucose tolerance test (OGTT) result at 24 to 28 weeks and were diagnosed as GDM in the first pregnancy according to the OGTT value (when any one of the following values is met or exceeded to the 75-g OGTT: 0 h [fasting], ≥5.10 mmol/L; 1 h, ≥10.00 mmol/L; and 2 h, ≥8.50 mmol/L). The prevalence of GDM recurrence and development of type 2 diabetes mellitus were calculated, and its related risk factors were analyzed.Results:In 6204 participants, there are 1002 women (1002/6204, 16.15%) with a history of GDM and 5202 women (5202/6204, 83.85%) without a history of GDM. There are significant differences in age (32.43 ± 4.03 years vs. 33.00 ± 3.34 years vs. 32.19 ± 3.37 years, P < 0.001), pregnancy interval (4.06 ± 1.44 years vs. 3.52 ± 1.43 years vs. 3.38 ± 1.35 years, P = 0.004), prepregnancy body mass index (BMI) (27.40 ± 4.62 kg/m2vs. 23.50 ± 3.52 kg/m2vs. 22.55 ± 3.47 kg/m2, P < 0.001), history of delivered macrosomia (22.7% vs. 11.0% vs. 6.2%, P < 0.001) among the development of diabetes mellitus (DM), recurrence of GDM, and normal women. Moreover, it seems so important in the degree of abnormal glucose metabolism in the first pregnancy to the recurrence of GDM and the development of DM. There are significant differences in OGTT levels of the first pregnancy such as area under the curve of OGTT value (18.31 ± 1.90 mmol/L vs. 16.27 ± 1.93 mmol/L vs. 15.55 ± 1.92 mmol/L, P < 0.001), OGTT fasting value (5.43 ± 0.48 mmol/L vs. 5.16 ± 0.49 mmol/L vs. 5.02 ± 0.47 mmol/L, P < 0.001), OGTT 1-hour value (10.93 ± 1.34 mmol/L vs. 9.69 ± 1.53 mmol/L vs. 9.15 ± 1.58 mmol/L, P < 0.001), OGTT 2-hour value (9.30 ± 1.66 mmol/L vs. 8.01 ± 1.32 mmol/L vs. 7.79 ± 1.38 mmol/L, P < 0.001), incidence of impaired fasting glucose (IFG) (fasting plasma glucose ≥5.6 mmol/L) (31.3% vs. 14.6% vs. 8.8%, P < 0.001), and incidence of two or more abnormal OGTT values (68.8% vs. 39.7% vs. 23.9%, P < 0.001) among the three groups. Using multivariate analysis, the factors, such as age (1.07 [1.02–1.12], P = 0.006), prepregnancy BMI (1.07 [1.02, 1.12], P = 0.003), and area under the curve of OGTT in the first pregnancy (1.14 [1.02, 1.26], P = 0.02), have an effect on maternal GDM recurrence; the factors, such as age (1.28 [1.01–1.61], P = 0.04), pre-pregnancy BMI (1.26 [1.04, 1.53], P = 0.02), and area under the curve of OGTT in the first pregnancy (1.65 [1.04, 2.62], P = 0.03), have an effect on maternal DM developed further.Conclusions:The history of GDM was significantly associated with a higher maternal risk for GDM recurrence during follow-up after the first pregnancy. The associated risk factors for GDM recurrence or development of DM include age, high pre-pregnancy BMI, history of delivered macrosomia, the OGTT level in the first pregnancy, such as the high area under the curve of OGTT, IFG, and two or more abnormal OGTT values. To prevent GDM recurrence, women with a history of GDM should do the preconception counseling before preparing next pregnancy.

Glucose tolerance test with a single abnormal value in pregnancy and the risk of type-2 diabetes mellitus.

To evaluate the association between a single abnormal value on a 3-h 100g oral glucose tolerance test (OGTT) results and future type-2 diabetes mellitus (Type-2 DM). Retrospective cohort study of women between 18 and 45years of age who underwent a 3-h OGTT during pregnancy and delivered in a tertiary medical center between 2007 and 2014. The women were followed for a median period of 64months postpartum. According to OGTT values, women were divided into three groups: normoglycemic (normal OGTT), single abnormal OGTT value (SAV) and gestational diabetes mellitus (two or more abnormal OGTT values, GDM). General pre-pregnancy characteristics, cardiovascular risk factors and future diagnosis of Type-2 DM, as the primary outcome, were recorded. During the study period, 5295 women underwent an OGTT and were followed for a median period of 64months (interquartile range of 32). The cohort was divided as following: 3639 (68.73%) were normoglycemic, 854 (16.13%) had a SAV in theOGTT and 802 (15.15%) were diagnosed with GDM. Compared with normoglycemic controls, women with SAV and GDM tended to be older (32.20, 33.10 and 31.35years for SAV, GDM and controls, respectively, p < 0.001); with higher rates of pre-pregnancy obesity (18.62%, 20.77% and 13.22% for SAV, GDM and controls, respectively, p < 0.001), pre-pregnancy hyperlipidemia (13.35%, 15.30% and 10.52% for SAV, GDM and controls, respectively, p = 0.021) and pre-pregnancy chronic hypertension (5.50%, 4.43% and 3.18% for SAV, GDM and controls, respectively, p = 0.01). Post-pregnancy Type-2 DM was diagnosed at a higher rate among women with SAV or GDM (2.69% for SAV, 7.39% for GDM and 0.66% for normoglycemic controls, p < 0.001). Using a cox proportional hazard regression, SAV and GDM were significantly and independently associated with a higher rate of future overt type-2 diabetes (adjusted aOR 3.59 for SAV and 11.38 for GDM, p < 0.001). In a sub-analysis of the OGTT values, overall, abnormal fasting glucose had the highest correlation with developing future Type-2 DM (8.95% compared with 6.02% for OGTT_60, 6.03% for OGTT_120 and 7.35% for OGTT_180, p < 0.001). A predictive model, combining multiple risk factors, as pre-pregnancy obesity and hypertension with SAV complicating the index pregnancy showed a risk as high as 3.40% for developing future Type-2 DM. SAV is independently associated with a significant higher rate of future Type-2 DM, as early as 5years following the index pregnancy.

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.

We aimed to quantify the risk of future maternal type 2 diabetes mellitus (T2DM) in women with gestational diabetes mellitus (GDM) based on the type and number of abnormal 75-g oral glucose tolerance test (OGTT) values and the diagnostic criteria used for the diagnosis of GDM. We conducted a population-based retrospective cohort study of all nulliparous women with a live singleton birth who underwent testing for GDM using a 75-g OGTT in Ontario, Canada (2007-2017). We estimated the incidence rate (per 1,000 person-years), overall risk (expressed as adjusted hazard ratio [aHR]), and risk at 5 years after 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 [DC] vs. International Association of the Diabetes and Pregnancy Study Groups [IADPSG] criteria). A total of 55,361 women met the study criteria. The median duration of follow-up was 4.4 (interquartile range 2.8-6.3; maximum 10.3) years. Using women without GDM as reference (incidence rate 2.18 per 1,000 person-years), women with GDM were at an increased risk of future T2DM; this risk was greater when using the DC 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 1,000 person-years, respectively). The risk of future maternal T2DM increased with the number of abnormal OGTT values and was highest for women with three abnormal values (incidence rate 49.93 per 1,000 person-years; 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, whereas women with an abnormal 2-h value had the lowest risk (aHR 14.09 [95% CI 12.46-15.93] vs. 9.22 [95% CI 8.19-10.37], respectively). Similar findings to those described above were observed when the risk of T2DM at a fixed time point of 5 years after the index pregnancy was considered as the outcome of interest. 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.

98-OR: Gestational Glucose Intolerance without Gestational Diabetes Is a Risk Factor for Type 2 Diabetes

Background: Women with gestational diabetes (GDM) have an increased risk of adverse perinatal outcomes and future type 2 diabetes (T2D). Gestational glucose intolerance (GGI, abnormal initial GDM screen) without GDM has been linked to adverse perinatal outcomes but is not a recognized T2D risk factor. We tested whether GGI without GDM is associated with incident T2D. Methods: Using clinical data from women seen at our US medical center for prenatal and primary care (1998-2018), we assessed risk of T2D (defined using validated laboratory and outpatient diagnoses) according to GGI/GDM status during pregnancy. We defined GGI as 1-hr glucose loading test (GLT) ≥ 140 mg/dl at ≥ 24 weeks gestation. We subcategorized GGI by 3-hr oral glucose tolerance test (OGTT) result. We used Cox proportional-hazard models with time-varying exposures/covariates to assess T2D risk after delivery, adjusting for age, race/ethnicity, parity, insurance type, marital status, BMI, and blood pressure. Women were followed from 1st delivery until diagnosed with T2D or censored at time of last primary care visit. Results: Among 13988 women, 17109 pregnancies had normal glucose tolerance (NGT, GLT &amp;lt; 140mg/dL). Among 3619 GGI pregnancies (GLT ≥ 140 mg/dl), 2076 had a normal OGTT, 699 had 1 abnormal OGTT value, and 844 had GDM (≥ 2 abnormal OGTT values). Over a median of 8.3 years of follow-up, 2.2% (N=304 women) developed T2D. In our primary comparison, women with GGI without GDM (16% of pregnancies) had increased T2D risk compared to women with NGT (HR 2.1 [1.5-2.9], p&amp;lt;0.001). Among women with GGI, T2D risk increased with the number of abnormal OGTT values (normal OGTT: HR 1.8; 1 abnormal OGTT value: HR 2.8; GDM: HR 11.7; p≤0.01 for all compared to NGT). Conclusions: Pregnant women with GGI without GDM have a two-fold increased risk of future T2D compared to those with NGT. Clinical data universally available during pregnancy identifies a large, previously unrecognized group of women who may benefit from T2D screening and prevention. Disclosure D. J. Selen: None. T. Thaweethai: None. S. Hsu: None. K. James: None. A. Kaimal: None. J. B. Meigs: Consultant; Self; Quest Diagnostics. C. E. Powe: None. Funding National Institutes of Health (2T32DK007028-46, K23DK113218); Robert Wood Johnson Foundation; Massachusetts General Hospital

Perinatal Outcomes in Mexican Women with Untreated Mild Gestational Diabetes Mellitus Diagnosed by the International Association of Diabetes and Pregnancy Study Groups Criteria.

PurposeTo compare the risk of adverse perinatal outcomes (APO) between pregnant women with mild gestational diabetes mellitus (GDM) diagnosed by the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria, on no specific treatment, versus pregnant women without GDM.Patients and MethodsA retrospective cohort study of pregnant women referred to the Instituto Nacional de Perinatología, in Mexico City, for prenatal care and delivery. Eligibility criteria were singleton pregnancy, age >18 years, gestational age 20–28 weeks, and no history of pre-gestational diabetes. The study population was divided into two groups: Group 1, comprising women with mild GDM defined by one abnormal glucose value at the oral glucose tolerance test (OGTT) according to IADPSG criteria [fasting: 5.1–5.2 mmol/L (92–94 mg/dL) or 2h 8.5–8.56 mmol/L (153–154 mg/dL)], who did not receive specific treatment for GDM, and Group 2, comprising women without GDM, matched for maternal age and pre-gestational body mass index (BMI). Women with two or more abnormal OGTT values, pre-gestational diabetes, any chronic disease, or multiple pregnancies were excluded.ResultsAs many as 282 women were included in each group. There were no significant differences in basal characteristics between groups. APO analysis showed that newborn weight was significantly higher in Group 1 (3042.4±499g) vs Group 2 (2910±565g) p=0.003; conversely, the incidence of large for gestational age (LGA) and macrosomic neonates was similar in both groups (6 vs 5.7% and 2.1 vs 2.2%, respectively). There were no differences in rates of preeclampsia and gestational hypertension, cesarean and preterm delivery, or premature rupture of membranes. A sub-analysis by maternal pre-gestational BMI showed that LGA incidence was significantly higher among babies born to women with pre-gestational BMI ≥30 kg/m2 in both groups.ConclusionThe risk of APO was similar among Mexican women with mild untreated GDM diagnosed by IADPSG criteria, compared to pregnant women without GDM. Pre-gestational BMI was an independent risk factor for LGA.

Perinatal outcome in gestational diabetes according to different diagnostic criteria.

Objectives To evaluate whether gestational diabetes mellitus (GDM) diagnosed by different criteria impacts perinatal outcome. Methods This was a retrospective study of deliveries with a diagnosis of GDM (2014-2016). Perinatal outcomes were compared between patients with: (1) GDM diagnosed according to a single abnormal value on the 100-g oral glucose tolerance test (OGTT); (2) two or more abnormal OGTT values; and (3) a 50-g glucose challenge test (GCT) value ≥200 mg/dL. Results A total of 1163 women met the inclusion criteria, of whom 441 (37.9%) were diagnosed according to a single abnormal OGTT value, 627 (53.9%) had two or more abnormal OGTT values and 95 (8.17%) had a GCT value ≥200 mg/dL. Diet-only treatment was significantly higher in the single abnormal value group (70.3% vs. 65.1% vs. 50.5%) and rates of medical treatment were significantly higher in the GCT ≥ 200 mg/dL group (P < 0.05). Women in the GCT ≥ 200 mg/dL group had higher rates of neonatal intensive care unit (NICU) admission (10.5% vs. 2.7% vs. 2.8%, P < 0.001) and neonatal hypoglycemia (5.3% vs. 0.5% vs. 0.8%, P < 0.001). On multivariate logistic regression, GCT ≥ 200 mg/dL was no longer associated with higher rates of NICU admission and neonatal hypoglycemia (P > 0.05). Conclusion No difference was noted in the perinatal outcome amongst the different methods used for diagnosing GDM.

Glycemic and metabolic features in gestational diabetes: singleton versus twin pregnancies.

A number of data on gestational diabetes mellitus (GDM) in singleton pregnancy is available, however, little is known about the glycemic characteristics of twin pregnancy with GDM. The aim of this study was to compare the severity of dysglycemia between twin and singleton pregnancies with GDM (T-GDM and S-GDM). We retrospectively analyzed pregnancies with GDM defined by the Japan Diabetes Society criteria (T-GDM, n = 20; S-GDM, n = 451) in our hospital. During the study period, women with GDM underwent self-monitoring of blood glucose measurements as well as dietary management. Insulin treatment was initiated when dietary treatment did not achieve the glycemic goal. The glycemic and metabolic characteristics were compared between T-GDM and S-GDM, as follows: gestational week at the diagnosis of GDM, 75 g oral glucose tolerance test (OGTT) results, HbA1c, insulin secretion (i.e. insulinogenic index [IGI] and Insulin Secretion-Sensitivity Index-2 [ISSI-2]), and insulin requirement before delivery. The rate of one abnormal OGTT value in T-GDM was similar to that in S-GDM (60% vs. 71%). There were no significant differences in gestational week and levels of HbA1c at diagnosis, levels of IGI and ISSI-2 between T-GDM and S-GDM (median, 20 weeks vs. 17 weeks, 5.0% vs. 5.2%, 0.58 vs. 0.71, 1.7 vs. 1.8, respectively). The rate of insulin treatment and a median dosage of insulin needed before delivery was comparable between the two groups (T-GDM vs. S-GDM: 45% vs. 32% and 14 vs. 13 unit/day). Our data suggested that the severity of dysglycemia in T-GDM was similar to that in S-GDM during pregnancy.

Relationship between the IADPSG-criteria-defined abnormal glucose values and adverse pregnancy outcomes among women having gestational diabetes mellitus: A retrospective cohort study.

To explore the influence of the 75 g oral glucose tolerance test (OGTT) on pregnancy outcomes and to determine the risk factors for adverse outcomes among women with gestational diabetes mellitus (GDM).This retrospective cohort study was conducted among women who had GDM and were treated between January 1, 2015 and December 31, 2017. The diagnostic criteria for GDM were proposed by the International Diabetes and Pregnancy Research Organization (IADPSG) in 2010. Women with GDM were stratified according to the number of abnormal OGTT values or the presence/absence of adverse pregnancy outcomes. Maternal characteristics, OGTT values, pregnancy outcomes, and the relationship between the latter 2 were analyzed.In total, 3221 pregnant women with GDM were included. The incidence of adverse outcomes was affected by maternal age (28–37 years, in particular; odds ratio [OR], 1.403; 95% confidence interval [CI], 1.037–1.899; P = .028), days of pregnancy (OR, 0.904; 95% CI, 0.894–0.914; P < .001), gestational weight gain (OR, 1.018; 95% CI, 1.000–1.036;, P = .048), and age of menarche (OR, 0.925; 95% CI, 0.863–0.992; P = .029). Both fasting plasma glucose (FPG) and 2-h OGTT were positively correlated with adverse outcomes, of which FPG was more predictive (FPG: OR, 1.143; 95% CI, 1.007–1.297; P = .038; 2-h OGTT: OR, 1.074; 95% CI, 1.018–1.133; P = .009). Meanwhile, higher abnormal OGTT values were associated with significantly increased risks of antenatal insulin treatment, cesarean delivery, premature delivery, gestational hypertension, premature rupture of membranes, preeclampsia, macrosomia, neonatal asphyxia, and full term low weight infants.OGTT values and the number of abnormal glucose are associated with various adverse pregnancy outcomes. Stratified management is recommended for pregnant women with GDM, especially those with fasting hyperglycemia and/or 3 abnormal OGTT values.

Characteristics of abnormal oral glucose tolerance test in GDM diagnosis and clinical correlation

Objectives: To describe the characteristics of abnormal oral glucose tolerance test (OGTT) values at gestational diabetes mellitus (GDM) diagnosis and their associations with clinical characteristics, and to evaluate the effect on GDM diagnosis if any OGTT value was omitted.Materials and methods: A cross-sectional study was conducted in 415 women diagnosed with GDM. The OGTT results were recorded and analyzed.Results: Of the 415 included women, mean gestational age at GDM diagnosis was 19.2 weeks and 57.6% were diagnosed before 20 weeks. The highest proportions of abnormal values were found at the 1st and 2nd hour (85.3% and 96.6%, respectively). If the 3rd hour OGTT value was omitted, 16.7% of GDM cases would be missed. Number of abnormal OGTT values and abnormal FPG were significantly associated with obesity. Only pre-pregnancy overweight and obesity independently associated with insulin requirement (adjusted OR: 2.28, 95%CI: 1.02–5.06; p = .044; and adjusted OR: 6.29, 95%CI: 2.67–14.85; p < .001, respectively).Conclusions: Over half of the GDM women had three or four abnormal OGTT values. Omission of the 3rd hour OGTT value would result in 16.7% of patients not being diagnosed with GDM. Number of abnormal OGTT values and abnormal FPG were associated with obesity, and insulin requirement was associated with pre-pregnancy overweight and obesity.