Gestational Glucose Intolerance Research Articles

Risk of Neonatal Hypoglycemia in Infants of Mothers With Gestational Glucose Intolerance.

To examine the relationship between gestational glucose intolerance (GGI) and neonatal hypoglycemia. This was a secondary analysis of 8,262 mother-infant dyads, with delivery at two hospitals between 2014 and 2023. We categorized maternal glycemic status as normal glucose tolerance (NGT), GGI, or gestational diabetes mellitus (GDM). We defined NGT according to a normal glucose load test result, GGI according to an abnormal glucose load test result with zero (GGI-0) or one (GGI-1) abnormal value on the 100-g oral glucose tolerance test, and GDM according to an abnormal glucose load test result with two or more abnormal values on the glucose tolerance test. Neonatal hypoglycemia was defined according to blood glucose <45 mg/dL or ICD-9 or ICD-10 diagnosis of neonatal hypoglycemia. We used logistic regression analysis to determine associations between maternal glucose tolerance category and neonatal hypoglycemia and conducted a sensitivity analysis using Δ-adjusted multiple imputation, assuming for unscreened infants a rate of neonatal hypoglycemia as high as 33%. Of infants, 12% had neonatal hypoglycemia. In adjusted models, infants born to mothers with GGI-0 had 1.28 (95% 1.12, 1.65), GGI-1 1.58 (95% CI 1.11, 2.25), and GDM 4.90 (95% CI 3.81, 6.29) times higher odds of neonatal hypoglycemia in comparison with infants born to mothers with NGT. Associations in sensitivity analyses were consistent with the primary analysis. GGI is associated with increased risk of neonatal hypoglycemia. Future research should include examination of these associations in a cohort with more complete neonatal blood glucose ascertainment and determination of the clinical significance of these findings on long-term child health.

Gestational glucose intolerance among pregnant women at the Cape Coast Teaching Hospital

BackgroundMalaria in pregnancy can have adverse outcomes if untreated. Both malaria and pregnancy are associated with insulin resistance and diabetes. Although malaria is treated prophylactically with gestational diabetes mellitus (GDM) screened for in pregnancy as part a routine antenatal care, their impacts have not been examined in terms of other forms of dysglycaemia. This cross-sectional study examined insulin resistance and its relationship with dysglycaemia and malaria among pregnant women in the Cape Coast Teaching Hospital (CCTH).MethodsUsing a structured questionnaire, demographic and clinical information were obtained from 252 pregnant women aged 18–42 years. Weight and height were measured for computation of body mass index (BMI). Measurement of insulin, lipid profile and glucose were taken under fasting conditions followed by oral glucose tolerant test. Insulin resistance and beta-cell function were assessed by the homeostatic model as malaria was diagnosed by microscopy.ResultsThe respective prevalence of GDM, gestational glucose intolerance (GGI) and insulin resistance were 0.8% (2/252), 19.44% (49/252) and 56.75% (143/252). No malaria parasite or dyslipidaemia was detected in any of the participants. Apart from BMI that increased across trimesters, no other measured parameter differed among the participants. Junior High School (JHS) education compared with no formal education increased the odds (AOR: 2.53; CI: 1.12–5.71; P = 0.03) but 2nd trimester of pregnancy compared to the 1st decreased the odds (AOR: 0.32; CI: 0.12–0.81; P = 0.02) of having insulin resistance in the entire sample. In a sub-group analysis across trimesters, pregnant women with JHS education in their 3rd trimester had increased odds (AOR: 4.41; CI: 1.25–15.62; P = 0.02) of having insulin resistance.ConclusionPrevalence of GDM and GGI were 0.8% and 19.44% respectively. The odds of insulin resistance increased in pregnant women with JHS education in the 3rd trimester. Appropriate measures are needed to assuage the diabetogenic risk posed by GGI in our setting.

Gestational glucose intolerance and pregnancy outcomes: a retrospective study in the primary care setting of Macau.

Although glucose intolerance is prevalent in Macau, it is rarely assessed during pregnancy. This study examined short-term maternal and neonatal outcomes at different maternal glucose levels in Macau. A total of 2388 pregnant women who received antenatal care at Health Centers and delivered at the Centro Hospitalar Conde de São Januário between June 2018 and December 2019 were included in this study. Gestational diabetes mellitus (GDM) was diagnosed using Carpenter and Coustan criteria, involving a 50 g glucose challenge test (GCT) followed by a 100g oral glucose tolerance test (OGTT). Participants were categorized into 4 groups: normal glucose tolerance if GCT was negative; mild gestational hyperglycemia in this study if positive GCT without GDM; GDM patients with normal fasting blood glucose (FBG) or high FBG in OGTT. Logistic regression analysis was employed to compare pregnancy outcomes among these 4 groups. Due to the limited number of cases, we combined several adverse maternal outcomes, including pregnancy-induced hypertension, assisted delivery, primary Caesarean section, moderate to severe perineal trauma, and postpartum hemorrhage, into a composite measure. The results showed higher rates of the aforementioned outcomes for mild gestational hyperglycemia and GDM with high FBG in OGTT groups [adjusted odds ratio (aOR) 1.32, 95% confidence interval (CI) 1.06-1.64; aOR 2.04, 95% CI 1.24-3.37], as well as macrosomia risk (aOR 2.02, 95% CI 1.11-3.66; aOR 5.04, 95% CI 2.03-12.52) and large-for-gestational age infants (aOR 1.48, 95% CI 1.02-2.16; aOR 4.34, 95% CI 2.31-8.15). Pregnancy outcomes were similar for normal glucose tolerance and GDM with normal FBG in OGTT. Mild gestational hyperglycemia raised the likelihood of adverse maternal outcomes and excessive infant birth weights. Even after achieving target glucose levels, GDM patients with elevated fasting glucose readings in OGTT remained at significant risk for these events. Instead, fasting normoglycemic GDM was treated effectively at Macau Health Centers.

Risk factors associated with early postpartum glucose intolerance in women with a history of gestational diabetes mellitus: a systematic review and meta-analysis.

This meta-analysis was aimed at exploring the incidence and risk factors of glucose intolerance in women with gestational diabetes mellitus (GDM) at 6-12 weeks postpartum to inform the development of preventive strategies. We searched Pubmed, Embase, Web of Science, the Cochrane Library, Ovid, China Knowledge Resource Integrated Database (CNKI), Wanfang Database and China Biology Medicine Database for entries between January 1990 and September 2022. The search terms included gestational diabetes mellitus, postpartum, glucose intolerance and type 2 diabetes. The meta-analysis was conducted using Stata 14.0. We included 37 studies, with 21 and 16 having low and medium risk of bias, respectively. The incidence of glucose intolerance in women with GDM 6-12 weeks postpartum was 27% (95% CI: 0.22-0.33). The following risk factors for GDM 6-12 weeks postpartum were identified: insulin use during pregnancy (OR = 3.23; 95% CI: 2.35-4.44), family history of diabetes (OR = 2.94; 95% CI: 1.98-4.33), abnormal fasting glucose levels at 24-28 weeks of gestation (OR = 1.15; 95% CI: 1.07-1.25), high pre-pregnancy BMI (OR = 1.63; 95% CI: 1.23-2.15), abnormal triglyceride levels during 28-40 weeks of gestation (OR = 2.18; 95% CI: 1.18-4.03), abnormal HbA1c levels at 28-40 weeks of gestation (OR = 6.62; 95% CI: 4.71-9.30), history of previous GDM (OR = 2.11; 95% CI: 1.27-3.49), and high 1-h glucose levels at 24-28 weeks of gestation (OR = 1.16; 95% CI:1.06-1.28). The incidence of glucose intolerance in GDM patients at 6-12 weeks postpartum was high. To prevent early postpartum glucose intolerance, healthcare providers should develop individualized interventions for GDM patients, depending on existing risk factors.

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.

1189-P: The Project Wellness Pilot Feasibility Randomized Controlled Trial, a Behavioral Physical Activity Intervention for Gestational Glucose Intolerance and Gestational Diabetes

Introduction: Animal evidence suggests that maternal exercise improves metabolic health in the offspring. The offspring of individuals with gestational glucose intolerance (GGI) or gestational diabetes mellitus (GDM) are at increased risk for large for gestational age, shoulder dystocia, obesity, and diabetes. Maternal physical activity (PA) is indicated for these pregnancies, though PA levels tend to be suboptimal and decline over pregnancy. This pilot feasibility randomized controlled trial explored the effects of a behavioral counseling intervention on late pregnancy maternal PA and neonatal anthropometrics. Methods: Twenty individuals with GGI or GDM were enrolled. Those randomized to the behavioral PA intervention met weekly with a lifestyle coach via Zoom for at least 5 sessions (10-20 minutes per session). Participants completed surveys and wore ActiGraph CentrePoint PA monitoring devices on their dominant wrist for a 7-day period, at both baseline and follow-up. The TwoRegressions algorithm estimated minute by minute metabolic equivalents of task (METs) for periods in which the devices were worn, and minutes per day at ≥ 3.0 METs, indicative of moderate to vigorous intensity PA (MVPA), were totaled. Neonatal measurements (n = 17) occurred within 3 days of birth. Results: Those in the PA intervention decreased MVPA less than controls [i.e., -4.0 minutes per day (95% CI -14.5, 6.5) vs. -23.5 minutes per day (95% CI -34.9, -12.1), P = .02]. Neonates born to those in the PA intervention were smaller than control neonates, however no difference attained statistical significance (e.g., weight, neonatal fat mass, total skinfolds). There was the suggestion of significant effect on subscapular skinfold (P = .07). Conclusion: A behavioral PA counseling intervention mitigated late pregnancy declines in PA in GGI or GDM, and could reduce upper-trunk adiposity in their neonates. Disclosure S.F.Ehrlich: None. B.G.Rand: None. N.Zite: Other Relationship; Merck &amp; Co., Inc. K.B.Fortner: Other Relationship; Pfizer Inc. A.M.Paudel: None. S.E.Crouter: None. J.M.Maples: None. Funding National Institutes of Health (K01DK105106)

1089-P: Gestational Glucose Intolerance and Risk of Childhood Overweight and Obesity

Infants of individuals with gestational glucose intolerance (GGI, abnormal glucose loading test [GLT] without gestational diabetes [GDM]) have increased risk of large for gestational age birthweight, but an association between GGI and childhood adiposity has not been consistently observed. We studied the risk of overweight and obesity in 2-5-year-old children exposed to varying degrees of maternal glycemia in utero in a retrospective hospital-based cohort. We defined normal glucose tolerance (NGT) as a GLT &amp;lt;140 mg/dl, GGI as GLT ≥ 140 mg/dl and zero (GGI-0) or 1 (GGI-1) abnormal values on a 3-hour 100-gram oral glucose tolerance test (OGTT), and gestational diabetes (GDM) as ≥2 abnormal values. We used logistic regression to investigate the risk of obesity, defined as body mass index (BMI) &amp;gt; 95th percentile, in children born to individuals with GGI and GDM as compared to NGT. In model 1, we adjusted for maternal age, gestational weight gain, parity, insurance, race/ethnicity, marital status, gestational age at delivery and infant sex; in model 2, we further adjusted for maternal 1st trimester BMI. Of n=12728 children, 48.5% were female, the mean (SD) gestational age at delivery was 39.4 (1.7) weeks, and the mean birthweight was 3341 (519) grams. A total of 10567 children were exposed to NGT in utero, 1156 to GGI-0, 428 to GGI-1, and 577 to GDM. Obesity was present in 12.9% of children exposed to NGT, 12.5% exposed to GGI-0, 16.6% exposed to GGI-1, and 18.5% exposed to GDM, respectively. In model 1, there was an increased odds of obesity in those exposed to GGI-1 (1.37 [1.04, 1.78], P=0.02) and GDM (1.61 [1.28, 2.02] P&amp;lt;0.001). After maternal BMI adjustment, we did not find a significant increased risk of obesity in any group compared to NGT (GGI-1: 1.15 [0.86, 1.51] P=0.33; GDM 1.24 (0.97, 1.57), P=0.08). After accounting for maternal BMI, children exposed to GGI and GDM in utero have a similar risk of obesity in early childhood to those born to NGT pregnancies. Disclosure J.Maya: None. S.Hsu: None. C.C.M.Schulte: None. K.James: None. T.Thaweethai: None. M.Hivert: None. C.E.Powe: Consultant; Mediflix, Inc., Other Relationship; Wolters Kluwer Health. Funding National Institutes of Health (T32DK007028-47S1)

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.

Pregnancy post-bariatric surgery: Improved outcomes with telephonic nutritional management program

BackgroundPregnancies post-bariatric surgery are increasingly common. It is important to understand how to manage prenatal care in this high-risk population to optimize perinatal outcomes. ObjectiveTo determine among pregnancies post-bariatric surgery whether participation in a telephonic nutritional management program was associated with improved perinatal outcomes and nutritional adequacy. Study designRetrospective cohort study of pregnancies post-bariatric surgery from 2012 to 2018. Participation in a telephonic management program with nutritional counseling, monitoring and nutritional supplement adjustment. Modified Poisson Regression estimated the relative risk using propensity score methods to account for baseline differences between the patients who participated in the program and patients who did not. Results1575 pregnancies occurred post-bariatric surgery, of which 1142 (72.5 % of pregnancies) participated in the telephonic nutritional management program. Participants in the program were less likely than non-participants to have a preterm birth (aRR 0.48, 95 % CI 0.35–0.67), preeclampsia (aRR 0.43, 95 % CI (0.27–0.69)), gestational hypertension (aRR 0.62, 95 % CI 0.41–0.93), and to have neonates admitted to a Level 2 or 3 (aRR 0.61, 95 % CI0.39–0.94; aRR 0.66, 95 % CI 0.45–0.97, respectively), after adjusting for the propensity score to account for baseline differences. Risk of cesarean delivery, gestational weight gain, glucose intolerance and birthweight did not differ by participation. Among 593 pregnancies with nutritional labs available, participants in the telephonic program were less likely to have nutritional inadequacy in late pregnancy (aRR 0.91, 95 % CI 0.88–0.94). ConclusionParticipation in a telephonic nutritional management program post-bariatric surgery was associated with improved perinatal outcomes and nutritional adequacy.

Abstract P244: Gestational Glucose Intolerance is Associated With Hypertensive Disorders of Pregnancy in a Large Hospital-Based Multiethnic Cohort

Introduction: Hypertensive disorders of pregnancy (HDP) are associated with higher future cardiovascular risk. Treatment of gestational diabetes (GDM) has been shown to reduce the risk of HDP. It is unknown if women with gestational glucose intolerance (GGI), defined as abnormal GDM screening but without a GDM diagnosis, are at higher risk of HDP. Currently, GGI is not treated. Hypothesis: We tested the hypothesis that GGI pregnancies have increased odds of HDP. Methods: This is a retrospective cohort study of 41,706 singleton pregnancies delivered at an academic center. Based on the results of GDM screening and diagnostic tests, pregnancies were categorized as normal glucose tolerance (NGT, glucose loading test &lt; 140 mg/dl), GGI (glucose loading test ≥140 mg/dl with 0 or 1 abnormal value on oral glucose tolerance testing [OGTT] thus without GDM), or GDM (≥ 2 abnormal values on OGTT). GGI was further classified into groups with zero (GGI-0) or 1 (GGI-1) abnormal OGTT values. We used laboratory, blood pressure, and delivery reports to capture HDP and exclude chronic hypertension. Generalized estimating equations for logistic regression were used to measure the risk of HDP after adjustment for age, 1st trimester BMI, parity, insurance, race/ethnicity, and marital status. A similar approach was used to test for associations between GGI and pre-eclampsia (PE). Results: A total of 84.5% of pregnancies were classified as NGT, 8.9% as GGI-0, 3.0% as GGI-1 and 3.6% as GDM. The unadjusted frequencies of HDP and PE were higher in GGI-1 (140 [11.2%] and 64 [5.1%] of 1,251) and GDM (165 [11.1%] and 94 [6.3%] of 1,485) compared to NGT (2,275 [6.5%] and 1,100 [3.1%] of 35,238) and GGI-0 (283 [7.6%] and 136 [3.6%] of 3,732). We observed greater odds of HDP in all 3 groups compared to NGT in adjusted models, and similar trends for PE (Figure 1). Conclusions: The risks of HDP and PE in GGI-1 are greater than for NGT pregnancies and similar to the risks in GDM. Our results suggest that women with GGI-1 should be considered for intervention, similar to GDM.

The Belgian Diabetes in Pregnancy Follow-Up Study (BEDIP-FUS): A Multi-Centric Prospective Cohort Study on the Long-Term Metabolic Risk across Different Degrees of Gestational Glucose Intolerance: Methodology and Design.

The Belgian Diabetes in Pregnancy follow-up study (BEDIP-FUS) aims to investigate the impact of body mass index (BMI), adiposity and different degrees of glucose intolerance on the metabolic profile and future risk for type 2 diabetes (T2D) in women and offspring five years after delivery in the BEDIP study. The BEDIP study was a prospective cohort study to evaluate different screening strategies for gestational diabetes (GDM) based on the 2013 WHO criteria. The aim of the BEDIP-FUS is to recruit 375 women-offspring pairs, stratified according to three different subgroups based on the antenatal result of the glucose challenge test (GCT) and oral glucose tolerance test (OGTT) during the BEDIP pregnancy. The follow-up visit consists of a 75 g OGTT, anthropometric measurements and questionnaires for the mothers, and a fasting blood sample with anthropometric measurements for the child. Primary outcome for the mother is glucose intolerance defined by the American Diabetes Association criteria and for the offspring the BMI z-score. Recruitment began in January 2021. The BEDIP-FUS study will help to better individualize follow-up in women with different degrees of hyperglycemia in pregnancy and their offspring.

Gestational glucose intolerance (GGI) and gestational diabetes mellitus (GDM) among antenatal women attending urban community health centers of Lucknow: A cross-sectional study.

Gestational diabetes mellitus (GDM) is an emerging public health concern in India, which has detrimental effects on both the mother and the baby. The data on prevalence of GDM was unavailable at secondary urban health facilities, from where a majority of pregnant women seek antenatal services, and the following study identifies this burden. A cross-sectional study was conducted from May 2019 to June 2020 among pregnant women attending the antenatal outpatient department (OPD) at secondary level health facilities in urban Lucknow. A semi-structured interview schedule was administered to the study subjects for collecting the relevant information and 75 g of oral glucose tolerance test was performed irrespective of the meal. The cut-off points taken for the diagnosis of GDM and gestational glucose intolerance (GGI) was as per the guidelines of the Ministry of Health and Family Welfare for diagnosis of GGI/GDM. The overall prevalence of GDM and GGI in the study was 11.6% and 16.8%, respectively. Three-fourth of the women (22/29) were diagnosed with GDM in the second trimester of pregnancy. The prevalence of GDM (16.7%) was significantly higher in pregnant women aged more than 25 years and in those who were overweight. Mean birth weight (3.2 ± 8.1 kg) of the babies was significantly higher in the women with GDM. Among the fetal complications was respiratory distress observed among 28 pregnant women and 31% of them had GDM and this was statistically significant. The prevalence of GGI and GDM was found 16.8% and 11.6%, respectively. Gestational age, pre-pregnancy weight, pre-pregnancy BMI, weight gain during the pregnancy, family history of diabetes. PCOS, macrosomia and GDM in prior pregnancies was found to significant with GDM in the study.

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.

Can Medical Nutrition Therapy Affect Feto-Maternal Outcomes in Gestational Glucose Intolerance: An Open-Label Pilot Randomized Control Trial in World's Diabetes Capital.

Gestational diabetes is defined as the carbohydrate intolerance of variable severity with onset or first recognition during pregnancy. Gestational glucose intolerance (GGI) is used to indicate pregnant women whose 2-h postprandial glucose is > 120mg/dl and below 140mg/dl (Diabetes in Pregnancy Study Group of India, DIPSI criteria). This study was planned to see whether intervention in GGI group helps to improve feto-maternal outcomes. This open-label randomized control trial was conducted in Department of Obstetrics and Gynaecology of King George's Medical University, Lucknow. Inclusion criteria were all the antenatal women attending the antenatal clinic and diagnosed as GGI, and exclusion criteria were overt diabetes. Total of 1866 antenatal women were screened, and among them, 220 (11.8%) women were diagnosed as gestational diabetes; 412 (22.1%) women were diagnosed as GGI. The mean fasting blood sugars in the women with GGI who had medical nutrition therapy were much lower than the women with GGI who did not have any intervention. The present study showed the women with GGI had higher complications like polyhydramnios, PPROM, foetal growth restriction, macrosomia, preeclampsia, preterm labour and vaginal candidiasis more in the women with GGI as compared to euglycaemic women. The present study of nutritional intervention in GGI group has shown trend towards lesser complication if we start medical nutrition therapy reflected by delayed development of GDM and less neonatal hypoglycaemia and hyperbilirubinemia.

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.

109-OR: Physiologic Subtypes of Gestational Glucose Intolerance and Risk of Future Prediabetes

Background: Gestational glucose intolerance (GGI, abnormal initial gestational diabetes [GDM] screen) conveys an increased risk of future diabetes (DM) , even when GDM criteria is not met. We previously defined subtypes of GGI/GDM according to the underlying mechanism leading to hyperglycemia (insulin resistance vs. deficiency) . We aimed to determine if GGI subtypes are at differential risk for future prediabetes/DM; we hypothesized increased risk with insulin deficient subtypes. Methods: We defined GGI as glucose loading test 1-hr glucose ≥ 140 mg/dL at &amp;gt; 22 weeks’ gestation. We applied homeostasis model assessment (HOMA) to fasting glucose and insulin at 16-20 weeks’ gestation and classified pregnancies with GGI without GDM into subtypes according to the presence of insulin resistance and/or deficiency. We used Cox proportional-hazards models with time-varying exposures to assess risk of preDM/DM (HbA1c ≥ 5.7% at ≥ 3 months after delivery) in each GGI subtype compared to pregnancies with normal glucose tolerance after adjustment for age, race/ethnicity, health insurance, and first trimester BMI. Women were censored at the time of last HbA1c or GDM diagnosis. Results: Of 671 women with a median 9.9 years of follow-up, 29% (n=196) developed preDM/DM. Among pregnancies in 113 women with GGI, 54% had the insulin resistant subtype (IR) , 25% had the insulin deficient subtype (ID) , and 16% had the mixed pathophysiology subtype (MP) . Subtypes with insulin deficiency (ID + MP) and insulin resistance (IR) were both associated with increased risk of preDM/DM (ID + MP hazard ratio [HR]=1.8 [1.1-2.9], p=0.02 and IR HR=1.7 [1.1-2.6], p=0.01) . Each insulin deficient subtype also appeared to carry increased risk: ID HR=1.7 (0.9-3.1, p=0.12) and MP HR=2.1 (1.0-4.2, p=0.048) . Conclusions: GGI confers an increased risk of future prediabetes/DM, regardless of the mechanism leading to glucose intolerance. A combination of insulin resistance and deficiency may convey the highest risk of future prediabetes/DM. Disclosure D.J. Selen: None. T. Thaweethai: None. K. James: None. J.L. Ecker: None. J.B. Meigs: Consultant; Quest Diagnostics. C.E. Powe: None. Funding National Institutes of Health (T32DK007028) , Massachusetts General Hospital (Physician Scientist Development Award and Claflin Distinguished Scholar’s Award)

Silent upsurge of gestational diabetes: Are we aware? A rural tertiary care experience of Central Gujarat.

Background:The prevalence of Gestational Diabetes Mellitus has been on the rise. With the dramatic increase in the prevalence of overweight, obesity, and inactivity amongst the population, it’s becoming a common problem affecting antenatal women and their offspring.Subjects and Methods:A prospective cross-sectional study was carried out involving antenatal women between 24-28 weeks of gestation at a tertiary care centre in a rural part of Gujarat. Patients were screened using the Diabetes in Pregnancy Study Group India (DIPSI) guidelines. Analysis was carried out using Chi-square and ANOVA test.Results:Patients having PG2BS ≥140 mg/dl were diagnosed as having Gestational Diabetes Mellitus (GDM), while those having PG2BS values between 120–139 mg/dl were diagnosed as having Gestational Glucose Intolerance (GGI). Out of the 300 patients screened, we found an overall prevalence of 52 (17.33%) having GDM and 65 (21.67%) having GGI. Most patients belonged to the age bracket of 21-30 years across all groups. The prevalence of GDM in rural antenatal women was 23 (44.2%) and in semi-urban antenatal women was 25 (48.1%) while GGI in the rural antenatal women was 45 (69.2%) followed by semi-urban antenatal women 19 (29.2). We found that Occupation, Residence, Lifestyle, Socio-Economic Class, Family history of Diabetes Mellitus, Body Mass Index (BMI) were all statistically significant whereas Antenatal Complications and Perinatal outcomes weren’t.Conclusion:With such a high prevalence of GGI, almost equivalent to GDM, it is important to identify patients having GGI and monitor them to prevent progression to GDM by starting an appropriate treatment modality.

Acetone Ingestion Mimics a Fasting State to Improve Glucose Tolerance in a Mouse Model of Gestational Hyperglycemia.

Gestational diabetes mellitus results, in part, from a sub-optimal β-cell mass (BCM) during pregnancy. Artemisinins were reported to increase BCM in models of diabetes by α- to β-cell conversion leading to enhanced glucose tolerance. We used a mouse model of gestational glucose intolerance to compare the effects of an artemisinin (artesunate) on glycemia of pregnant mice with vehicle treatment (acetone) or no treatment. Animals were treated daily from gestational days (GD) 0.5 to 6.5. An intraperitoneal glucose tolerance test was performed prior to euthanasia at GD18.5 or post-partum. Glucose tolerance was significantly improved in both pregnant and non-pregnant mice with both artesunate and vehicle-alone treatment, suggesting the outcome was primarily due to the acetone vehicle. In non-pregnant, acetone-treated animals, improved glucose tolerance was associated with a higher BCM and a significant increase in bihormonal insulin and glucagon-containing pancreatic islet cells, suggesting α- to β-cell conversion. BCM did not differ with treatment during pregnancy or post-partum. However, placental weight was higher in acetone-treated animals and was associated with an upregulation of apelinergic genes. Acetone-treated animals had reduced weight gain during treatment despite comparable food consumption to non-treated mice, suggesting transient effects on nutrient uptake. The mean duodenal and ileum villus height was reduced following exposure to acetone. We conclude that acetone treatment may mimic transient fasting, resulting in a subsequent improvement in glucose tolerance during pregnancy.