Incidence Of GDM Research Articles

Low plasma vitamin B12 in pregnancy is associated with gestational ‘diabesity’ and later diabetes

This study was designed to test the hypothesis that low plasma vitamin B(12) concentrations combined with high folate concentrations in pregnancy are associated with a higher incidence of gestational diabetes (GDM) and later diabetes. Women (N = 785) attending the antenatal clinics of one hospital in Mysore, India, had their anthropometry, insulin resistance (homeostasis model assessment-2) and glucose tolerance assessed at 30 weeks' gestation (100 g oral glucose tolerance test; Carpenter-Coustan criteria) and at 5 years after delivery (75 g OGTT; WHO, 1999). Gestational vitamin B(12) and folate concentrations were measured in stored plasma samples. Low vitamin B(12) concentrations (<150 pmol/l, B(12) deficiency) were observed in 43% of women and low folate concentrations (<7 nmol/l) in 4%. B(12)-deficient women had higher body mass index (p < 0.001), sum of skinfold thickness (p < 0.001), insulin resistance (p = 0.02) and a higher incidence of GDM (8.7% vs 4.6%; OR 2.1, p = 0.02; p = 0.1 after adjusting for BMI) than non-deficient women. Among B(12)-deficient women, the incidence of GDM increased with folate concentration (5.4%, 10.5%, 10.9% from lowest to highest tertile, p = 0.04; p for interaction = 0.2). Vitamin B(12) deficiency during pregnancy was positively associated with skinfold thickness, insulin resistance (p < 0.05) and diabetes prevalence at 5 year follow-up (p = 0.009; p = 0.008 after adjusting for BMI). The association with diabetes became non-significant after excluding women with previous GDM (p = 0.06). Maternal vitamin B(12) deficiency is associated with increased adiposity and, in turn, with insulin resistance and GDM. Vitamin B(12) deficiency may be an important factor underlying the high risk of 'diabesity' in south Asian Indians.

Screening for gestational diabetes: usefulness of clinical risk factors

There is little consensus regarding selective or universal screening for gestational diabetes. The aim of this study is to determine the influence of risk factors on incidence of GDM in Iranian population by using 75 g OGTT. At the first prenatal visit, 924 pregnant women were assessed for age, BMI, obstetric history, family history of diabetes, and diagnosis of polycystic ovary syndrome before pregnancy. All eligible women underwent 2-h 75 g oral glucose tolerance test. Gestational diabetes was diagnosed according to American Diabetes Association criteria. During study period, 68 [7.4% (95% CI 5.9-9.2)] cases of GDM were found. Age, pre-pregnancy BMI, and family history of DM were the independent clinical predictors of GDM. In women with age <25, BMI < or = 24.9, and negative family history for diabetes, the risk of GDM was 0.008 (0.001-0.044). This risk increased to 0.250 (0.102-0.495) in women with age > or =30, BMI > or = 30 and positive family history for diabetes. With selective screening and without screening in low risk group, we will do 13.6% (126 of 924) less screening tests while missing potentially 1.5% (1 of 68) of GDM cases. Age, BMI, and family history of diabetes were independent risk factors in developing gestational diabetes. Concerning these factors, we do not miss substantial number of GDM cases with selective screening.

Obesidade e gravidez

�SUMMARY Prevalence of obesity is increasing steadily in fertile women. We aimed to investigate its relation with pregnancy outcome in a group of Portuguese pregnant women. A retrospective analysis of 37 obese pregnant women (O group) was undertaken in the Endocrinology/Obstetric Unit, from 1998 to 2004. Control group included 33 pregnant women (C group) with normal body mass index (BMI). Our O and C groups were age matched (O: 27.9±4.35; C: 28.6±5.36 years; ns), with average BMI of 38.38 (O group) and 22.5 (C group, p<0.0001). Weight gain during pregnancy was significantly more pronounced in the C group (11.82) as compared to the O group (7.89, p<0.01). Obstetric history revealed an incidence of 24.3% of spontaneous abortions in obese patients in contrast with 6% in the control group. In which concerns complications during pregnancy, women in the O group had higher incidence of GDM (16.2%) than in the C group (3%, p=0.066). Furthermore, 27% developed

Is Gestational Diabetes Mellitus an Important Contributor to Metabolic Disorders in Trinidad and Tobago?

Objective. To investigate the incidence of Gestational Diabetes Mellitus at the Mt. Hope Women's Hospital and to describe its epidemiological pattern. Design. A retrospective observational study (Jan 2005 to Dec 2007). Setting. A teaching hospital of The University of the West Indies. Population/Sample. Pregnant women who gave birth. Methods. A sample size of 720. The variables analyzed were: age, ethnicity, BMI of mother, family history of diabetes; history of GDM, obstetric history, birth weight and APGAR score of infant. Main Outcome Measures. (1) Incidence of cases of GDM. (2) Impact of the measured variable. Chi-squares, odds ratios and logistic regression were performed. Results. The incidence of GDM was 4.31% (95% C.I. 2.31%, 6.31%). The proportion of GDM patients for the years 2005, 2006, and 2007 were 1.67%, 4.58%, and 6.67%, respectively. Age, Obesity Ethnicity, Family history of diabetes and a history of GDM were determined risk factors. Associations between GDM and (1) Mode of Delivery and (2) APGAR score of the baby were found. Discussion & Conclusion. There was an apparent increase in the incidence of GDM. Additional studies should be conducted to measure the occurrence of GDM in Trinidad and Tobago. Efforts to promote public awareness and a healthy lifestyle should be made to reverse this trend.

Should severely obese women complete childbearing prior to undergoing bariatric surgery?

GOING BARIATRIC SURGERY? ELLEN LANDSBERGER, YVONNE ANKRAH, CJ SEGAL-ISAACSON, EDITH GUREWITSCH, LISA LEVINE, FRANCINE EINSTEIN, CYNTHIA CHAZOTTE, Albert Einstein College of Medicine, Obstetrics & Gynecology and Women’s Health, Bronx, New York, Albert Einstein College of Medicine, Department of Epidemiology & Population Health, Bronx, New York, Johns Hopkins University, Gynecology and Obstetrics, Baltimore, Maryland OBJECTIVE: Gastric bypass surgery (GBP) has become increasingly popular to treat severe obesity. 80% of patients having GBP are women. This study compares pregnancy outcomes of severely obese women who have undergone GBP with similar patients matched to their preoperative and postoperative body mass index (BMI). STUDY DESIGN: A retrospective comparison study utilizing 3 groups of 19 patients each: Group 1=patients who had GBP, Group 2=1 patients matched to preoperative BMI, Group 3=patients matched to postoperative BMI. Patients delivered from 2004-2006. Data were analyzed utilizing Chi-Square and analysis of variance. RESULTS: Even with significant weight loss, most GBP patients remained obese. Mean BMI=37.1 (SDG7.7), mean BMI of Group 2=47.6 (G7.3), mean BMI group 3=36.4 (G7.1) There were no significant differences in the pregnancy outcomes among the three groups. There was a trend toward preeclampsia in the GBP group (p=.051); but no difference in chronic hypertension. Although the pre-op BMI group 2 had the heaviest babies (3454G764gms), the mean birthweights were similar (GBP=3002G609gms, Grp 3=3093G590gms); the incidence of IUGR and macrosomia was not different. Although there was not a significant difference in gestational diabetes (GDM) alone, the incidence of GDM and pregestational diabetes was lower in the GBP group (3/19,15.8%) than in group 2 (8/19,42.1%) or group 3 (4/ 19,21.1%). There was 1 second trimester loss in the GBP and group 2. There were no differences in mode of delivery, preterm delivery, anemia, or perinatal complications among the groups. CONCLUSION: Many women who have had GBP remain obese despite significant weight loss. Although significant differences in pregnancy outcomes were not observed, the higher rate of preeclampsia in the GBP group deserves further study. Our data suggest that GBP may safely be performed in women prior to completion of childbearing.

Recurrence of fetal macrosomia (> 4500G) in gestational diabetes is less frequent than in non-diabetic pregnancies

LESS FREQUENT THAN IN NON-DIABETIC PREGNANCIES MICHAEL E. FOLEY, LESLIE DALY, MARY COFFEY, RICHARD FIRTH, BRENDAN KINSLEY, COLM O’HERLIHY, University College Dublin, Obstetrics and Gynaecology, Dublin, Ireland, University College Dublin, Public Health Medicine & Epidemiology, Dublin, Ireland, National Maternity Hospital, Dublin, Ireland, Ireland OBJECTIVE: To determine the incidence and rate of recurrence of fetal macrosomia (>4500 g) at term (>37 weeks) in singleton gestational diabetic (GDM) and non-diabetic pregnancies. STUDY DESIGN: GDM was diagnosed by selective screening (50 g glucose challenge), indicated by risk factors and performed at 29-32 weeks gestation; positive cases (>8.3 mmol/L) underwent a 100-g glucose tolerance test (considered positive if at least two abnormal values). GDM was audited prospectively (1998 to 2002) and the incidence of fetal macrosomia and the rate of its recurrence were compared with non-diabetic pregnancies. RESULTS: The institutional incidence of GDM was 1% (388/37,406); 3.3% of the antenatal population were screened. Among 388 GDM patients (multiparas 77%), the incidence of macrosomia at 7.9% (31/388) was significantly greater than among non-diabetic pregnancies (3.7%, 535/14,461; P ! .0001). Mean gestational age of GDM pregnancies at delivery (39.5 wk) was significantly less than among non-diabetics (40.6 wk; P ! .001). Of 535 non-diabetic women with a macrosomic infant, 34% (182/535) had undergone negative screening for GDM. The recurrence rate of macrosomia in GDM at 26%( 13/50), was half that in non-diabetics (59%, 166 /279; P ! .001). Among multiparas whose previous infant was not macrosomic, significantly more GDM mothers delivered macrosomic infants than non-diabetics (5.3% vs. 2.6%; P = .003). Best predicators of macrosomia in GDM pregnancies were previous macrosomic infant (29%), maternal age >40 years (17%), and weight >100 kg (16%). Among insulin-dependent diabetic mothers (>37 weeks), fetal macrosomia occurred in 13% (21/161) with a recurrence rate of 47% ( 8/17). CONCLUSION: Rate of recurrence of macrosomia in GDM is half that in nondiabetic pregnancies, suggesting that dietary intervention can influence birthweight outcome. Dietary modification might be considered in all women with a history of macrosomia. 159 SCREENING FOR GESTATIONAL DIABETES: DIFFERENT CUT-OFFS FOR DIFFERENT ETHNICITIES? TANIA ESAKOFF, YVONNE CHENG, AARON B. CAUGHEY, University of California, San Francisco, Department of Obstetrics, Gynecology and Reproductive Sciences, San Francisco, California OBJECTIVE: To examine whether screening guidelines for gestational diabetes should be modified based on ethnicity. STUDY DESIGN: This is a retrospective cohort study of 14,565 pregnancies screened for gestational diabetes between January 1988 and December 2001. Values of the 50-g glucose-loading test (GLT) were examined at 5-point increments from 130 mg/dL to 150 mg/dL. The sensitivity and false positive rates (FP) of various GLT cut-offs were compared among Caucasians, African Americans, Hispanics and Asians. Outcomes were compared using the c test. RESULTS: The overall prevalence of gestational diabetes in the study population was 6.3%. The prevalence of gestational diabetes when stratified by ethnicity was 4.1% in Caucasians, 4.3% in African Americans, 7.0% in Hispanics, and 9.7% in Asians. Sensitivities and false positive rates at GLT cutoffs ranging from 130 to 150 were stratified by ethnicity below (Table). CONCLUSION: To maximize the sensitivity and to minimize the false positive rate of the GLT, it may be reasonable to consider varying the cut-off based on ethnicity. For example, if the goal is to achieve maximum sensitivity but achieve approximately a 10% false-positive rate, we would recommend 135 mg/dL for African Americans, 140 mg/dL for Caucasians and Hispanics, and 145 mg/dL for Asians. Alternatively, if the goal is to achieve 95% sensitivity, the screening threshold would need to be 135 mg/dL for African Americans and 130 mg/dL for the other ethnicities.

Incidence of gestational diabetes and relationship to obesity in Chilean pregnant women

Gestational diabetes (GDM) is associated to a worse outcome of pregnancy. This justifies efforts for finding possible causes of GDM that would allow implementing preventive interventions. To study incidence of GDM and its relation with obesity and other traditional risk factors. A retrospective study was performed in 234 women who had delivered a singleton during the last 12 months, attended in an outpatient clinic in Santiago, Chile. Familiar and personal history, body mass index (BMI), obstetrical-related pathology and data about the labor and the newborn were analyzed. GDM was diagnosed in 11.2% of the women. BMI before pregnancy was 26.6 +/- 4.4 kg/m2 (mean +/- SD) and it was 25 or over in 37.8% of women. Women who developed GDM had significantly higher BMI in the pre-pregnancy stage and in the second and third trimester of pregnancy (p < 0.001). The average age was greater in the GDM group (31 +/- 0.2 yr versus 26 +/- 0.41 yr). Incidence of GDM was 14.4% among women 25 years old or older and increased to 21.4% when they had, in addition, a BMI of 25 or over. Age, BMI, and family history of diabetes were all independently correlated with the development of GDM. Elective caesarean sections were more common in GDM than in non-GDM women (p < or = 0.01) and complications were present in 3/23 of newborns of women with GDM and 2/199 among women without GDM (p < 0.01) GDM and obesity are highly prevalent in Chilean pregnant women. BMI, first degree relative with DM and age are independent risk factors for the development of GDM.

Epidemiology of gestational diabetes mellitus and its association with Type 2 diabetes.

Gestational diabetes (GDM) is defined as carbohydrate intolerance that begins or is first recognized during pregnancy. Although it is a well-known cause of pregnancy complications, its epidemiology has not been studied systematically. Our aim was to review the recent data on the epidemiology of GDM, and to describe the close relationship of GDM to prediabetic states, in addition to the risk of future deterioration in insulin resistance and development of overt Type 2 diabetes. We found that differences in screening programmes and diagnostic criteria make it difficult to compare frequencies of GDM among various populations. Nevertheless, ethnicity has been proven to be an independent risk factor for GDM, which varies in prevalence in direct proportion to the prevalence of Type 2 diabetes in a given population or ethnic group. There are several identifiable predisposing factors for GDM, and in the absence of risk factors, the incidence of GDM is low. Therefore, some authors suggest that selective screening may be cost-effective. Importantly, women with an early diagnosis of GDM, in the first half of pregnancy, represent a high-risk subgroup, with an increased incidence of obstetric complications, recurrent GDM in subsequent pregnancies, and future development of Type 2 diabetes. Other factors that place women with GDM at increased risk of Type 2 diabetes are obesity and need for insulin for glycaemic control. Furthermore, hypertensive disorders in pregnancy and afterwards may be more prevalent in women with GDM. We conclude that the epidemiological data suggest an association between several high-risk prediabetic states, GDM, and Type 2 diabetes. Insulin resistance is suggested as a pathogenic linkage. It is possible that improving insulin sensitivity with diet, exercise and drugs such as metformin may reduce the risk of diabetes in individuals at high risk, such as women with polycystic ovary syndrome, impaired glucose tolerance, and a history of GDM. Large controlled studies are needed to clarify this issue and to develop appropriate diabetic prevention strategies that address the potentially modifiable risk factors.

Gestational diabetes: current aspects on pathogenesis and treatment.

Gestational diabetes (GDM) is a carbohydrate intolerance resulting in hyperglycaemia of variable severity with onset or first recognition during pregnancy. The incidence of GDM is between 0.15-15%, which corresponds to the prevalence of type 2 diabetes and IGT in a given country.--The predominant pathogenic factor in GDM could be the inadequate insulin secretion. If GDM is not properly treated the risk of adverse maternal (preeclampsia) and fetal (large-for-gestational-age infant, macrosomia, birth trauma, cesarean section, still-birth) outcome increases. Hypertension is more prevalent in GDM, and GDM is diagnosed more frequently in women with chronic hypertension.--In order to screen for disturbances of carbohydrate metabolism during pregnancy a simple method suitable for all pregnant women would be desirable, however no such method is available at present. According to the latest WHO recommendation the screening for GDM should be performed universally with the standard 75 g oGTT evaluating only the 2-hour blood glucose values or together with the fasting ones. The latter could provide even an exact diagnosis of the carbohydrate metabolic state.--To manage GDM the first step prompt after diagnosis is to educate adequate dietary needs. If the blood sugar values in spite of an adequate diet exceed the desirable target values, insulin treatment has to be initiated.--GDM is a predictor of diabetes (mainly type 2) later in life. The cumulative incidence of type 2 diabetes is about 50% at 5 years. This review of the current literature including our own experience strongly supposes that prior GDM is also a predictor or even an early manifestation of the metabolic (insulin resistance) syndrome. By all means GDM is a cardiovascular risk factor that could be screened to prevent late complications. The previously presented evidence also strongly suggests that yearly check-ups for women with previous GDM are inevitably important.

Is There a Seasonal Variation in the Incidence of Gestational Diabetes?

It has been suggested that the incidence of gestational diabetes (GDM) may vary with different seasons of the year. The fasting and 2 h glucose levels after a 75 g glucose tolerance test were therefore examined in 2749 women being tested for GDM and were correlated with the mean temperature at 0900 h by month and by season. The mean monthly temperature ranged from 22.3 degrees C in January to 13.6 degrees C in July. The monthly incidence of GDM ranged from 3.5% (95% CI, 0.7-6.3) in September to 8.7% (4.7-12.7) in November. The seasonal incidence of GDM ranged from 7.4% (5.6-9.2) in autumn to 5.5% (3.5-7.5) in winter. Chi-squared analysis did not suggest a significant association between the proportion of women diagnosed with GDM and either the month (p = 0.47) or the season (p = 0.39). Multiple regression analysis, after correction for maternal age, parity, BMI, and the week of testing revealed a non-significant association between fasting glucose and monthly temperature (p = 0.36) and an increase in the 2 h glucose of 0.026 mmol l-1 for each increase of 1 degree C in temperature (p = 0.011). In a temperate coastal area of Australia these differences do not appear clinically significant and have not caused a variation in the incidence of GDM with different seasons.