Incidence Of Gestational Diabetes Mellitus In Women Research Articles

Screening of gestational diabetes mellitus using fasting plasma glucose before the 24th gestational week in women with different pre-pregnancy body mass index

Background: Gestational Diabetes Mellitus (GDM) is usually diagnosed between 24th and 28th gestational week using the 75-g Oral Glucose Tolerance Test (OGTT). It is controversial that if FPG ≥92 mg/dL before 24th gestational week should be intervened or not. The aim of this study was to evaluate the value of FPG to screen GDM before 24th gestational week in women with different pre-pregnancy Body Mass Index (BMI).Methods: This was a hospital based retrospective cohort study done at CHC Balipatna, Khurdha, Odisha. Women who had a singleton live birth between June 20, 2016 and June 30, 2019, resided in Balipatna block area and received prenatal care in the Community Health Centre, were included in this study. Pre-pregnancy BMI, FPG before the 24th gestational week, and one-step GDM screening with 75 g-OGTT at the 24th to 28th gestational weeks were extracted from medical records and analyzed. The pregnant women were classified into four groups based on pre-pregnancy BMI: Group A (underweight), Group B (normal), Group C (overweight) and Group D (obesity). Statistical analysis using independent sample t-test, Analysis of Variance (ANOVA) and Pearson Chi-square test was done.Results: The prevalence of GDM was 20.0% (68/341) in the study population. FPG decreased gradually as the gestational age increased in all pre-pregnancy BMI groups until the 19th gestational week. The incidence of GDM in women with FPG ≥92 mg/dL in the 19th to 24th gestational weeks and pre-pregnancy overweight or obesity was significantly higher than that in women with FPG ≥92 mg/dL and pre-pregnancy BMI <24.0 kg/m2.Conclusions: FPG decreased gradually as the gestational age increased in all pre-pregnancy BMI groups until the 19th gestational week. Pre-pregnancy overweight or obesity was associated with an increased FPG value before the 24th gestational week. FPG ≥92 mg/dL between 19 and 24 gestational weeks should be treated as GDM in women with pre-pregnancy overweight and obesity.

Are women positive for the One Step but negative for the Two Step screening tests for gestational diabetes at higher risk for adverse outcomes?

The aim of this study was to evaluate if women meeting criteria for gestational diabetes mellitus (GDM) by the One Step test as per International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria but not by other less strict criteria have adverse pregnancy outcomes compared with GDM-negative controls. The primary outcome was the incidence of macrosomia, defined as birthweight >4000g. Electronic databases were searched from their inception until May 2017. All studies identifying pregnant women negative at the Two Step test, but positive at the One Step test for IADPSG criteria were included. We excluded studies that randomized women to the One Step vs. the Two Step tests; studies that compared different criteria within the same screening method; randomized studies comparing treatments for GDM; and studies comparing incidence of GDM in women doing the One Step test vs. the Two Step test. Eight retrospective cohort studies, including 29983 women, were included. Five study groups and four control groups were identified. The heterogeneity between the studies was high. Gestational hypertension, preeclampsia and large for gestational age, as well as in some analyses cesarean delivery, macrosomia and preterm birth, were significantly more frequent, and small for gestational age in some analyses significantly less frequent, in women GDM-positive by the One Step, but not the Two Step. Women meeting criteria for GDM by IADPSG criteria but not by other less strict criteria have an increased risk of adverse pregnancy outcomes such as gestational hypertension, preeclampsia and large for gestational age, compared with GDM-negative controls. Based on these findings, and evidence from other studies that treatment decreases these adverse outcomes, we suggest screening for GDM using the One Step IADPSG criteria.

Risk Factors and Plasma Glucose Profile of Gestational Diabetes in Omani Women.

We sought to conduct a detailed study on the risk factors of gestational diabetes mellitus (GDM) in Omani women to determine the actual and applicable risk factors and glucose profile in this population. We conducted a cross-sectional case-control study using pregnant women diagnosed with GDM. Pregnant women without GDM were used as a control group. We collected information related to age, family history, prior history of pregnancy complications, age of marriage, age of first pregnancy, fasting glucose level, and oral glucose tolerance test (OGTT) results from three hospitals in Oman through face-to-face interviews and hospital records. The median age of women with GDM was 33 years old (p < 0.050). A significant risk was noted in women with a history of diabetes (p < 0.001), and those with mothers' with a history of GDM. A significant (p < 0.010) relationship with a likelihood ratio of 43.9 was observed between the incidence of GDM in women with five or six pregnancies, a history of > 3 deliveries, height < 155 cm, and pregnancy or marriage at age < 18 years (p < 0.010). The mean difference in random plasma glucose, one-hour OGTT, and two-hour OGTT was significantly higher in GDM cases compared to control. Glucose profile, family history, anthropometric profile, and age of first pregnancy and marriage should be considered while screening for GDM and determining the care needs of Omani women with GDM.

High iron level in early pregnancy increased glucose intolerance

High iron stores in pregnancy are essential in preventing negative outcomes for both infants and mothers; however the risk of gestational diabetes mellitus (GDM) might also be increased. We intend to study the relationship between increased iron stores in early pregnancy and the risk of glucose intolerance and GDM. This prospective, observational, single-hospital study involved 104 non-anemic pregnant women, divided into 4 groups based on the quartile values for ferritin at the first trimester of pregnancy. All participants were screened for GDM with 75-g oral glucose tolerance test (OGTT) at 24–28 weeks’ gestation. We observed that ferritin levels at early pregnancy were significantly correlated to glucose level after OGTT at 1-h and 2-h (rho=0.21, p<0.05; rho=0.43, p<0.001 respectively). Furthermore, in the higher quartile for ferritin (>38.8μg/L) glycemia at 2-h OGTT was significantly higher than in the others quartiles (p=0.002). In multivariate regression analysis, serum ferritin was a significant determinant of glycemia at 2-h OGTT. Although we did not find a significant association in the incidence of GDM in women with higher serum ferritin levels, probably in reason to the limit power of our study, our data demonstrated that the role of iron excess is tightly involved in the pathogenesis of glucose intolerance. We report for the first time that high ferritin values in early pregnancy are predictors of impaired glucose tolerance in non-anemic women. Individual iron supplementation should be evaluated in order to minimize glucose impairment risk in women with high risk of diabetes.

Effect of dietary myo-inositol supplementation in pregnancy on the incidence of maternal gestational diabetes mellitus and fetal outcomes: a randomized controlled trial

Objective: To test the hypothesis that dietary myo-inositol may improve insulin resistance and the development of gestational diabetes mellitus (GDM) in women at high risk of this disorder.Design: A prospective, randomized, double-blind, placebo controlled clinical trial, pilot study.Participants: Non-obese singleton pregnant women with an elevated fasting glucose in the first or early second trimester were studied throughout pregnancy.Intervention: Supplementation with myo-inositol or placebo during pregnancy.Main outcome measure: Development of GDM on a 75 g oral glucose tolerance test at 24–28 weeks’ gestation. Secondary outcome measures were increased in BMI, need for maternal insulin therapy, macrosomia, polyhydramnios, neonatal birthweight and hypoglycemia.Results: Thirty-six women were allocated to receive myo-inositol and 39 placebo. The incidence of GDM in mid-pregnancy was significantly reduced (p = 0.001) in women randomized to receive myo-inositol compared to placebo (relative risk 0.127). Women randomized to receive myo-inositol also required less insulin therapy, delivered at a later gestational age, had significantly smaller babies with fewer episodes of neonatal hypoglycemia.Conclusions: Myo-inositol supplementation in pregnancy reduced the incidence of GDM in women at high risk of this disorder. The reduction in incidence of GDM in the treatment arm was accompanied by improved outcomes.

244: Risk of gestational diabetes mellitus analysed by the rate of weight gain before screening

While maternal obesity increases the risk of Gestational Diabetes Mellitus (GDM), there is little evidence that decreased Gestational Weight Gain (GWG) in obese women (according to the Institute of Medicine revised recommendations) improves glucose tolerance. Also, previous studies use Total GWG rather than the rate of GWG before the Glucose Tolerance Test (GTT) was performed. This prospective observational study compared the incidence of GDM in women with a GWG/week > the mean with that in women with a GWG/week < the mean before their GTT for each Body Mass Index (BMI) category.