Normal Glucose Challenge Test Research Articles

The association between normal 50-g glucose challenge test results and risk for future metabolic morbidities: Aretrospective cohort study.

To study the association between normal glucose challenge test (GCT) results during pregnancy and the incidence of future maternal metabolic morbidities. This was a population-based retrospective cohort study conducted between the years 2005 and 2020. The study included all women aged 17-55 years who underwent GCT as part of the routine prenatal care at the Central District of Clalit Health Services, Israel. The highest GCT result per woman was categorized into five study groups: <120 (reference), 120-129, 130-139, 140-149, and ≥150 mg/dL. Adjusted hazard ratios of the study groups for metabolic morbidities were calculated with Cox proportional survival analysis models. Among a total of 77 568 women participants, 53%, 12.3%, and 10.3% had normal GCT results of <120, 120-129, and 130-139 mg/dL, respectively. During the study period of 6.07 ± 4.35 years, 13 151 (17.0%) cases of metabolic morbidities were documented. High-normal GCT results of 120-129 and 130-139 mg/dL were significantly associated with increased risk for future metabolic morbidity compared with <120 mg/dL (adjusted hazard ratio [aHR] 1.15, 95% confidence interval [CI] 1.08-1.22 and aHR 1.32, 95% CI 1.24-1.41, respectively). Although GCT is only recommended as a screening tool for gestational diabetes mellitus, high results, even within the normal range, may point to maternal increased risk for future metabolic morbidity.

Treatment of Gestational Diabetes Mellitus and Maternal Risk of Diabetes After Pregnancy.

To compare postpartum glucose tolerance between women treated for gestational diabetes mellitus (GDM) and those not treated. Metabolic testing was performed at 3 and 12 months postpartum in 599 women comprising the following gestational glucose tolerance groups: 1) normal glucose challenge test (GCT) and oral glucose tolerance test (OGTT) during pregnancy, 2) abnormal GCT with normal OGTT, 3) gestational impaired glucose tolerance, 4) mild untreated GDM, and 5) severe treated GDM. Birth weight progressively increased across groups 1-4 before falling steeply in treated GDM (P < 0.0001). In contrast, at 3 and 12 months, insulin sensitivity and β-cell function progressively decreased across the five groups, mirrored by rising fasting and 2-h glucose (all P < 0.0001). Accordingly, prevalence of prediabetes/diabetes at 12 months increased in a stepwise manner across groups 1-5 (2.8%, 9.6%, 13.5%, 21.5%, and 32.6%, respectively; P < 0.0001). Treating GDM lowers birth weight but does not disrupt the association between gestational glycemia and maternal prediabetes/diabetes after pregnancy.

Glucose Testing in an Index Pregnancy and Outcomes in a Subsequent Pregnancy: Implications for Screening and a Novel Risk Calculator.

Our objective was to assess whether variables from an index pregnancy (PG1) can be used to guide testing for gestational diabetes mellitus (GDM) in a subsequent pregnancy (PG2) and to create a risk calculator for GDM in PG2. This was a retrospective cohort study of patients delivering ≥2 singleton gestations at >24 weeks' gestation from June 2009 to December 2018, for whom results of a 1-hour glucose challenge test (GCT) were available from PG1. Univariable and multivariable analyses were performed to evaluate factors associated with GDM in PG2. In total, 4,278 patients met the inclusion criteria. Among patients with a normal 1-hour GCT (<140 mg/dL) in PG1 (n = 3,719), 3.9% were diagnosed with GDM in PG2. In multivariable analysis of this group, GDM in PG2 was associated with higher GCT in PG1 (adjusted odds ratio [aOR]: 1.05, 95% confidence interval [CI]: 1.04-1.06), large for gestational age neonate in PG1 (aOR: 1.97, 95% CI: 1.24-3.13), and higher BMI (aOR: 1.08, 95% CI: 1.05-1.11). A novel risk calculator for GDM in PG2 was developed based on these associations. Using a risk cut-off of 15%, the calculator had a positive predictive value of 26% and a negative predictive value of 97%, with 3.2% of patients identified as "at risk". Among patients with abnormal 1-hour GCT in PG1, 38.3% (n = 214/559) had an abnormal 1-hour GCT in PG2 and 34.5% (n = 74/214) of these patients received a diagnosis of GDM. A normal 1-hour GCT in an PG1 is followed by GDM in a subsequent pregnancy in only 3.9% of cases. A novel calculator supports replacing universal screening with targeted testing in subsequent pregnancies in this population. Among patients with an abnormal 1-hour GCT in PG1, nearly 40% have an abnormal 1-hour GCT in a subsequent pregnancy. Direct diagnostic testing can be considered in such patients. · Normal GCT in a first pregnancy is associated with normal GCT in subsequent pregnancy.. · A risk calculator can target diabetes testing in a subsequent pregnancy.. · Abnormal GCT in a first pregnancy is associated with abnormal GCT in subsequent pregnancy..

The ability of a low value on an early GCT to identify women not needing repeat testing in the second trimester

Objective To evaluate the predictive value of a low early glucose challenge test (GCT) in ruling out a subsequent diagnosis of gestational diabetes in the second trimester. Methods This was a retrospective cohort study of women at a single clinic who had a normal early GCT between 2016 and 2020. Patients who did not have repeat screening in the late second trimester were excluded. Demographic data were extracted from the record. The primary outcome was a normal GCT or glucose tolerance test in the late second trimester. Logistic regression and receiver operator curves (ROC) were performed to assess the ability of the early GCT value to predict subsequent normal glucose screening. Results Of the 532 pregnant persons with normal early GCT, 62 (11.7%) were subsequently diagnosed with gestational diabetes in the second trimester. None of the patients (N = 56), who had a GCT value less than 80 mg/dL were diagnosed with gestational diabetes in the second trimester. The prediction of subsequent normal screening using the early GCT on a ROC plot produced an area under the curve (AUC) of 0.67, 95% CI (0.60–0.74). Adding age, prior history of gestational diabetes and family history of diabetes mellitus to the prediction, only improved the AUC to 0.75, 95% CI (0.66, 0.82). Conclusion Early GCT value was a fair predictor for normal second trimester glucose testing for gestational diabetes. However, high-risk patients with an early GCT value of less than 80 mg/dL may be able to forego repeat second trimester screening.

High Levels of 25-OH-Vitamin D and Copper in Pregnant Women with Abnormal Glucose Challenge Test.

Several hormones and elements are involved in the homeostasis of glucose metabolism during pregnancy. This present study determined the differences among the factors involved in glucose regulation for pregnant women with and without an abnormal glucose challenge test (GCT), but without gestational diabetes mellitus, during the second trimester of gestation and the postpartum period. One hundred and six pregnant women who had received routine prenatal and postpartum examinations at our hospital were recruited. Sugar-related tests and the levels of pregnancy-associated hormones and 25-OH-vitamin D were performed using a clinical autoanalyzer; six elements were assessed using graphite furnace atomic absorption spectrometry or inductively coupled plasma mass spectrometry. The women in the abnormal GCT group (n = 27) featured significantly higher levels of 25-OH-vitamin D (p = 0.006) and copper (p < 0.001) than those in the normal GCT group (n = 79). After adjusting for possible pregnancy factors, abnormal GCT remained the significant contributing factor for the elevated levels of 25-OH-vitamin D and copper during gestation (p = 0.046 and 0.002, respectively). Furthermore, significant positive correlations existed between 25-OH-vitamin D and glucose after a 50-g GCT (p = 0.001), 25-OH-vitamin D and HbA1C (p = 0.004), serum copper and glucose after a 50-g GCT (p = 0.003), and serum copper and HbA1C (p < 0.001). We conclude that blood 25-OH-vitamin D and copper are strongly correlated with glucose levels during gestation; these two factors are potential clinical predictors for maternal impaired glucose tolerance and, indirectly, for reducing perinatal risks and neonatal complications.

Evaluation of Perinatal Outcome in Women with Impaired Glucose Homeostasis During Pregnancy

Background: Glucose tolerance testing in pregnancy identifies many women with glycaemic responses that exceed normal range but that do not meet the threshold required to diagnose Gestational Diabetes Mellitus. It is controversial whether maternal hyperglycemia less severe than in diabetes is associated with increased risk of adverse pregnancy outcome or not. Materials and methods: All women were subjected to Glucose Challenge Test(GCT) with 50 gram glucose either at first visit or between 24-28 weeks on the basis of risk profile. High risk cases were screened at first visit and the rest between 24-28 weeks. Patients with a GCT value ≥200mg/dl were not subjected for GTT and were diagnosed as GDM.Value of GCT &lt;140 mg/dl was taken as normal. Irrespective of GCT result, women were subjected to Oral Glucose Tolerance Test (OGTT) as recommended by WHO with 75 gram glucose using WHO criteria. Study group was identified with 4 categories with abnormal glucose homoeostasis as defined by the following criteria: 1. Abnormal GCT (&gt;140 mg/dl) with normal OGTT; 2. Normal GCT with only Impaired Fasting Glucose(IFG) in OGTT; 3. Normal GCT with Gestational Glucose Intolerance(GGI); 4. Patients diagnosed as GDM: a. If fasting is &gt;126mg/dl; b. If 2hr OGTT ≥ 140mg/dl &amp; ≤ 199 mg/dl; c. If value of either GCT or OGTT &gt;200 mg/dl. The control group comprised of women with normal GCT and normal OGTT. In all the above groups, adverse prenatal outcome and maternal outcomes were evaluated by the primary and secondary outcome measures. Results: There were 10 cases (15.3%) of hypertensive disorder of pregnancy in the study group (3 cases of gestational hypertension in abnormal GCT, 3 cases of pre eclampsia in each GGI and GDM and 1 antepartum eclampsia in GGI category) and 2 cases in control group (3%) (p=0.03). There were 2 cases of Fetal Growth Reduction (FGR) and 5 cases of Premature Rupture Of Membranes(PROM) in both study and control group. There was 1 case of cholestasis of pregnancy in study group. Term inductions were 11 and 13 in the study and control group respectively.Within the study group number of cases induced were more in GGI(n=7) and GDM(n=4) category. There were 14 caesarean sections (21.5%) and 2 (3%) instrumental deliveries among the study group. However there were 6 caesarean sections (9.2%) and no instrumental deliveries among control groups. The rate of elective LSCS is more in GDM (n=5) vs other 3 categories and the difference is significant (p=0.04) The overall number of LSCS (14 cases) was significantly higher in GDM. Conclusion: Cases with abnormal glucose homeostasis of lesser degree than GDM, like only abnormal GCT, IFG and GGI also were observed to have adverse maternal outcomes than controls, in form of hypertensive disorders of pregnancy, significantly higher LSCS rates, and increased risk of macrosomia. Instead of 2 step procedure, single step screening cum diagnostic test with 75 gm OGTT for diagnosing GDM could be an option to be universally practiced.

The association between gestational impaired glucose tolerance and hyperglycemic markers: A prospective study.

To investigate the association between gestational impaired glucose tolerance (GIGT), and laboratory and clinical hyperglycemic markers. A prospective study in Holon between 2017 and 2019. Women with a singleton term delivery and one abnormal value in their last three oral glucose tolerance test measurements (OGTTs; GIGT group, n=60) were compared with control women with normal glucose challenge test (GCT) and/or OGTT measurements (n=60). Primary outcomes were elevated cord-blood C-peptide (>90th percentile), maternal hemoglobin A1c (HbA1c), abnormal HbA1c (>5.7%), and neonatal skinfold thickness. Secondary outcomes included large for gestational age (LGA). Women in the GIGT group were older (33.3±5.3 vs 31.1±4.8years; P=0.019), and had a higher rate of LGA (26.7% vs 6.7%; P=0.005), macrosomia (13.3% vs 0%; P=0.006), elevated C-peptide (16.7% vs 1.7%, P=0.008), and abnormal HbA1c (13.3% vs 0%, P=0.006). Skinfold thickness was also significantly higher in the GIGT group. HbA1c (adjusted odds ratio [aOR], 10.48; 95% confidence interval [CI], 1.19-91.91; P=0.033) and GIGT (aOR, 11.43; 95% CI, 1.78-73.39; P=0.01) were independently associated with LGA. Women with GIGT on OGTT demonstrated "hyperglycemic characteristics" relative to those with normal GCT and/or OGTT.

189 Predicting gestational diabetes in subsequent pregnancy using a novel risk calculator: implications for testing

The current standard is to screen all women for gestational diabetes (GDM) regardless of prior history. We assessed whether variables from an index pregnancy (PG1) in women with a normal 1-hour glucose challenge test (GCT) can be used to guide testing in subsequent pregnancy (PG2), and created a risk calculator for GDM in PG2. We studied a cohort of women who delivered 2 singleton pregnancies at >24 weeks' gestation at a single institution from June 2009-December 2018. All patients had normal GCTs in PG1 (200mg/dL, >2 elevated values on a 3-hour diagnostic test (GTT, Carpenter-Coustan criteria), or a diagnosis of GDM by ICD codes. Univariable and multivariable analyses (MVA) were performed to examine the relationship between GDM in PG2 and demographic, clinical, and laboratory variables from PG1. A risk calculator for GDM in PG2 was created using regression coefficients from the MVA. 3,719 women met inclusion criteria and 146 (3.9%) developed GDM in PG2 (Table 1). In MVA, those with GDM in PG2 were significantly more likely to be older, have higher GCTs in PG1, be of Hispanic ethnicity or Asian race, have delivered large for gestational age neonates in PG1 and have a higher BMI in PG2 (Table 2). A risk calculator for GDM in PG2 was created using race/ethnicity, PG2 age and BMI and PG1 GCT result and birthweight category. Using a risk cutoff of 20%, 3.7% of patients are identified as being "at risk" of GDM in PG2, with a positive predictive value (PPV) of 29% and a negative PV of 97%. Among patients with a normal GCT in PG1, the likelihood of a diagnosis of GDM in PG2 is only 3.9%. A calculator is presented for estimating individual risk using readily available data. Use of this calculator may permit supplanting the current practice of universal GDM screening in subsequent pregnancies with a targeted approach, limiting screening to fewer than 4% of women with normal GCTs in the index pregnancy.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Pregnancy Outcomes Among Class 3 Obese Women With Normal Early Glucola [31D

INTRODUCTION: ACOG recommends early screening for glucose intolerance in obese women, who are at increased risk of insulin resistance. We aimed to assess the risk of developing GDM based on the value of a normal early 50g oral glucose challenge test (GCT). METHODS: Retrospective cohort of non-anomalous singleton pregnancies with maternal BMI ≥40 at one institution, 2013–2017. Pregnancies with multiple gestation, late entry to care, type 1 or 2 diabetes, and missing diabetes-screening information are excluded. Primary outcome was development of GDM. Secondary outcomes include fetal growth restriction, fetal macrosomia, gestational age at delivery, large for gestational age, delivery BMI, total pregnancy weight gain, labor induction, shoulder dystocia, and cesarean delivery. Bivariate statistics compare demographics, pregnancy complications and delivery characteristics of women with early GCT &gt;100 and women who with early GCT 101–134. Regression models used to estimate odds of primary outcome. RESULTS: Of 169 women, 66 (39%) had an early GCT &lt;100, and 103 (61%) had an early GCT of 101–134. Women with low normal eGCT were more likely to use recreational drugs (P=.03). Other baseline demographics did not differ. The rate of GDM was low in this population (5.3%), with no difference in the rate of GDM between women with a low normal eGCT and high normal eGCT (P=.9). The median neonatal birthweight was higher in the normal GCT group as compared to the low GCT (P=.03). CONCLUSION: Among women with class 3 obesity, the specific value of an early normal GCT was not predictive of developing GDM by the third trimester.

A Low 50-gram, 1-hour Glucose Challenge Test Value Predicts Neonatal Birth Weight Less than the 10th Percentile: A Systematic Review and Meta-Analysis.

This study aimed to perform a systematic review with meta-analysis to investigate if women with a low 50-g, 1-hour glucose challenge test (GCT) value are at risk for having neonates with a birth weight less than the 10th percentile. A computerized literature search was conducted to identify studies that compared outcomes of pregnant women with a low GCT value versus women with a normal GCT value during routine screening for gestational diabetes. Sixteen cohort studies were included for analysis. Women with a low GCT value were noted to have a 43% increased odds of having neonates with birth weight less than the 10th percentile (odds ratio [OR]: 1.43; 95% confidence interval [CI]: 1.28-1.60) and 30% increased odds of having neonates with a birth weight less than 2,500 g (OR: 1.3; 95% CI: 1.0-1.7) when compared with women with a normal GCT value. The rates of preterm delivery, neonatal intensive care unit (NICU) admission, pregnancy-induced hypertension (PIH)/preeclampsia, respiratory distress, NICU, and Apgar scores less than 7 were similar in the two groups. A low GCT value defined as less than 90 mg/dL identifies pregnancies at elevated risk for having neonates with a birth weight less than the 10th percentile.

Oral glucose tolerance test for suspected late onset gestational diabetes

Background Oral glucose tolerance test is used for the diagnosis of gestational diabetes at the second trimester, however, its use at term has been questioned. Objective To compare obstetric outcomes in women with and without abnormal oral glucose tolerance test (OGTT) conducted at term due to large for gestational age (LGA) fetuses or polyhydramnios. Methods A retrospective cohort study including all women ≥37 weeks of gestation, with normal glucose challenge test (GCT), who performed 100 g OGTT at term, due to LGA fetus or polyhydramnios between January 2012 and January 2017. Abnormal OGTT was considered according to Carpenter and Coustan criteria. Data are presented as median and inter-quadrantile range (IQR). Results Database included 34,897 women, of them, 1131 (3.2%) met inclusion criteria. A total of 150 (13.2%) and 981 (86.7%) women were included in the abnormal and the normal OGTT groups, respectively. Women in the abnormal OGTT group had higher glucose levels on GCT [126 (IQR 107–137) versus 110 (IQR 91–132) mg/dL; p = .001]. The rate of cesarean deliveries was twice as high in the abnormal OGTT group [37 (24.7%) versus 103 (10.5%); p = .001]. No difference in the rate of shoulder dystocia, postpartum hemorrhage (PPH) or third and fourth-degree perineal tear was observed among women who delivered vaginally. Conclusions Abnormal OGTT at term was related to a higher rate of cesarean deliveries, with no difference in obstetrical complications among women who delivered vaginally.

Association of glucose levels in pregnancy with use of health care services

AimsTo determine whether women with abnormal gestational diabetes (GDM) screening test results short of frank GDM have increased health-services utilization compared to women with normal results. MethodsWe conducted a retrospective-cohort study among 29,999 women enrolled in Kaiser Permanente Northwest who completed GDM screening (two-step method: 1-h, 50-g glucose-challenge test (GCT); 3-h, 100-g oral-glucose-tolerance test (OGTT)). Test results were categorized as normal GCT (referent, n = 25,535), normal OGTT (n = 2246), abnormal OGTT but not GDM (n = 1477), and GDM (n = 741). Rate ratios (RRs) were calculated for utilization measures and analyses were age- and BMI-adjusted. ResultsCompared to women with normal GCT, rates for obstetrical ultrasound, noninvasive and invasive antenatal testing, and ambulatory visits to the obstetrics department were significantly greater among women with abnormal OGTT (RRs 1.2 [95%CI 1.1, 1.4], 1.3 [1.1, 1.4], 1.7 [1.3, 2.3], and 1.1 [1.1, 1.1], respectively) and GDM (RRs 1.8, 1.8, 2.0, and 1.3, respectively). Women with abnormal OGTT results were more likely to visit a dietician than women with normal GCT; RRs ranged from 4.0 [3.3, 4.9] for women with abnormal GCT but normal OGTT to 72.1 [64, 81] for women with GDM. ConclusionsHealth-services utilization increased with severity of glucose result, even among women without GDM.

Does Serum Hemoglobin A1C during Early Pregnancy Predict Performance on the 1-Hour Glucose Challenge Test? [28B

INTRODUCTION: Our objective was to determine the negative and positive predictive values of hemoglobin A1c (HgbA1c) levels, conceptualized as a screening test, in predicting abnormal 1-hour glucose challenge test (GCT) results in pregnancy. METHODS: This was a retrospective cohort study. We calculated the negative predictive value of HgbA1c levels in predicting normal 1-hour GCT (less than or equal to 140 mg/dl) and the positive predictive value in predicting an abnormal 1-hour GCT of greater than 140 mg/dl. RESULTS: We examined 635 pregnancies where the HgbA1c was measured in the same patient on the same day as or before the 1-hour GCT was performed. The median time interval between performance of the HgbA1c test and the 1-hour GCT was 95 days (IQR 56-122 days). Among women with HgbA1c levels less than or equal to 4.9, 5.0, and 5.1, the probability of their 1-hour GCT being 140 mg/dl or less was 91.3%, 91.0% and 90.1%, respectively. Among our study population, 14.5%, 22.8%, and 35.0% had HgbA1c levels less than or equal to 4.9, 5.0 and 5.1, respectively. Among women with HgbA1c levels greater than 6.1, the probability of their 1-hour GCT being greater than 140 mg/dl was 100%. However, only 0.3% of our population had HgbA1c greater than 6.1. CONCLUSION: Our study adds to the body of evidence that HgbA1c cannot replace the 1-hour GCT as a screening test for gestational diabetes, but low values can reliably predict a normal 1-hour GCT. Therefore, some women could be spared from doing the 1-hour GCT.

414: High-normal 50-gram glucose challenge test and future metabolic diseases: a population- based study

A 1-hour 50-gram glucose challenge test (GCT) is the first step in the screening for gestational diabetes mellitus (GDM). Accumulating evidence show that women with high- normal GCT levels are at elevated risk for immediate obstetric complications such as large for gestational age newborns and greater likelihood for caesarean delivery. We sought to examine the risk for metabolic disorders later in life, among women with high-normal GCT levels, as compared to low normal and abnormal GCT. This cohort study included all pregnant women who underwent GCT between the years 2005 to 2018 at the Central District of Clalit Health Services, the largest health maintenance organization in Israel. Rates of metabolic diseases (MTD) were compared between the three study groups: women with history of only Low-normal GCT (<124 mg/dL), High normal (125- 139 mg/dL) and abnormal GCT >140 mg/dL. Data on maternal ages and GCT results for each test performed, as well as MTD such as diabetes and obesity were collected and analyzed from the computerized database. Multivariable survival model was used to study the association between GCT levels and MTD risk, while adjusting for maternal age. A total of 66,869 women performed 1 to 10 GCTs to a total of 117,435 tests during the study period; 23% of study participants (n=15,360) had at least one abnormal result; 11.3% (n=7566) of participants had a diagnosis of MTD. As compared to women with low normal GCT (only), women with a history of high normal and abnormal GCT were at higher risk for MTD (10.4% vs. 12.4% and 13.0%, p<0.001, age adjusted HR=1.18; 95%CI 1.09-1.24, and 1.18; 95%CI 1.11-1.25, for high normal and abnormal GCT, respectively). There was no significant difference in MTD risk between women with history of high normal and abnormal GCT results (age adjusted HR=1.02; 95%CI 0.94-1.10; p=0.67). As compared to women with low normal GCT, women with high normal GCT, similarly to women with abnormal GCT, are at increased MTD risk. Although GCT is a screening test, it may be a predictor of MTD later in life, and women with high normal GCT results may benefit from close monitoring of their metabolic status.

A Modified Two-Step Screening Strategy for Gestational Diabetes Mellitus Based on the 2013 WHO Criteria by Combining the Glucose Challenge Test and Clinical Risk Factors.

This study determines if a modified two-step screening strategy with a glucose challenge test (GCT) ≥ 7.2 mmol/L and clinical risk factors improves the diagnostic accuracy for gestational diabetes mellitus (GDM), based on 2013 WHO criteria, while limiting the number of oral glucose tolerance tests (OGTT). This was a prospective multicentric cohort study with 1811 participants receiving both GCT and 75 g OGTT in pregnancy. Participants and health care providers were blinded for GCT. Characteristics were analyzed across four glucose tolerance groups: abnormal (≥7.2 mmol/L), GCT GDM (n = 165), normal GCT GDM (n = 63), abnormal GCT normal glucose tolerant (NGT) (n = 472); normal GCT NGT (n = 1113). Compared to normal GCT NGT women, normal GCT GDM women had increased rates of obesity (23.8% vs. 10.5%, p < 0.001), ethnic minority background (19.3% vs. 8.2%, p < 0.001) and a history of GDM (13.8% vs. 4.6%, p = 0.03). By combined screening of GCT ≥ 7.2 mmol/L with these risk factors, sensitivity increased to respectively, 74.1–78.1% using one risk factor, and to 82.9% using any of these risk factors with a specificity of 57.5%. By using a modified two-step screening strategy, the number of women needing both a GCT and OGTT would be reduced to 25.5%, and 52.6% of all OGTTs could be avoided, compared to a universal one-step approach.

Rising plasminogen activator inhibitor-1 and hypoadiponectinemia characterize the cardiometabolic biomarker profile of women with recent gestational diabetes

BackgroundGestational diabetes (GDM) and milder gestational impaired glucose tolerance (GIGT) identify women at risk of developing type 2 diabetes and cardiovascular disease later in life. Accordingly, the postpartum years after gestational dysglycemia can provide insight into early events in the natural history of these disorders. We thus sought to prospectively evaluate the relationship between gestational glucose tolerance and emerging cardiometabolic biomarkers [adiponectin, chemerin, retinol-binding protein-4 (RBP-4), C-reactive protein (CRP), plasminogen activator inhibitor-1 (PAI-1)] at both 1- and 3-years postpartum in a cohort reflecting the full spectrum of gestational dysglycemia (from normal to GIGT to GDM).MethodsThree-hundred-and-thirty-nine women completed a glucose challenge test (GCT) and oral glucose tolerance test (OGTT) in pregnancy, which identified 4 gestational glucose tolerance groups: GDM (n = 105); GIGT (n = 59); abnormal GCT with normal OGTT (n = 99); and normal GCT with normal OGTT (n = 76). At 1- and 3-years postpartum, the women underwent repeat OGTT with measurement of biomarkers (adiponectin/chemerin/RBP-4/CRP/PAI-1).ResultsSerum adiponectin was lower in women with GDM and GIGT at both 1-year and 3-years (both P ≤ 0.002), whereas chemerin, RBP-4, CRP and PAI-1 showed no differences across the 4 groups. Importantly, the change in PAI-1 between 1- and 3-years progressively increased from the normal GCT group to the abnormal GCT group to GIGT to GDM (P = 0.03). Indeed, both GDM (t = 2.98, P = 0.003) and GIGT (t = 2.14, P = 0.03) independently predicted an increase in PAI-1 from 1- to 3-years postpartum.ConclusionsHypoadiponectinemia and rising PAI-1 over time are early features of the cardiometabolic biomarker profile of women with recent gestational dysglycemia.

Relationship between 50-g glucose challenge test and large for gestational age infants among pregnant women without gestational diabetes

The study aimed to compare the incidence of large for gestational age (LGA) infants between women with a false positive and normal glucose challenge test (GCT), and to evaluate the factors associated with LGA. A total of 480 pregnant women at risk for gestational diabetes mellitus (GDM); 160 with a false positive GCT and 320 with normal GCT results were included. The incidence of LGA and other pregnancy outcomes were compared between the two groups. Possible associated factors for LGA were also evaluated. Women with a false positive GCT were significantly older and more likely to be multiparous. The incidence of LGA was comparable between the false positive and normal GCT groups (15.6% vs. 13.1%, p = .456). Other pregnancy outcomes were also comparable. Logistic regression analysis showed that pre-pregnancy underweight significantly reduced the risk of LGA (adjusted OR 0.25, 95% CI 0.07–0.87, p = .029) while a second trimester weight gain >7 kg significantly increased the risk of LGA (adjusted OR 3.13, 95% CI 1.67–5.89, p < .001).Impact StatementWhat is already known on this subject? Women with a false-positive GCT (abnormal GCT but normal OGTT) can be considered as having an early form of glucose intolerance which similar adverse outcomes to GDM could develop. Previous studies have reported that a mild maternal hyperglycaemia in the absence of GDM is associated with LGA, macrosomia, shoulder dystocia and a caesarean delivery. There is no current recommendation for any intervention or treatment among women with a false positive GCT.What the results of this study add? The results of this study showed that an incidence of LGA was not significantly increased in the false positive GCT groups and that other pregnancy outcomes were comparable. A pre-pregnancy underweight significantly reduced the risk of LGA while a second trimester weight gain >7 kg significantly increased the risk of LGA.What the implications are of these findings for clinical practice and/or further research? As a gestational weight gain is modifiable, behavioural and a dietary intervention as well as a close monitoring of the weight gain could help in lowering the risk of LGA, even in the absence of GDM. Further studies which are more widely generalisable are needed to elucidate the relationship between 50 g GCT and the adverse outcomes and to investigate the benefits of a specific intervention among this specific group of women.

Association between inflammatory potential of diet and odds of gestational diabetes mellitus among Iranian women

Background: The possible relationship between diet-related inflammation and the risk of gestational diabetes mellitus (GDM) requires further investigation, especially in non-Western populations. We examined the association between dietary inflammatory index (DII) scores and GDM in a case-control study conducted in Iran.Methods: This study included 122 GDM cases and 266 controls hospitalized for acute non-neoplastic diseases. Cases were pregnant women aged 18–40 years, who visited major general hospitals in different regions of Tehran. Pregnant women were screened for gestational diabetes between the 24th and 28th week of gestation with a 50-g, 1-hour glucose challenge test (GCT). Cases were diagnosed positive for GDM. Controls were pregnant women who had normal GCT test. DII scores were computed from dietary intake assessed by a previously validated 147-item food frequency questionnaire. Logistic regression models adjusted age, gestational age, energy, exercise, BMI, smoking exposure, family history of diabetes, and history of multivitamin intake were used to estimate odds ratios (ORs) and 95% confidence intervals (CI).Results: Subjects with higher DII scores (i.e. indicating a more proinflammatory diet) had a higher odd of GDM with the DII being used as both a continuous (OR = 1.20; 95% CI = 0.94–1.54) and as categorical (ORtertile 3vs1 = 2.10; 95% CI = 1.02–4.34, p-trend = .03).Conclusions: These results indicate that a proinflammatory diet, as evidenced by higher DII scores, is associated with increased odds of GDM among Iranian women.

Biomarkers of vascular injury and endothelial dysfunction after recent glucose intolerance in pregnancy.

Women with gestational diabetes mellitus and milder gestational impaired glucose intolerance have elevated future risks of type 2 diabetes and cardiovascular disease. However, it is unclear whether they show postpartum evidence of vascular injury/dysfunction, an early event in the natural history of cardiovascular disease. In total, 337 women underwent a glucose challenge test and oral glucose tolerance test in pregnancy, yielding four gestational glucose tolerance groups: gestational diabetes mellitus, gestational impaired glucose intolerance, abnormal glucose challenge test with normal glucose tolerance on the oral glucose tolerance test and normal glucose challenge test with normal glucose tolerance. At 3 years postpartum, they underwent repeat oral glucose tolerance test (on which 69 women had pre-diabetes/diabetes) and measurement of the following serum markers of vascular injury/dysfunction: thrombomodulin, E-selectin, P-selectin, intercellular adhesion molecule-3 and vascular cell adhesion molecule-1. At 3 years postpartum, mean adjusted vascular cell adhesion molecule-1 was the only vascular marker that differed across the previous gestational glucose tolerance groups. On multiple linear regression analysis, each strata of gestational dysglycaemia was an independent predictor of lower vascular cell adhesion molecule-1 at 3 years postpartum (gestational diabetes mellitus: p = 0.005; gestational impaired glucose intolerance: p = 0.003; abnormal glucose challenge test normal glucose tolerance: p = 0.0008), as was current pre-diabetes/diabetes ( p = 0.01). Dysregulation of vascular cell adhesion molecule-1 may be an early event in the natural history of cardiovascular disease in women with recent glucose intolerance in pregnancy.

MORPHOLOGICAL AND FUNCTIONAL MYOCARDIAL ABNORMALITIES IN THE CHORNOBYL NPP ACCIDENT CLEAN-UP WORKERS OF «IODINE» PERIOD HAVING GOT TYPE 2 DIABETES MELLITUS.

Evaluation of morphological and functional myocardial abnormalities in the Chornobyl NPP (ChNPP)accident clean-up workers (ACUW) of the «iodine» period exposed to ionizing radiation at a young age and havinggot the type 2 diabetes mellitus (T2DM). The ChNPP ACUW of «iodine» period (n=111) exposed to ionizing radiation (IR) at a young age(18-35 years) were involved in the study. Subjects having got the T2DM were included in study Group I (n = 66), per-sons with normal glucose challenge test were selected as a comparison Group II (n = 45). External radiation doses (ERD)ranged from 10 to 860 mSv. The Group III (clinical control) included persons having got the T2DM with no radiationexposure in a history (n=20). Group IV was the normative one. There was no statistical difference between the groups inage, sociodemographic characteristics and level of education. Echocardiography and cardiac Doppler sonography wereperformed in one- and two-dimensional regimens according to the recommendations of the European Association ofEchocardiography. Total adiponectin and proinflammatory cytokine (TNF-α and IL-6) concentrations were assayed by theimmunoenzyme method. Statistical processing of data was carried out using the Microsoft® Exel 2002 software. Myocardial remodeling in the ChNPP ACUW of a «iodine» period having the T2DM occurred through a sig-nificant increase of its linear parameters. Volumetric parameters (EDV, ESV and their indexes) were within maximumpermissible limits significantly exceeding however the values in the Group IV. There was aт increase in myocardialmass of the left ventricle and its indices with the formation of structural-geometric abnormalities, mainly in theform of concentric hypertrophy with a decrease in the myocardial contractile capacity. There was no differences ofthe vast majority of key morphometric parameters of myocardium in the dose subgroups, while in persons with ERD> 500 mSv the incidence of serious left ventricular hypertrophy (LVMMI > 149 g/m2) significantly exceeded thisvalue in individuals with lower ERD. At a maximum ERD the more intense fibroplastic processes were observed inmyocardium [a significant increase in the interstitial collagen volumetric fraction (ICVF)] as compared to the caseswith ERD up to 50 mSv. Intensification of myocardial fibroblastic processes occurred in the comparizin group andgroup off clinical control. In combination with concentric myocardial hypertrophy this may lead to an increased riskof cardiovascular complications. Strong negative correlation was revealed between the parameters of left ventricu-lar structure in diastole and adiponectin level in the ChNPP ACUW of a «iodine» period with diagnosed T2DM, high-lighting its cardioprotective effect. At the same time, the content of FNP-α and IL-6 proinflammatory cytokines hada positive correlation with the main parameters of abnormal myocardial remodeling, indicating the possibility oftheir role in unfavorable cardiovascular modifications. The decreased adiponectin level and elevated levels of TNF-α and IL-6 in the ChNPP ACUW of a«iodine» period having got the T2DM are the meaningful factors in progression of LV geometric remodeling. Togetherwith fibroplastic processes (a significant increase in ICVF) this may be a basis for the development of myocardialremodeling processes, namely a concentric hypertrophy, which is a prerequisite for the development of complica-tions in cardiovascular system.