Prior History Of Gestational Diabetes Mellitus Research Articles

Prevalence and associated factors of gestational diabetes mellitus: A multicenter, cross-sectional study in mekong delta region

The purpose of this study was to determine the prevalence and associated factors of gestational diabetes mellitus (GDM) in the Mekong Delta region. A multicenter, cross-sectional descriptive study was conducted on 1727 pregnant women undergoing oral glucose tolerance testing (OGTT) at 4 major central hospitals of 4 provinces in the Mekong Delta region from 06/2017 to 06/2022. Results: Among 1727 pregnant women undergoing OGTT, the overall prevalence of GDM is 17.1% (296/1727), and the prevalence in 4 provinces ranges from 15.4 to 19.0%. Multivariate logistic regression analysis revealed 10 associated factors increasing the risk of GDM, including maternal age ≥ 25, Kinh ethnicity, urban residence, lower than high school education, family history of diabetes in the first generation, BMI ≥ 25 kg/m2, weight gain ≥ 12kg, history of miscarriage, history of delivering babies ≥ 4000g, and prior GDM history (p ≤ 0.05). Conclusion: The prevalence of GDM in the Mekong Delta region is nearly 1/5 of pregnant women, so screening for GDM should be routinely conducted for all pregnant women between 24 and 28 weeks of gestation, particularly those with risk factors associated with an increased risk of GDM.

No role of the third-trimester inflammatory factors in the association of gestational diabetes mellitus with postpartum cardiometabolic indicators

BackgroundThe influence of gestational diabetes mellitus (GDM) on postpartum cardiometabolic indicators is primarily restricted to glucose and lipid metabolism, however the indicators for liver and kidney function have been rarely explored, and the role of the third-trimester inflammatory factors in these associations has never been investigated.MethodsBased on the Ma’anshan birth cohort (MABC), women with or without GDM history were selected and invited to participate in a 6-year postpartum follow-up. The fasting blood samples were collected to measure 16 comprehensive metabolic indicators during a 6-year postpartum follow-up: fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c), triglycerides (TG), total cholesterol (TC), uric acid (UA), blood urea nitrogen (BUN), serum creatinine (SCR), etc. Seven inflammatory factors, including TNF-α, IFN-γ, IL-1β, IL-6, IL-10, IL-12p70, and IL-17 A, were measured with serum samples collected during the third trimester of pregnancy. Linear regression models were used to analyze the associations between GDM and 6-year postpartum metabolic indicators, GDM and third-trimester inflammatory factors, and the third-trimester inflammatory factors and 6-year postpartum metabolic indicators. Mediating and moderating effect analyses were further performed to explore if the third-trimester inflammatory factors mediate or modify the association between GDM and postpartum cardiometabolic indicators.ResultsFrom July 2021 to August 2022, 307 participants have been followed up, with 99 women with a prior GDM history. Compared with those without GDM, individuals with a prior history of GDM had significantly elevated levels of FPG (β = 0.40, 95% CI: 0.18 to 0.62, PFDR < 0.001), HbA1c (β = 0.22, 95% CI: 0.09 to 0.34, PFDR = 0.009), TyG (β = 0.22, 95% CI: 0.07 to 0.37, PFDR = 0.024) at 6 years postpartum, and the association between GDM and SCR (β = 2.43, 95% CI: 0.02 to 4.85, PFDR = 0.144) reached nominal significance level. GDM history was associated with a decreased level of third-trimester IL-17 A (β = -0.58, 95% CI: -0.99 to -0.18, PFDR = 0.035). No significant association between third-trimester inflammatory factors and 6-year postpartum metabolic indicators was observed. And no mediating or moderating effect of third-trimester inflammatory factors was observed in those associations.ConclusionA prior history of GDM was significantly associated with elevated FPG, HbA1c, and TyG in women at 6 years postpartum, whereas third-trimester inflammatory factors had no role in mediating or moderating these associations.

Twin Pregnancy Complicated by Gestational Diabetes Mellitus: Maternal and Neonatal Outcomes.

The risk of gestational diabetes mellitus (GDM) in twin pregnancies is more than double that of singleton pregnancies. Although twin pregnancies present unique challenges for fetal growth and prenatal management, the approach to GDM diagnosis and treatment is the same regardless of plurality. Data on pregnancy outcomes for individuals with GDM and a twin pregnancy are limited and conflicting. To describe the maternal characteristics associated with GDM in twin pregnancies and to assess the associated pregnancy outcomes compared to twin pregnancies unaffected by GDM. A retrospective cohort study was conducted at Mayo Clinic, Rochester, Minnesota, USA, and included predominantly Causasian women aged 18 to 45 years who received prenatal care for a twin pregnancy from 2017-2022. Maternal characteristics and a broad spectrum of pregnancy outcomes were evaluated. Universal GDM screening involved a 50 g oral glucose challenge test +/- a 100 g oral glucose tolerance test. GDM was diagnosed in 23% pregnancies (n = 104/452). Compared to those without, women with GDM had known risk factors including a higher prepregnancy body mass index (31.1vs 26.3 kg/m2; P < .01) and a prior history of GDM (21.7 vs 5.9%; P < .01). There were no differences in maternal pregnancy complications or neonatal outcomes between groups. Attendance at postpartum glucose testing among women with GDM was poor at 27.9% (29/104). These data suggest that women with twin pregnancies share a similar GDM risk profile to those with singleton pregnancies and provide reassuring evidence that current management for GDM twin pregnancies produces similar outcomes to twin pregnancies without GDM.

Diagnostic significance of individual glucose values in oral glucose tolerance test and the associated risk factors for gestational diabetes mellitus in pregnant mothers: A cross-sectional study

Background: The diagnosis of gestational diabetes mellitus (GDM) is mainly based on oral glucose tolerance test (OGTT) in Sri Lankan clinical setting. The present study was to assess the diagnostic significance of individual glucose values in 75g OGTT in a group of pregnant mothers, to modify the test procedure to make it more convenient and cost-effective and to identify the associated risk factors for GDM.Methods: A total of 150 pregnant women within the second trimester and attending the antenatal clinics at Teaching Hospital Mahamodara were recruited for the study. Data collection was carried out via an interviewer-administered questionnaire followed by retrieval of laboratory data on OGTT.Results: Seventeen pregnant women (11.33%) were diagnosed with GDM by OGTT based on the WHO criteria. Diagnosis was based on either fasting or 2-hour glucose values alone or by increased levels in more than one of those parameters. None of them were diagnosed based on the 1-hour glucose value alone. The AUC values were 0.951 (0.884, 1.000), 0.829 (0.715, 0.942) and 0.859 (0.776, 0.943) respectively for fasting, 1-hour and 2-hour glucose concentrations (CI 95%). GDM was associated with uncontrolled sweet consumption (X2=5.86, p=0.015) and no association was observed with reference to maternal age, parity, BMI, positive family history of diabetes, and prior history of GDM or diabetes mellitus.Conclusion: Fasting and 2-hour plasma glucose values have higher diagnostic accuracy over 1-hour glucose values and the findings suggest the performance of fasting and 2-hour samples alone in the standard 75g OGTT procedure for the diagnosis of GDM.

The incidence and risk factors of postpartum diabetes in women from Bangladesh, India and Sri Lanka (South Asia) with prior gestational diabetes mellitus: Results from the LIVING study

AimTo study, the incidence and risk factors for postpartum diabetes (DM), in women with gestational diabetes mellitus (GDM) from South Asia (Bangladesh, India and Sri Lanka), followed for nearly two years after delivery. MethodsWomen with prior GDM diagnosed using IADPSG criteria were invited at 19 centres across Bangladesh, India and Sri Lanka for an oral glucose tolerance test (OGTT) following childbirth, and were enrolled in a randomized controlled trial. The glycaemic category (outcome) was defined from an OGTT based on American Diabetes Association criteria. ResultsParticipants (n = 1808) recruited had a mean ± SD age of 31.0 ± 5.0 years. Incident DM was identified, between childbirth and the last follow-up, in 310 (17.1 %) women [incidence 10.75/100 person years], with a median follow-up duration of 1.82 years after childbirth. Higher age, lower education status, higher prior pregnancy count, prior history of GDM, family history of DM, and postpartum overweight/obese status were significantly associated with incident DM. Women in Bangladesh had a higher cumulative incidence of DM [16.49/100 person years] than in Sri Lanka [12.74/100 person years] and India [7.21/100 person years]. ConclusionsA high incidence of DM was found in women with prior GDM in South Asia, with significant variation between countries. Women from Bangladesh had a significantly higher pregnancy count, family history of DM and overweight/obese status, despite having significantly lower age, which could be responsible for their higher rates of DM.Registration of this study: The study was registered with the Clinical Trials Registry of India (CTRI/2017/06/008744), Sri Lanka Clinical Trials Registry (SLCTR/2017/001), and ClinicalTrials.gov (NCT03305939).

ODP247 The Detection of Metabolic Dysfunction–Associated Fatty Liver Disease via Fibroscan® in Early–to–Mid Pregnancy is an Independent Risk Factor for the Development of Gestational Diabetes Mellitus

Abstract Aims To investigate whether the detection of metabolic dysfunction–associated fatty liver disease (MAFLD), formerly known as non–alcoholic fatty liver disease (NAFLD), in early–to–mid pregnancy is associated with the development of gestational diabetes mellitus (GDM). Methods A prospective longitudinal study was conducted on singleton pregnant women enrolled from a multiethnic obstetrics service in Sydney, Australia. A FibroScan ® was performed between 10–24 weeks to assess for hepatic steatosis in women with at least one risk factor for developing GDM, as per the Australasian Diabetes in Pregnancy Society (ADIPS) Guidelines 2014. A controlled attenuation parameter (CAP) score ≥233.5 dB/m was indicative of MAFLD, with severity graded as mild (Grade S1: CAP 233.5–267 dB/m), moderate (Grade S2: CAP 268–301 dB/m) and severe (Grade S3: CAP ≥302 dB/m). A liver stiffness measure (LSM) score ≥7. 0 kPa was indicative of hepatic fibrosis. Women were advised to fast for at least 2 hours prior to their FibroScan ® . GDM was determined by the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) 2010 criteria, with a 75–gram oral glucose tolerance test (OGTT) performed between 24–28 weeks gestation. The cohort were separated by GDM status and categorical variables were compared with Pearson's chi–squared test or Fisher's exact test, and continuous variables with independent t-test or Mann–Whitney U test. Multiple logistic regression analysis was used to determine the independent predictors of GDM, reported as odds ratios (OR) and 95% confidence intervals (CI). Results Three–hundred and twenty–eight women were eligible for inclusion in our study. Of these, 135 (41.2%) had FibroScan ® –detected MAFLD, where 85 (25.9%) had Grade S1, 39 (11.9%) had Grade S2 and 11 (3.4%) had Grade S3. None of the women had hepatic fibrosis. Over 97% of women were fasting for at least 2 hours prior to their FibroScan ® . GDM was diagnosed in 87 (26.5%) women. A significantly higher rate of GDM were identified in women with MAFLD compared to those without (36.3% vs. 19.7%, p&amp;lt;0. 01). Women with MAFLD were more likely obese, with pre–pregnancy body mass index (BMI) over 27.5kg/m 2 in Asians and over 30kg/m 2 in Europeans (58.5% vs. 12.4%, p&amp;lt;0. 01), had an earlier diagnosis (prior to 24 weeks gestation) of GDM (8.1% vs. 1.6%, p&amp;lt;0. 01) and administered insulin for treatment of their GDM (12.6% vs. 4.7%, p&amp;lt;0. 01). After adjustment for ethnicity, pre–pregnancy BMI, prior history of GDM and a family history of diabetes, MAFLD remained an independent predictor of GDM development (adjusted OR 2.55, 95% CI 1.43–4.52, p&amp;lt;0. 01). Conclusions The detection of MAFLD via FibroScan ® in early–to–mid pregnancy was an independent risk factor for the development of GDM. FibroScan ® is a quick and safe measure to help screen for MAFLD and may further aid in the risk stratification of women at–risk of developing GDM. Presentation: No date and time listed

Abnormal glucose tolerance in women with prior gestational diabetes mellitus: a 4-year follow-up study.

Adoption of the International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria for diagnosis of gestational diabetes mellitus (GDM) varies worldwide. Early detection of women at increased risk of developing type 2 diabetes mellitus (T2DM) following GDM enables initiation of measures to delay disease onset. To determine the 4-year cumulative incidence and risk factors for developing abnormal glucose tolerance (AGT) among women with previous GDM using modified IADPSG criteria. Additionally, to review post-natal attendance at diabetes screening and the impact of post-partum lifestyle modifications and breastfeeding on the risk of T2DM development. Four hundred twenty-six women with a prior history of GDM were invited to participate in the study, 4years after the index pregnancy. The following were completed: body measurements, oral glucose tolerance test (OGTT), glycated haemoglobin (HbA1c), vitamin D, and other biochemistry measurements. Participants also completed a lifestyle questionnaire. Of the 74 women who participated, 15 (20%) had AGT. Predictive factors for AGT development were as follows: fasting glucose levels (p = 0.004), HbA1c (p = 0.008) at GDM diagnosis, and early pregnancy BMI (p = 0.001). Thirty-three (45%) women had not attended their postnatal screening. The odds ratio of the association between breastfeeding and AGT development was 0.16 (95% CI: 0.05 to 0.53). The proportion of women who develop AGT after a diagnosis of GDM remains high. The factors associated with progression to AGT are available at GDM diagnosis. Preventing AGT in this group is possible by supporting breastfeeding. Attendance at post-natal screening should also be encouraged.

Estimating the Risk of Insulin Requirement in Women Complicated by Gestational Diabetes Mellitus: A Clinical Nomogram.

PurposeThis study sought to develop a nomogram for the prediction of insulin requirement in a Chinese population with gestational diabetes mellitus (GDM).Materials and MethodsWe performed a retrospective cohort study involving 626 Chinese women with GDM, of whom 188 were treated with insulin. “Least absolute shrinkage and selection operator” regression was used to optimize the independent predictors of insulin requirement during pregnancies complicated with GDM. Cox proportional hazards regression analysis was performed to establish a prediction model incorporating the selected predictors, and the nomogram was constructed to achieve individual prediction. The C-index, calibration plot and decision curve analysis were used to validate the model.ResultsMaternal age, family history of type 2 diabetes mellitus in a first-degree relative, a prior GDM history, fasting plasma glucose, hemoglobin A1c, gestational age, and body mass index values at the time of GDM diagnosis were the risk factors for insulin treatment. The model displayed medium predictive power with a C-index of 0.77 (95% confidence interval: 0.73–0.81) and relatively good calibration accuracies. The decision curve demonstrated a positive net benefit with a threshold between 0.09 and 0.70.ConclusionThe findings suggest that our nomogram, incorporating seven indicators, is useful in predicting individualized survival probabilities of insulin requirement.

Current type 2 diabetes, rather than previous gestational diabetes, is associated with liver disease in U.S. Women

AimTo investigate the relative contribution of previous gestational diabetes mellitus (GDM) and current type 2 diabetes (T2D) on the development of liver fibrosis, the strongest predictor of end-stage liver disease. MethodsThis is a population-based cross-sectional study based on data from the 2017–2018 cycle of the National Health and Nutrition Examination Survey. We included women age ≥ 20 years that had delivered at least one live birth and had available data on vibration-controlled transient elastography (VCTE). Liver steatosis and fibrosis were assessed by the median value of controlled attenuation parameter (CAP) and liver stiffness measurement (LSM), respectively. ResultsAmong the 1699 women included in the study, 144 (10.1%, 95% CI 7.7–13.2) reported a previous diagnosis of GDM. Women with previous GDM were younger, had a higher BMI, a higher prevalence of T2D and were significantly older at the time they had the last live birth. Univariate analysis did not show a significant difference between women with and without a prior history of GDM in terms of both steatosis (44.8% vs 39.4%, p = 0.464) and fibrosis (7.5% vs 7.6%, p = 0.854). Multivariable logistic regression analysis showed that BMI, γ-glutamyltranspeptidase levels, T2D (OR 2.96, 95% CI 1.48–5.93, p < 0.01), HBV and HCV infection were associated with higher odds of significant fibrosis, while previous GDM showed a neutral effect. ConclusionsWomen with previous GDM that do not develop overt T2D might not experience a poor hepatic prognosis.

Factors predicting recurrence of gestational diabetes in a high-risk multi-ethnic population.

Women with gestational diabetes mellitus (GDM) have an increased risk of adverse pregnancy outcomes. This study examined predictors for GDM recurrence at their next pregnancy in a multi-ethnic population. Clinical outcomes of women with GDM at the index as well as the subsequent pregnancies were also compared. A retrospective review of women with GDM (between 2008 and 2016) who had a subsequent pregnancy at a tertiary institution was conducted. The clinical characteristics of both pregnancies were documented. Among 3587 singleton pregnancies complicated by GDM, 501 fell pregnant again and 367 (73.1%) developed GDM in their subsequent pregnancies. Subsequent pregnancies had higher birthweight (3426±563 vs 3290±506g, P<0.001) but the rate of pre-eclampsia was lower (1.0% vs 4.2%, P=0.003). Univariate analysis showed that older age, prior history of GDM, pre-pregnant body mass index (BMI), two-hour glucose level on glucose tolerance test (GTT), insulin requirement at the index pregnancy, and inter-pregnancy weight gain were associated with recurrent GDM. Using stepwise logistic regression analysis, pre-pregnant BMI, glucose levels on GTT at index pregnancy and inter-pregnancy weight gain were independent predictors for recurrent GDM. The odds ratios for recurrent GDM among those who gained more than 8kg were 20.5 (5.0-84.5), compared with those who lost over 5kg between the two pregnancies. GDM recurrence rate was independent of ethnic backgrounds. Women with GDM have high risk of GDM recurrence at their next pregnancy. Inter-pregnancy weight gain is a strong predictor of recurrent GDM, and strategies to help women lose weight post-partum may be invaluable.

Trend of various adiposity indices in women with and without history of gestational diabetes: a population-based cohort study

BackgroundData of studies focusing on the trends of adiposity indices among women with prior gestational diabetes mellitus (GDM), are limited and controversial. The aim of this study was to compare overtime trends of adiposity indices in women with and without history of GDM, using data of the long term longitudinal population-based Tehran-Lipid and Glucose-Study (TLGS).MethodsA total of 3395 eligible women aged (20–50 years), including 801 women with prior history of GDM and 2594 non-GDM controls were recruited from among Tehran-Lipid and Glucose-Study participants. Generalized estimating equations were applied to assess the time trend of adiposity indices including obesity, central obesity, body mass index (BMI), lipid accumulation product index (LAP), visceral adiposity index (VAI) and a body shape index (ABSI) in women with prior GDM and the non-GDM groups after further adjustment for age and BMI.ResultsMedian follow-up years for the GDM and non-GDM groups were 12.12 and 11.62 years, respectively. Women with GDM at initiation had worse adiposity indices than their healthy counterparts. While overall odds of obesity in women with prior GDM were significantly higher those of the non-GDM groups (OR: 1.35; 95% CI, 1.03–1.7; P = 0.03), both these groups overtime revealed a positive trend in obesity (P trend < 0.001), an incremental trend which was less pronounced in GDM women (OR: 0.87; 95% CI, 0.80, 0.95; P interaction = 0.001). Women with prior GDM had higher odds of central obesity, compared to non-GDM groups (OR: 1.44; 95% CI, 1.06–1.96; P = 0.02) and showed a significant an incremental trend overtime for both groups (P trend < 0.001 for both) without statistically significant interaction in terms of their GDM status (P interaction = 0.134). Mean VAI in women with prior GDM was significantly higher than the non-GDM group (19.7, 95%CI: 6.24, 33.15, P = 0.004), although both groups overtime experienced a negative trend (− 10.9, 95%CI: -13.1, − 2.1, P < 0.001); the GDM group showed a higher decrease in VAI (mean changes: -6.62; 95% CI, − 11,-2.1; P interaction = 0.001). However overtime there was a positive trend in LAP and ABSI among both women with and without prior-GDM, though the mean changes were less obvious in women with prior GDM.ConclusionWomen with prior GDM gained better control of their adiposity than non-GDM women. Nevertheless the increasing numbers of individuals with GDM and uncontrolled adiposity indices, require prompt attention be paid to the issue.

Gestational Diabetes Mellitus Knowledge Assessment among Saudi Women.

BACKGROUND:IDF estimates that 16.2% of women giving live births in 2015 had some form of hyperglycemia during pregnancy. In Saudi, a study estimated that the prevalence of gestational diabetes mellitus (GDM) is 39.4%.AIM:We aimed to assess Saudi women’s GDM knowledge and awareness.METHODS:A cross-sectional study was conducted between August and December 2016 in Saudi Arabia using a validated questionnaire that included 12 questions focused on awareness and knowledge about GDM. Their responses were scored, and participants were divided poor knowledge (≤ 4/12) fair/good knowledge (≥ 5/12).RESULTS:A total of 9002 adult female participated. Mean age was 27.8 ± 7.9, and they were mainly married urban residents with bachelor’s degrees or higher. The mean overall score was 5.5 ± 2.5 with most of them in the fair GDM knowledge category. Participants were mostly aware of the GDM risk factors (54%) while they were least aware of the GDM diagnosis (15.9%). Multigravida and a prior history of GDM were the two risk factors about which participants were most aware (67.7%). Compared to those with poor knowledge, those with fair/good knowledge were more likely to live in urban areas, live in the central region of Saudi Arabia, work in medical fields, and be married, educated, and have personal and/or family histories of chronic diseases (all P values < 0.001).CONCLUSION:Our study showed a high prevalence of poor awareness and knowledge, mainly in those areas relating to GDM diagnosis.

Diabetes incidence and influencing factors in women with and without gestational diabetes mellitus: A 15year population-based follow-up cohort study.

Very few extensive follow-up investigations evaluating patients with history of gestational diabetes mellitus (GDM) have been documented. We conducted this longitudinal study to estimate the incidence of diabetes and its predictors in women with and without GDM. A total of 2458 eligible women, aged 20-50years (476 with GDM and 1982 without GDM) were selected from among participants of the Tehran Lipid and Glucose study, based on the World Health Organization definition for GDM screening. Pooled logistic regression was used to assess the association between time-dependent covariates and diabetes. The incidence rate of diagnosed diabetes was 9/1000 for women with GDM and 4/1000 for their counterparts, without GDM. Kaplan-Meier curve indicated a significantly shorter median time for developing diabetes in women with a history of GDM (6.95years [IQ: 4.22-10.71]), compared to their healthy peers (8.45years [IQ: 5.08-10.89]). BMI and previous family history of diabetes were found as major risk factors for future diabetes in women with GDM. The results presented here lead to better identification and selection of at-risk women with prior GDM history.

Prediction of Gestational Diabetes Mellitus in Early Pregnancy: Is Abdominal Skin Fold Thickness 20 mm or More an Independent Risk Predictor?

Background: Gestational Diabetes Mellitus (GDM) is associated with several maternal and perinatal complications. Early detection and treatment can improve pregnancy outcomes. Objectives: To determine the prevalence, risk factors and predictors of GDM in early pregnancy at the University of Port Harcourt Teaching Hospital, (UPTH), Port Harcourt Nigeria. Methods: A cohort of 235 mothers who registered for antenatal care between 15 - 18 weeks of gestation at UPTH was prospectively studied. Their socio-demographic data, examination findings, anthropometric measurements, fasting blood sugar at booking and OGTT results at 28 weeks gestation were collated and entered into PC with SPSS for windows version 21.0 which was also used for the analysis. Variables were expressed as absolute numbers, percentages or means with standard deviations and significant differences determined using chi square test or the student “t” test as appropriate. The level of significance was set at P Women who had GDM were significantly older (P = 0.001), had higher weight (t = 2.95, P = 0.01), BMI (t = 2.29, P = 0.02), abdominal skin fold thickness (t = 4.15, P = 0.001), blood pressure (t = 3.38, P = 0.001) compared to women who did not. Previous history of GDM was significantly different between two groups as χ2 = 93.56 and P = 0.001. Abdominal skin fold thickness and prior GDM history were found to be independent predictors of GDM on application of multiple logistic regression analysis. Conclusion: The prevalence of GDM in Port Harcourt is 14.9% and major risk factors are obesity, previous GDM history, advanced age and hypertension. Abdominal skin fold thickness ≥ 20 mm is an independent predictor. The risk of developing GDM can be predicted in early second trimester using algorithm incorporating risk factor screening and anterior abdominal wall skin fold thickness estimation.

Accelerated metabolic susceptibility to type 2 diabetes in older women with a history of gestational diabetes

The purpose of this study is to compare central obesity, insulin sensitivity, and cardiovascular disease risk factors between premenopausal and postmenopausal women with a history of gestational diabetes mellitus (GDM), controls, and women with type 2 diabetes (T2DM). Subjects were 73 overweight/obese and sedentary women who had a history of GDM (n=31) and were either premenopausal (n=11, 44±1 years, X±s.e.m.), postmenopausal (n=20, 58±1 years), or without a history of GDM as healthy postmenopausal controls (n=27, 57±1 years) or postmenopausal with T2DM (n=16, 59±1 years). The premenopausal GDM women had higher maximal oxygen uptake and lower visceral fat than the other three groups (P<0.05). BMI, %body fat, subcutaneous abdominal fat, and intramuscular fat did not differ significantly among the four groups. Glucose utilization (M, 3 h 40 mU/m2 per min hyperinsulinemic–euglycemic clamps) was 27% higher (P=0.05) in pre- than postmenopausal GDM and was not different between premenopausal GDM and postmenopausal controls. M was 28% lower (P=0.06) in postmenopausal GDM than controls and was not significantly different between postmenopausal GDM and T2DM groups. Thus, despite being younger and more physically fit, premenopausal women with prior GDM display similar central obesity, glucose, and metabolic profiles as postmenopausal controls. Postmenopausal women with prior GDM are more insulin resistant than controls of similar age, adiposity, and fitness levels and display comparable glucose utilization rates as similar as women with T2DM suggesting that a prior history of GDM may be an early manifestation of increased risk of later T2DM.

Diagnosis of gestational diabetes mellitus: Can we avoid the glucose challenge test?

To identify risk factors for gestational diabetes mellitus (GDM) in patients who had either a normal or abnormal glucose tolerance test (GTT) after failing the initial glucose challenge test (GCT). If identified, consideration can be given to circumvent the glucose challenge test for those at risk. A chart review was performed on 557 patients with abnormal GCT, 278 had an abnormal GTT (cases), and 279 had normal GTT (controls). The following risk factors were extracted: patients' age, body mass index (BMI), ethnicity, selected personal history, and family history. A primary logistic regression and secondary exploratory logistic regression were used to analyze the data. Of the risk factors reviewed age, BMI, and prior history of GDM were predictive of GDM in the current pregnancy. Age 30-34 had an odds ratio (OR) of 1.95, 95% confidence interval (CI) [1.25,3.05] and over 35 had an OR 3.87 CI [2.12,7.05]. BMI over 30 had an OR 1.95, CI [1.25,3.05] and prior GDM had an OR 2.82 CI [1.55,5.13]. The combination of age and BMI had a significant OR, but not a significant increase over individual risk factors. Screening by risk factors to circumvent glucose challenge testing may cause unnecessary testing and cost.

Effect of the Diagnostic Criteria of the International Association of Diabetes and Pregnancy Study Groups on the Prevalence of Gestational Diabetes Mellitus In Urban Mexican Women: A Cross-Sectional Study

To explore the prevalence of gestational diabetes mellitus (GDM), defined by the previous criteria of the American Diabetes Association (ADA), as well as the criteria suggested by the International Association of Diabetes and Pregnancy Study Groups (IADPSG), in an unselected group of urban Mexican pregnant women and to analyze the frequency of large for gestational age (LGA) newborns in this same group of women with use of both diagnostic criteria. A cross-sectional study included 803 consecutive Mexican urban women with a singleton pregnancy, without concomitant diseases and no prior history of GDM, who underwent a 2-step screening protocol for diagnosis of GDM at admission to prenatal care. The ADA criteria identified 83 women (10.3%) whereas the IADPSG criteria diagnosed 242 women (30.1%) having GDM (P = .0001). Fasting glucose concentrations during the 100-g 3-hour oral glucose tolerance test were abnormal in 116 women (14.4%) and in 160 women (19.9%) on the basis of ADA and IADPSG criteria, respectively (P = .004). The frequency of LGA newborns was 7.4% based on IADPSG criteria and 6.0% based on ADA criteria-no significant difference (P = .64). With use of the IADPSG criteria, the prevalence of GDM increased almost 3-fold in comparison with that for the ADA criteria. Nevertheless, no significant difference was found in the prevalence of LGA newborns.

Identifying postpartum intervention approaches to prevent type 2 diabetes in women with a history of gestational diabetes

BackgroundWomen who develop gestational diabetes mellitus (GDM) have an increased risk for the development of type 2 diabetes. Despite this "window of opportunity," few intervention studies have targeted postpartum women with a history of GDM. We sought perspectives of women with a history of GDM to identify a) barriers and facilitators to healthy lifestyle changes postpartum, and b) specific intervention approaches that would facilitate participation in a postpartum lifestyle intervention program.MethodsWe used mixed methods to gather data from women with a prior history of GDM, including focus groups and informant interviews. Analysis of focus groups relied on grounded theory and used open-coding to categorize data by themes, while frequency distributions were used for the informant interviews.ResultsOf 38 women eligible to participate in focus groups, only ten women were able to accommodate their schedules to attend a focus group and 15 completed informant interviews by phone. We analyzed data from 25 women (mean age 35, mean pre-pregnancy BMI 28, 52% Caucasian, 20% African American, 12% Asian, 8% American Indian, 8% refused to specify). Themes from the focus groups included concern about developing type 2 diabetes, barriers to changing diet, and barriers to increasing physical activity. In one focus group, women expressed frustration about feeling judged by their physicians during their GDM pregnancy. Cited barriers to lifestyle change were identified from both methods, and included time and financial constraints, childcare duties, lack of motivation, fatigue, and obstacles at work. Informants suggested facilitators for lifestyle change, including nutrition education, accountability, exercise partners/groups, access to gyms with childcare, and home exercise equipment. All focus group and informant interview participants reported access to the internet, and the majority expressed interest in an intervention program delivered primarily via the internet that would include the opportunity to work with a lifestyle coach.ConclusionTime constraints were a major barrier. Our findings suggest that an internet-based lifestyle intervention program should be tested as a novel approach to prevent type 2 diabetes in postpartum women with a history of GDM.Trial RegistrationClinicalTrials.gov: NCT01102530

Clinical Indications for Abnormal Early Gestational 50-g Glucose Tolerance Testing

Providers occasionally screen women thought to be at particularly increased risk of gestational diabetes mellitus (GDM) with a first- or second-trimester ("early") glucose tolerance test (GTT). We sought to describe how the frequency of abnormal early GTT varies by indication for testing. This is a retrospective cohort study of women receiving prenatal care in our clinic who underwent a 50-g GTT at less than 24 weeks between 2003 and 2006. Three hundred five women received an early GTT. The most common indications for early screening were obesity (53%), family history of diabetes (15%), prior history of GDM (10%), and multifetal gestation (5%). The frequency of abnormal testing in patients with multifetal gestations and a personal history of GDM was higher than in those undergoing early testing because of obesity. The frequency of abnormal early GTT varies by indication for testing. These data may be used in the allocation of health care resources.

Relationship Between Body Mass Index and Gestational Diabetes Mellitus in Immigrant Asian and Middle-Eastern Women in the United States

TEXT: Effects of overweight and obesity on the prevalence of Gestational Diabetes Mellitus (GDM) were investigated in two ethnic groups in the US: Asian and Middle-Eastern (M-E). Prenatal and delivery records of 567 patients (231 Asian and 336 M-E) from two private practice Obstetrics-Gynecology offices were reviewed. Subjects were screened for GDM at 24-28 weeks gestation. Those with plasma glucose 138 mg/dl underwent a 3-hour, 100g glucose tolerance test for diagnosis of GDM by the physician. Overall GDM prevalence (cases/100) was 6.5. Prevalence of 10.0 for Asian women was higher than the 4.2 for M-E women (p 0.006), and 2.7 for a non-Hispanic White population from a previous state-derived study (p 0.000). Women diagnosed with GDM (GDM ) were heavier than women with normal glucose tolerance (GDM ). Average BMI was 25.4 4.7 vs 21.5 3.2 (p 0.000) for Asian women, and 29.1 5.8 vs 25.2 4.6 (p 0.001) for M-E women. Relative risk for developing GDM for women with BMI 25 versus women with BMI 25 was 2.5 for Asians and 1.4 for M-E women. Compared to M-E women, Asians were older (p 0.000), less parous (p 0.000), and had lower BMI (p 0.000). A higher percentage of GDM Asians had pregravida BMI 25 (p 0.024), gained excessive weight (p 0.000), and had prior history of GDM (p 0.023) than the GDM Asians. More GDM M-E women had a family history of diabetes (p 0.003) and delivered heavier babies (p 0.032) than the GDM women. Ethnicity and obesity were important risk factors for developing GDM in this sample.