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Zhang L, Zheng W, Huang W, Zhang L, Liang X, Li G. Differing risk factors for new onset and recurrent gestational diabetes mellitus in multipara women: a cohort study. BMC Endocr Disord 2022; 22:3. [PMID: 34983464 PMCID: PMC8728925 DOI: 10.1186/s12902-021-00920-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 11/29/2021] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES To assess whether recurrent gestational diabetes mellitus (GDM) and newly diagnosed GDM share similar risk factors. METHODS The study recruited a cohort of 10,151 multipara women with singleton pregnancy who delivered between 2016 and 2019 in Beijing, China. The prevalence of recurrent GDM and associated risk factors were analyzed between women with and without prior GDM history. RESULTS Eight hundred and seventy-five (8.6%) multipara women had a diagnosis of GDM during previous pregnancies. The prevalence of GDM and pre-gestational diabetes mellitus were 48.34% (423/875) and 7.89% (69/875) if the women were diagnosed with GDM during previous pregnancies, as compared to 16.00% (1484/9276) and 0.50% (46/9276) if the women were never diagnosed with GDM before. In women without a history of GDM, a variety of factors including older maternal age, higher pre-pregnancy body mass index (PPBMI), prolonged interval between the two pregnancies, higher early pregnancy weight gain, family history of type 2 diabetes mellitus (T2DM), maternal low birth weight, and higher early pregnancy glycemic and lipid indexes were generally associated with an increased risk of GDM at subsequent pregnancy. In women with a history of GDM, higher PPBMI, higher fasting glucose level and maternal birthweight ≥4000 g were independent risk factors for recurrent GDM. CONCLUSIONS GDM reoccurred in nearly half of women with a history of GDM. Risk factors for recurrent GDM and newly diagnosed GDM were different. Identifying additional factors for GDM recurrence can help guide clinical management for future pregnancies to prevent GDM recurrence.
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Affiliation(s)
- Li Zhang
- Division of Endocrinology and Metabolism, Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, No 251, Yaojiayuan Road, Chaoyang District, Beijing, 100026, China
- Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Wei Zheng
- Division of Endocrinology and Metabolism, Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, No 251, Yaojiayuan Road, Chaoyang District, Beijing, 100026, China
- Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Wenyu Huang
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Lirui Zhang
- Division of Endocrinology and Metabolism, Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, No 251, Yaojiayuan Road, Chaoyang District, Beijing, 100026, China
- Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Xin Liang
- Division of Endocrinology and Metabolism, Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, No 251, Yaojiayuan Road, Chaoyang District, Beijing, 100026, China
- Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Guanghui Li
- Division of Endocrinology and Metabolism, Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, No 251, Yaojiayuan Road, Chaoyang District, Beijing, 100026, China.
- Beijing Maternal and Child Health Care Hospital, Beijing, China.
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Bhattacharya S, Nagendra L, Krishnamurthy A, Lakhani OJ, Kapoor N, Kalra B, Kalra S. Early Gestational Diabetes Mellitus: Diagnostic Strategies and Clinical Implications. Med Sci (Basel) 2021; 9:59. [PMID: 34698239 PMCID: PMC8544345 DOI: 10.3390/medsci9040059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 09/17/2021] [Accepted: 09/18/2021] [Indexed: 12/16/2022] Open
Abstract
Preexisting diabetes mellitus (DM) should be ruled out early in pregnancy in those at risk. During screening, a significant proportion of women do not reach the threshold for overt DM but fulfill the criteria used for diagnosing conventional gestational DM (cGDM). There is no consensus on the management of pregnancies with intermediate levels of hyperglycemia thus diagnosed. We have used the term early gestational DM (eGDM) for this condition and reviewed the currently available literature. Fasting plasma glucose (FPG), oral glucose tolerance test, and glycated hemoglobin (HbA1c) are the commonly employed screening tools in early pregnancy. Observational studies suggest that early pregnancy FPG and Hba1c correlate with the risk of cGDM and adverse perinatal outcomes. However, specific cut-offs, including those proposed by the International Association of the Diabetes and Pregnancy Study Group, do not reliably predict the development of cGDM. Emerging data, though indicate that FPG ≥ 92 mg/dL (5.1 mmol/L), even in the absence of cGDM, signals the risk for perinatal complication. Elevated HbA1c, especially a level ≥ 5.9%, also correlates with the risk of cGDM and worsened outcome. HbA1c as a diagnostic test is however besieged with the usual caveats that occur in pregnancy. The studies that explored the effects of intervention present conflicting results, including a possibility of fetal malnutrition and small-for-date baby in the early treatment group. Diagnostic thresholds and glycemic targets in eGDM may differ, and large multicenter randomized controlled trials are necessary to define the appropriate strategy.
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Affiliation(s)
| | - Lakshmi Nagendra
- Department of Endocrinology, K.S Hegde Medical Academy, Mangalore 575018, India;
| | | | - Om J. Lakhani
- Department of Endocrinology, Zydus Hospital, Ahmedabad 380058, India;
| | - Nitin Kapoor
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore 632004, India;
| | - Bharti Kalra
- Department of Obstetrics, Bharti Hospital, Karnal 132001, India;
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal 132001, India;
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Sánchez-García A, Rodríguez-Gutiérrez R, Saldívar-Rodríguez D, Guzmán-López A, Mancillas-Adame L, González-Nava V, Santos-Santillana K, González-González JG. Early triglyceride and glucose index as a risk marker for gestational diabetes mellitus. Int J Gynaecol Obstet 2020; 151:117-123. [PMID: 32679624 DOI: 10.1002/ijgo.13311] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/08/2020] [Accepted: 07/14/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To assess the risk of gestational diabetes mellitus (GDM) according to the triglyceride and glucose (TyG) index values during the first trimester of pregnancy in Latin American women. METHODS Pregnant women were enrolled at their first prenatal visit at the Obstetric Division in the University Hospital "Dr. José E. González". Triglycerides and fasting plasma glucose (FPG) were collected to determine the TyG index. GDM diagnosis was performed by a single-step 2-hour 75-g oral glucose tolerance test. Generalized linear models were used to determine risk ratios; pregnancy outcomes at delivery were collected from the hospital medical records. RESULTS A total of 164 pregnant women were included. GDM was present in 29 (17.7%) women. No significant differences in age, first-trimester body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters), family history of diabetes, and TyG index were observed between GDM cases and the reference group without GDM. The adjusted analysis showed no association between TyG and GDM (risk ratio [RR] 1.03, 95% confidence interval [CI] 0.57-1.88]). Higher TyG index values between women with and without a diagnosis of GDM in the second trimester were observed. No significant differences were identified in pregnancy outcomes, although a trend was observed for hyperbilirubinemia in women with first-trimester TyG index values greater than 8.7. CONCLUSIONS Our findings do not support the use of the TyG index for GDM prediction in Latin American women.
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Affiliation(s)
- Adriana Sánchez-García
- Endocrinology Division, Facultad de Medicina y Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, NL, Mexico
| | - René Rodríguez-Gutiérrez
- Endocrinology Division, Facultad de Medicina y Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, NL, Mexico.,Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit México), Universidad Autónoma de Nuevo León, Monterrey, NL, Mexico.,Knowledge and Evaluation Research Unit in Endocrinology, Mayo Clinic, Rochester, MN, USA.,Research Unit, Facultad de Medicina y Hospital Universitario "Dr. Jose E. González", Universidad Autónoma de Nuevo León, Monterrey, NL, Mexico
| | - Donato Saldívar-Rodríguez
- Obstetric Division, Facultad de Medicina y Hospital Universitario "Dr. Jose E. González", Universidad Autónoma de Nuevo León, Monterrey, NL, Mexico
| | - Abel Guzmán-López
- Obstetric Division, Facultad de Medicina y Hospital Universitario "Dr. Jose E. González", Universidad Autónoma de Nuevo León, Monterrey, NL, Mexico
| | - Leonardo Mancillas-Adame
- Endocrinology Division, Facultad de Medicina y Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, NL, Mexico.,Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit México), Universidad Autónoma de Nuevo León, Monterrey, NL, Mexico
| | - Victoria González-Nava
- Endocrinology Division, Facultad de Medicina y Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, NL, Mexico.,Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit México), Universidad Autónoma de Nuevo León, Monterrey, NL, Mexico
| | - Karla Santos-Santillana
- Endocrinology Division, Facultad de Medicina y Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, NL, Mexico
| | - José G González-González
- Endocrinology Division, Facultad de Medicina y Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, NL, Mexico.,Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit México), Universidad Autónoma de Nuevo León, Monterrey, NL, Mexico.,Research Unit, Facultad de Medicina y Hospital Universitario "Dr. Jose E. González", Universidad Autónoma de Nuevo León, Monterrey, NL, Mexico
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Sert UY, Ozgu-Erdinc AS. Gestational Diabetes Mellitus Screening and Diagnosis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1307:231-255. [PMID: 32314318 DOI: 10.1007/5584_2020_512] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
An ideal screening test for gestational diabetes should be capable of identifying not only women with the disease but also the women with a high risk of developing gestational diabetes mellitus (GDM). Screening and diagnosis are the main steps leading to the way of management. There is a lack of consensus among healthcare professionals regarding the screening methods worldwide. Different study groups advocate a variety of screening methods with the support of evidence-based comprehensive data. Some of the organizations suggest screening for high risk or all pregnant women, while others prefer to offer definitive testing without screening. Glycemic thresholds are also not standardized to decide GDM among different guidelines. Prevalence rates of GDM vary between populations and with the choice of glucose thresholds for both screening and definitive tests. One-step or two-step methods have been used for GDM diagnosis. However, screening includes selecting patients with historical risk factors, 50 g 1-h glucose challenge test, fasting plasma glucose, random plasma glucose, and hemoglobin A1c with different cutoffs. In this chapter, screening and diagnosis methods of GDM accepted by different study groups will be discussed which will be followed by the evaluation of different glycemic thresholds. Then the advantages and disadvantages of used methods will be explained and the chapter will finish with an evaluation of the current international guidelines.
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Affiliation(s)
- U Yasemin Sert
- Ministry of Health-Ankara City Hospital, Universiteler Mahallesi Bilkent Cad, Ankara, Turkey
| | - A Seval Ozgu-Erdinc
- Ministry of Health-Ankara City Hospital, Universiteler Mahallesi Bilkent Cad, Ankara, Turkey.
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