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Taieb A, Majdoub M, Souissi N, Chelly S, Ben Abdelkrim A. Determination of the Contributing Factors and HbA1c Cutoff Leading to Glucose Tolerance Abnormalities Following Gestational Diabetes. Cureus 2024; 16:e56218. [PMID: 38618305 PMCID: PMC11016321 DOI: 10.7759/cureus.56218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2024] [Indexed: 04/16/2024] Open
Abstract
The prevalence of gestational diabetes mellitus (GDM) has been steadily increasing over the past years. It is a major risk factor for glucose intolerance and type 2 DM (T2DM). The American Diabetes Association recommends that women whose pregnancy was complicated by GDM be screened for persistent glucose abnormalities at six to 12 weeks postpartum with either a fasting plasma glucose test alone or with a fasting 75-g, two-hour oral glucose tolerance test. This study aimed to identify the main predictive factors of glucose tolerance disorders in early postpartum women with a recent history of GDM. In this retrospective descriptive study, we identified 400 women who met the eligibility criteria for the study. The mean age was 34.54 ± 5.51 years. A total of 70% had a family history of DM, 16% had a personal history of GDM, and 23% had fetal macrosomia in previous pregnancies. The overall incidence of postpartum carbohydrate tolerance disorders was 36.4%, including 12% prediabetes and 24.4% DM. The prevalence of prediabetes and T2DM after delivery was higher with older maternal age, multigravidity, a higher BMI, a history of GDM, and fetal macrosomia in previous pregnancies. Furthermore, the persistence of this impaired glucose tolerance in postpartum was associated with a higher term of diagnosis, a higher glycated hemoglobin (HbA1c) percentage (the discriminant cutoff value with the best sensitivity/specificity ratio was 5.25%), the use of insulin therapy, cesarean section delivery, and fetal macrosomia. After adjusting for confounders, only prior GDM, a higher HbA1c level, macrosomia, and gestational term were found to significantly affect postpartum glucose tolerance. Although postpartum screening for T2DM is recommended for all women with GDM, a significant number of patients fail it. A better knowledge of predictive factors for this outcome is therefore needed for a more effective and targeted medical intervention.
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Affiliation(s)
- Ach Taieb
- Endocrinology, Hospital University of Farhat Hached Sousse Tunisia, Sousse, TUN
| | - Marwa Majdoub
- Endocrinology, Hospital University of Farhat Hached Sousse Tunisia, Sousse, TUN
| | - Nesrine Souissi
- Nutrition, Hospital University of Farhat Hached Sousse Tunisia, Sousse, TUN
| | - Souhir Chelly
- Infectious Control and Prevention, Hospital University of Farhat Hached Sousse Tunisia, Sousse, TUN
| | - Asma Ben Abdelkrim
- Endocrinology, Hospital University of Farhat Hached Sousse Tunisia, Sousse, TUN
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Belsti Y, Moran L, Handiso DW, Versace V, Goldstein R, Mousa A, Teede H, Enticott J. Models Predicting Postpartum Glucose Intolerance Among Women with a History of Gestational Diabetes Mellitus: a Systematic Review. Curr Diab Rep 2023; 23:231-243. [PMID: 37294513 PMCID: PMC10435618 DOI: 10.1007/s11892-023-01516-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/22/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE OF REVIEW Despite the crucial role that prediction models play in guiding early risk stratification and timely intervention to prevent type 2 diabetes after gestational diabetes mellitus (GDM), their use is not widespread in clinical practice. The purpose of this review is to examine the methodological characteristics and quality of existing prognostic models predicting postpartum glucose intolerance following GDM. RECENT FINDINGS A systematic review was conducted on relevant risk prediction models, resulting in 15 eligible publications from research groups in various countries. Our review found that traditional statistical models were more common than machine learning models, and only two were assessed to have a low risk of bias. Seven were internally validated, but none were externally validated. Model discrimination and calibration were done in 13 and four studies, respectively. Various predictors were identified, including body mass index, fasting glucose concentration during pregnancy, maternal age, family history of diabetes, biochemical variables, oral glucose tolerance test, use of insulin in pregnancy, postnatal fasting glucose level, genetic risk factors, hemoglobin A1c, and weight. The existing prognostic models for glucose intolerance following GDM have various methodological shortcomings, with only a few models being assessed to have low risk of bias and validated internally. Future research should prioritize the development of robust, high-quality risk prediction models that follow appropriate guidelines, in order to advance this area and improve early risk stratification and intervention for glucose intolerance and type 2 diabetes among women who have had GDM.
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Affiliation(s)
- Yitayeh Belsti
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Lisa Moran
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Demelash Woldeyohannes Handiso
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Vincent Versace
- Deakin Rural Health, School of Medicine, Deakin University, Warrnambool, Australia
| | - Rebecca Goldstein
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Monash Health, Clayton, Melbourne, Australia
| | - Aya Mousa
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Monash Health, Clayton, Melbourne, Australia
| | - Joanne Enticott
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
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Zieleniak A, Zurawska-Klis M, Cypryk K, Wozniak L, Wojcik M. Transcriptomic Dysregulation of Inflammation-Related Genes in Leukocytes of Patients with Gestational Diabetes Mellitus (GDM) during and after Pregnancy: Identifying Potential Biomarkers Relevant to Glycemic Abnormality. Int J Mol Sci 2022; 23:ijms232314677. [PMID: 36499008 PMCID: PMC9737950 DOI: 10.3390/ijms232314677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/14/2022] [Accepted: 11/18/2022] [Indexed: 11/26/2022] Open
Abstract
Although the immune system has been implicated in the pathophysiology of gestational diabetes mellitus (GDM) and postpartum abnormal glucose tolerance (AGT), little is known about the transcriptional response of inflammation-related genes linked to metabolic phenotypes of GDM women during and after pregnancy, which may be potential diagnostic classifiers for GDM and biomarkers for predicting AGT. To address these questions, gene expression of IL6, IL8, IL10, IL13, IL18, TNFA, and the nuclear factor κB (NFκB)/RELA transcription factor were quantified in leukocytes of 28 diabetic women at GDM diagnosis (GDM group) and 1-year postpartum (pGDM group: 10 women with AGT and 18 normoglycemic women), using a nested RT-PCR method. Control pregnancies with normal glucose tolerance (NGT group; n = 31) were closely matched for maternal age, gestational age, pre-pregnancy BMI, pregnancy weight, and gestational weight gain. Compared with the NGT group, IL8 was downregulated in the GDM group, and IL13 and RELA were upregulated in the pGDM group, whereas IL6, IL10, and IL18 were upregulated in the GDM and pGDM groups. The TNFA level did not change from pregnancy to postpartum. Associations of some cytokines with glycemic measures were detected in pregnancy (IL6 and RELA) and postpartum (IL10) (p < 0.05). Receiver operating characteristic (ROC) curves showed that IL6, IL8, and IL18, if employed alone, can discriminate GDM patients from NGT individuals at GDM diagnosis, with the area under the ROC curves (AUCs) of 0.844, (95% CI 0.736−0.953), 0.771 (95% CI 0.651−0.890), and 0.714 (95% CI 0.582−0.846), respectively. By the logistic regression method, we also identified a three-gene panel (IL8, IL13, and TNFA) for postpartum AGT prediction. This study demonstrates a different transcriptional response of the studied genes in clinically well-characterized women with GDM at GDM diagnosis and 1-year postpartum, and provides novel transcriptomic biomarkers for future efforts aimed at diagnosing GDM and identifying the high risk of postpartum AGT groups.
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Affiliation(s)
- Andrzej Zieleniak
- Department of Structural Biology, Faculty of Biomedical Sciences, Medical University of Lodz, 90-752 Lodz, Poland
| | - Monika Zurawska-Klis
- Department of Internal Diseases and Diabetology, Medical University of Lodz, 92-213 Lodz, Poland
| | - Katarzyna Cypryk
- Department of Internal Diseases and Diabetology, Medical University of Lodz, 92-213 Lodz, Poland
| | - Lucyna Wozniak
- Department of Structural Biology, Faculty of Biomedical Sciences, Medical University of Lodz, 90-752 Lodz, Poland
| | - Marzena Wojcik
- Department of Structural Biology, Faculty of Biomedical Sciences, Medical University of Lodz, 90-752 Lodz, Poland
- Correspondence: ; Tel.: +48-426-393-238
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García-Moreno RM, Benítez-Valderrama P, Barquiel B, Hillman N, Herranz L, Pérez-de-Villar NG. Predictors of postpartum glucose metabolism disorders in women with gestational diabetes mellitus. Diabetes Metab Syndr 2022; 16:102629. [PMID: 36191536 DOI: 10.1016/j.dsx.2022.102629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS Postpartum glucose metabolism disorders are a common problem in women with gestational diabetes mellitus (GDM). They are often underdiagnosed since many patients do not attend the postpartum screening. This study aims to assess predictors of postpartum glucose metabolism disorders and type 2 diabetes mellitus (T2DM) after GDM. MATERIAL AND METHODS Retrospective study in women with GMD who underwent postpartum screening for glucose metabolism disorders (n = 2688). Logistic regression was used in the statistical analysis. RESULTS 24.6% of women had postpartum glucose metabolism disorder. In multivariate analysis, pre-pregnancy body mass index (BMI) 25-30 kg/m2 (OR 1.46, 95%CI 1.05 to 2.02) or BMI ≥30 kg/m2 (OR 2.62, 95%CI 1.72 to 3.96), diagnosis of GDM before 20 weeks of pregnancy (OR 2.33, 95%CI 1.57 to 3.46), fasting plasma glucose after diagnosis of GDM ≥90 mg/dl (OR 2.12, 95%CI 1.50 to 2.98), postprandial glucose ≥100 mg/dl (OR 1.47, 95%CI 1.09 to 2.99), and HbA1c in the third trimester of pregnancy ≥5.3% (2.04, 95%CI, 1.52 to 2.75) were independent predictors for any postpartum glucose metabolism disorder. CONCLUSION postpartum screening for T2DM should be performed in all women with GDM, and it is especially important not to lose follow-up in those with one or more predictive factors.
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Affiliation(s)
- Rosa M García-Moreno
- Department of Endocrinology and Nutrition, Hospital Universitario La Paz, Madrid, Spain.
| | | | - Beatriz Barquiel
- Department of Endocrinology and Nutrition, Hospital Universitario La Paz, Madrid, Spain
| | - Natalia Hillman
- Department of Endocrinology and Nutrition, Hospital Universitario La Paz, Madrid, Spain
| | - Lucrecia Herranz
- Department of Endocrinology and Nutrition, Hospital Universitario La Paz, Madrid, Spain
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Bartáková V, Barátová B, Pácal L, Ťápalová V, Šebestová S, Janků P, Kaňková K. Development of a New Risk Score for Stratification of Women with Gestational Diabetes Mellitus at High Risk of Persisting Postpartum Glucose Intolerance Using Routinely Assessed Parameters. Life (Basel) 2021; 11:life11060464. [PMID: 34070991 PMCID: PMC8224770 DOI: 10.3390/life11060464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 01/21/2023] Open
Abstract
The aims of the study were (i) to find predictive factors for early postpartum conversion of gestational diabetes mellitus (GDM) into persisting glucose intolerance (PGI), (ii) to evaluate potential differences in adverse perinatal outcomes in GDM women with and without early postpartum PGI and, finally, (iii) to establish a risk score to predict postpartum PGI. A cross-sectional study comprised 244 GDM patients with known age, parity, positive family history of diabetes, pre-gestational BMI, comorbidities, smoking history, results of mid-trimester oral glucose tolerance test, HbA1c, obstetric complications, neonatal outcomes and mode of delivery. A risk score was calculated using parameters with highest odds ratios in a statistic scoring model. Significant differences between women with and without PGI postpartum were ascertained for mid-trimester fasting plasma glucose (p < 0.001), HbA1c above 42 mmol/mol (p = 0.035), prevalence of obesity (p = 0.007), hypothyroidism, family history of diabetes and smoking. We also observed higher incidence of prolonged and complicated delivery in PGI group (p = 0.04 and 0.007, respectively). In conclusion, this study identified several parameters with predictive potential for early PGI and also adverse peripartal outcomes. We established a simple risk-stratification score for PGI prediction applicable for GDM affected women prior their leaving maternity ward. Yet, given a relatively small sample size as a main limitation of this study, the proposed score should be validated in the larger cohort.
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Affiliation(s)
- Vendula Bartáková
- Department of Pathophysiology, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic; (B.B.); (L.P.); (K.K.)
- Correspondence: ; Tel.: +420-549-495-807
| | - Beáta Barátová
- Department of Pathophysiology, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic; (B.B.); (L.P.); (K.K.)
- Department of Pediatrics, University Children Hospital, Černopolní 9, 613 00 Brno, Czech Republic
| | - Lukáš Pácal
- Department of Pathophysiology, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic; (B.B.); (L.P.); (K.K.)
| | - Veronika Ťápalová
- Department of Obstetrics and Gynaecology, University Hospital Brno, 625 00 Brno, Czech Republic; (V.Ť.); (P.J.)
| | - Silvie Šebestová
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic;
| | - Petr Janků
- Department of Obstetrics and Gynaecology, University Hospital Brno, 625 00 Brno, Czech Republic; (V.Ť.); (P.J.)
- Department of Nursing and Midwifery, Masaryk University, 625 00 Brno, Czech Republic
| | - Kateřina Kaňková
- Department of Pathophysiology, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic; (B.B.); (L.P.); (K.K.)
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Kawasaki M, Arata N, Sakamoto N, Osamura A, Sato S, Ogawa Y, Yasuhi I, Waguri M, Hiramatsu Y. Risk factors during the early postpartum period for type 2 diabetes mellitus in women with gestational diabetes. Endocr J 2020; 67:427-437. [PMID: 31969529 DOI: 10.1507/endocrj.ej19-0367] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
For women with gestational diabetes mellitus (GDM), the evaluation of glucose tolerance (GT) in the early postpartum period is universally recommended. Nevertheless, few studies have evaluated the risk factors for T2DM on the basis of GT data obtained during the early postpartum period. We aimed to identify the risk factors for type 2 diabetes mellitus (T2DM) by evaluating GT in the first 12 weeks postpartum (12wPP) in women with GDM and to categorize the risk using a combination of the principal risk factors. This retrospective multicenter observational study included 399 East Asian women with GDM who underwent a 75-g oral glucose tolerance test (OGTT) within 12wPP, which was repeated annually or biennially and used to identify the postpartum development of T2DM. Forty-three women (10.8%) developed T2DM during a median follow-up period of 789 ± 477 days. The independent risk factors for T2DM were pre-pregnancy obesity (BMI ≥25 kg/m2), early postpartum impairment in glucose tolerance (IGT), and an early postpartum glycated hemoglobin (HbA1c) ≥5.7%. The odds ratios (95% confidence intervals) for T2DM were 3.2 (1.3-7.8) in women with either early postpartum IGT or pre-pregnancy obesity, 9.2 (3.0-28.3) in those with early postpartum IGT, pre-pregnancy obesity, and HbA1c <5.7%, and 51.4 (16.1-163.9) in those with early postpartum IGT, pre-pregnancy obesity, and HbA1c ≥5.7%, compared with those without obesity or IGT. T2DM risk in East Asian women with GDM should be stratified according to pre-pregnancy obesity and early postpartum IGT, and these patients should be followed up and receive appropriate care for their risk category.
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Affiliation(s)
- Maki Kawasaki
- Department of Health Policy, National Center for Child Health and Development, Tokyo 157-0074, Japan
- Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
| | - Naoko Arata
- Division of Maternal Medicine, Center for Maternal-Fetal, Neonatal, and Reproductive Medicine, National Center for Child Health and Development, Tokyo 157-0074, Japan
| | - Naoko Sakamoto
- Department of Epidemiologic Research, Faculty of Nursing, Toho University, Tokyo 143-8540, Japan
| | - Anna Osamura
- Division of Diabetes, Metabolism and Endocrinology, Department of Medicine, Showa University School of Medicine, Tokyo 142-8666, Japan
| | - Siori Sato
- Division of Maternal Medicine, Center for Maternal-Fetal, Neonatal, and Reproductive Medicine, National Center for Child Health and Development, Tokyo 157-0074, Japan
| | - Yoshihiro Ogawa
- Department of Molecular and Cellular Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Ichiro Yasuhi
- Department of Obstetrics and Gynecology, National Hospital Organization Nagasaki Medical Center, Omura, Nagasaki 856-8562, Japan
| | - Masako Waguri
- Department of Obstetric Medicine, Osaka Women's and Children's Hospital, Izumi, Osaka 594-1101, Japan
| | - Yuji Hiramatsu
- Okayama City General Medical Center, Okayama 700-0962, Japan
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Coetzee A, Mason D, Hall DR, Hoffmann M, Conradie M. Evidence for the utility of antenatal HbA1c to predict early postpartum diabetes after gestational diabetes in South Africa. Diabetes Res Clin Pract 2018; 143:50-55. [PMID: 29969724 DOI: 10.1016/j.diabres.2018.06.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 06/12/2018] [Accepted: 06/22/2018] [Indexed: 12/27/2022]
Abstract
Aim To evaluate antenatal HbA1c at diagnosis and in the 4 weeks preceding delivery to predict early postpartum diabetes mellitus (DM) in women with Gestational Diabetes Mellitus (GDM). Methods Seventy-eight women with GDM were prospectively assessed. The ability of HbA1c at GDM diagnosis (t1) and in the 4 weeks preceding delivery (t2) to predict DM 6-12 weeks after delivery was investigated. Glucose assessment was performed between November 1, 2015, and November 1, 2016 at Tygerberg Hospital (TH), Cape Town, South Africa (SA). Individuals with known pre-existing diabetes were excluded. Results HbA1c of 6.2% (44 mmol/mol) and 6.5% (48 mmol/mol) at t1 predicted DM with sensitivities of 95% and 90% and specificities of 62% and 70% respectively. At t2 the best cut-off for HbA1c, in accordance with t1, was also 6.2% (44 mmol/mol; sensitivity 92%, specificity 56%). Nineteen of the 29 women with suspected pre-gestational DM had HbA1c levels ≥ 6.5% (48 mmol/mol) at t1. The increased risk for postpartum DM with HbA1c ≥ 6.2% (44 mmol/mol) was four-fold (OR 3.97 CI 2.08-7.59p < 0.001) at t1 and five-fold (OR 5.08 CI 1.60-16.25 p = 0.006) at t2. Conclusion HbA1c lower than 6.5% (48 mmol/mol) predicts postpartum DM in women with GDM. HbA1c can serve as instrument to improve postpartum follow-up.
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Affiliation(s)
- Ankia Coetzee
- Department of Medicine, Division of Endocrinology, Stellenbosch University and Tygerberg Hospital, PO Box 19063, Tygerberg, Cape Town 7505, South Africa.
| | - Deidre Mason
- Department of Obstetrics & Gynecology, Tygerberg Hospital, PO Box 19063, Tygerberg, Cape Town 7505, South Africa.
| | - David R Hall
- Department of Obstetrics & Gynecology, Stellenbosch University and Tygerberg Hospital, PO Box 19063, Tygerberg, Cape Town 7505, South Africa.
| | - Mariza Hoffmann
- Department of Chemical Pathology, National Health Laboratory Services, Stellenbosch University and Tygerberg Hospital, PO Box 19063, Tygerberg, Cape Town 7505, South Africa.
| | - Magda Conradie
- Department of Medicine, Division of Endocrinology, Stellenbosch University and Tygerberg Hospital, PO Box 19063, Tygerberg, Cape Town 7505, South Africa.
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Nishikawa T, Ono K, Hashimoto S, Kinoshita H, Watanabe T, Araki H, Otsu K, Sakamoto W, Harada M, Toyonaga T, Kawakami S, Fukuda J, Haga Y, Kukidome D, Takahashi T, Araki E. One-hour oral glucose tolerance test plasma glucose at gestational diabetes diagnosis is a common predictor of the need for insulin therapy in pregnancy and postpartum impaired glucose tolerance. J Diabetes Investig 2018; 9:1370-1377. [PMID: 29624902 PMCID: PMC6215946 DOI: 10.1111/jdi.12848] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 03/19/2018] [Accepted: 03/25/2018] [Indexed: 12/15/2022] Open
Abstract
Aims/Introduction Gestational diabetes mellitus (GDM) is a risk for adverse perinatal outcomes, and patients with a history of GDM have an increased risk of impaired glucose tolerance (IGT). Here, we carried out two non‐interventional and retrospective studies of GDM patients in Japan. Materials and Methods In the first study, we enrolled 529 GDM patients and assessed predictors of the need for insulin therapy. In the second study, we enrolled 185 patients from the first study, and assessed predictors of postpartum IGT. Results In the first study, gestational weeks at GDM diagnosis and history of pregnancy were significantly lower, and pregestational body mass index, family history of diabetes mellitus, 1‐ and 2‐h glucose levels in a 75‐g oral glucose tolerance test (OGTT), the number of abnormal values in a 75‐g OGTT, and glycated hemoglobin were significantly higher in participants receiving insulin therapy. In the second study, 1‐ and 2‐h glucose levels in a 75‐g OGTT, the number of abnormal values in a 75‐g OGTT, glycated hemoglobin, and ketone bodies in a urine test were significantly higher in participants with OGT. Logistic regression analysis showed that gestational weeks at GDM diagnosis, 1‐h glucose levels in a 75‐g OGTT and glycated hemoglobin were significant predictors of the need for insulin therapy, and 1‐h glucose levels in a 75‐g OGTT at diagnosis and ketone bodies in a urine test were significant predictors for postpartum IGT. Conclusions Antepartum 1‐h glucose levels in a 75‐g OGTT was a predictor of the need for insulin therapy in pregnancy and postpartum IGT.
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Affiliation(s)
- Takeshi Nishikawa
- Department of Diabetes and Endocrinology, National Hospital Organization, Kumamoto Medical Center, Kumamoto, Japan
| | - Keiko Ono
- Department of Diabetes and Endocrinology, National Hospital Organization, Kumamoto Medical Center, Kumamoto, Japan
| | - Shoko Hashimoto
- Department of Diabetes and Endocrinology, National Hospital Organization, Kumamoto Medical Center, Kumamoto, Japan
| | - Hiroyuki Kinoshita
- Department of Diabetes and Endocrinology, National Hospital Organization, Kumamoto Medical Center, Kumamoto, Japan
| | - Takuro Watanabe
- Department of Diabetes and Endocrinology, National Hospital Organization, Kumamoto Medical Center, Kumamoto, Japan
| | - Hirotaka Araki
- Department of Diabetes and Endocrinology, National Hospital Organization, Kumamoto Medical Center, Kumamoto, Japan
| | - Kae Otsu
- Department of Diabetes and Endocrinology, National Hospital Organization, Kumamoto Medical Center, Kumamoto, Japan
| | - Wakana Sakamoto
- Department of Diabetes and Endocrinology, National Hospital Organization, Kumamoto Medical Center, Kumamoto, Japan
| | - Masahiro Harada
- Department of Diabetes and Endocrinology, National Hospital Organization, Kumamoto Medical Center, Kumamoto, Japan
| | | | | | | | - Yoshio Haga
- Amakusa Central General Hospital, Amakusa, Japan
| | - Daisuke Kukidome
- Faculty of Life Sciences, Department of Metabolic Medicine, Kumamoto University, Kumamoto, Japan
| | - Takeshi Takahashi
- Department of Diabetes and Endocrinology, National Hospital Organization, Kumamoto Medical Center, Kumamoto, Japan
| | - Eiich Araki
- Faculty of Life Sciences, Department of Metabolic Medicine, Kumamoto University, Kumamoto, Japan
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9
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Coetzee A, Mason D, Hall DR, Conradie M. Prevalence and predictive factors of early postpartum diabetes among women with gestational diabetes in a single-center cohort. Int J Gynaecol Obstet 2018; 142:54-60. [PMID: 29574853 DOI: 10.1002/ijgo.12494] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 01/28/2018] [Accepted: 03/22/2018] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To determine the prevalence of diabetes at 6-12 weeks postpartum among women with gestational diabetes mellitus (GDM), and to identify prenatal postpartum diabetes predictors. METHODS In the present prospective cohort study, glucose statuses of consecutive women newly diagnosed with hyperglycemia during pregnancy were evaluated at 6-12 weeks postpartum between November 1, 2015, and November 1, 2016, at Tygerberg Hospital, Cape Town, South Africa. Women with known diabetes were excluded. RESULTS There were 78 patients included; 36 (46%) patients had abnormal postpartum glucose values (21 [27%] diabetes; 15 [19%] pre-diabetes) and 29 (37%) had overt diabetes in pregnancy. In univariate analyses, GDM diagnosis before 24 weeks of pregnancy (P<0.001), degree of hyperglycemia at diagnosis (P=0.001), need for insulin (P=0.001), glycosylated hemoglobin (HbA1c) in the month preceding delivery (P=0.006), older than 36 years (P=0.039), family history of diabetes (P=0.048), and preterm labor (P=0.039) were risk factors for postpartum diabetes. Multivariate analyses confirmed family history of diabetes (OR 7.45, 95% CI 1.05-52.76; P=0.044), HbA1c at diagnosis (OR 5.33, 95% CI 2.25-12.60; P<0.001), and age (OR 8.8, 95% CI 1.35-58.45; P=0.023), as robust predictors of diabetes after GDM. CONCLUSION The high prevalence of diabetes supports early postpartum oral glucose tolerance testing. Several women had undiagnosed diabetes. The risk factors identified could be useful for prenatal risk stratification.
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Affiliation(s)
- Ankia Coetzee
- Department of Medicine, Division of Endocrinology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Deidre Mason
- Department of Obstetrics & Gynecology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - David R Hall
- Department of Obstetrics & Gynecology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Magda Conradie
- Department of Medicine, Division of Endocrinology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
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Kugishima Y, Yasuhi I, Yamashita H, Sugimi S, Umezaki Y, Suga S, Fukuda M, Kusuda N. Risk factors associated with the development of postpartum diabetes in Japanese women with gestational diabetes. BMC Pregnancy Childbirth 2018; 18:19. [PMID: 29310607 PMCID: PMC5759797 DOI: 10.1186/s12884-017-1654-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 12/29/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Although the onset of gestational diabetes (GDM) is known to be a significant risk factor for the future development of type 2 diabetes, this risk specifically in women with GDM diagnosed by the International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria has not yet been thoroughly investigated. This study was performed to investigate the risk factors associated with the development of postpartum diabetes in Japanese women with a history of GDM, and the effects of the differences in the previous Japanese criteria and the IADPSG criteria. METHODS This retrospective cohort study included Japanese women with GDM who underwent at least one postpartum oral glucose tolerance test (OGTT) between 2003 and 2014. Cases with overt diabetes in pregnancy were excluded. We investigated the risk factors including maternal baseline and pregnancy characteristics associated with the development of postpartum diabetes. RESULTS Among 354 women diagnosed with GDM during the study period, 306 (86%) (116/136 [85.3%] and 190/218 [87.2%] under the previous criteria and the IADPSG criteria, respectively) who underwent at least 1 follow-up OGTT were included in the study. Thirty-two women (10.1%) developed diabetes within a median follow-up period of 57 weeks (range, 6-292 weeks). Eleven (9.5%) and 21 (11.1%) were diagnosed as GDM during pregnancy based on the previous Japanese criteria and the IADPSG criteria, respectively, which did not significantly differ between those criteria. A multivariate logistic regression analysis revealed that HbA1c and 2-h plasma glucose (PG) at the time of the diagnostic OGTT during pregnancy were independent predictors of the development of diabetes after adjusting for confounders. The adjusted relative risk of HbA1c ≥5.6% for the development of diabetes was 4.67 (95% confidence interval, 1.53-16.73), while that of 2-h PG ≥183 mg/dl was 7.02 (2.51-20.72). CONCLUSIONS A modest elevation of the HbA1c and 2-h PG values at the time of the diagnosis of GDM during pregnancy are independent predictors of the development of diabetes during the postpartum period in Japanese women with a history of GDM. The diagnostic criteria did not affect the incidence of postpartum diabetes.
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Affiliation(s)
- Yukari Kugishima
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 2-chome Kubara, Omura City, Nagasaki, 856-8562, Japan
| | - Ichiro Yasuhi
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 2-chome Kubara, Omura City, Nagasaki, 856-8562, Japan.
| | - Hiroshi Yamashita
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 2-chome Kubara, Omura City, Nagasaki, 856-8562, Japan
| | - So Sugimi
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 2-chome Kubara, Omura City, Nagasaki, 856-8562, Japan
| | - Yasushi Umezaki
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 2-chome Kubara, Omura City, Nagasaki, 856-8562, Japan
| | - Sachie Suga
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 2-chome Kubara, Omura City, Nagasaki, 856-8562, Japan
| | - Masashi Fukuda
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 2-chome Kubara, Omura City, Nagasaki, 856-8562, Japan
| | - Nobuko Kusuda
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 2-chome Kubara, Omura City, Nagasaki, 856-8562, Japan
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Brown FM, Wyckoff J. Application of One-Step IADPSG Versus Two-Step Diagnostic Criteria for Gestational Diabetes in the Real World: Impact on Health Services, Clinical Care, and Outcomes. Curr Diab Rep 2017; 17:85. [PMID: 28799123 PMCID: PMC5552830 DOI: 10.1007/s11892-017-0922-z] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW This paper seeks to summarize the impact of the one-step International Association of Diabetes and Pregnancy Study Groups (IADPSG) versus the two-step gestational diabetes mellitus (GDM) criteria with regard to prevalence, outcomes, healthcare delivery, and long-term maternal metabolic risk. RECENT FINDINGS Studies demonstrate a 1.03-3.78-fold rise in the prevalence of GDM with IADPSG criteria versus baseline criteria. Women with GDM by IADPSG criteria have more adverse pregnancy outcomes than women with normal glucose tolerance (NGT). Treatment of GDM by IADPSG criteria may be cost effective. Use of the fasting glucose as a screen before the 75-g oral glucose tolerance test to rule out GDM with fasting plasma glucose (FPG) < 4.4 (80 mg/dl) and rule in GDM with FPG ≥ 5.1 mmol/l (92 mg/dl) reduces the need for OGTT by 50% and its cost and inconvenience. The prevalence of postpartum abnormal glucose metabolism is higher for women with GDM diagnosed by IADPSG criteria versus that for women with NGT. Data support the use of IADPSG criteria, if the cost of diagnosis and treatment can be controlled and if lifestyle can be optimized to reduce the risk of future diabetes.
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Affiliation(s)
- Florence M Brown
- Joslin Diabetes Center, 1 Joslin Pl, Boston, MA, 02215, USA.
- Harvard Medical School, Boston, USA.
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12
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Claesson R, Ignell C, Shaat N, Berntorp K. HbA1c as a predictor of diabetes after gestational diabetes mellitus. Prim Care Diabetes 2017; 11:46-51. [PMID: 27692850 DOI: 10.1016/j.pcd.2016.09.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 08/28/2016] [Accepted: 09/03/2016] [Indexed: 12/16/2022]
Abstract
AIM We wanted to investigate third-trimester HbA1c as a predictor of diabetes after gestational diabetes mellitus (GDM). METHODS Women with GDM were followed up prospectively for five years from pregnancy to detect the development of diabetes. The ability of HbA1c to predict diabetes was evaluated with receiver-operating characteristic (ROC) curves and logistic regression analysis. RESULTS By five years, 73 of 196 women had been diagnosed with diabetes. An optimal cut-off point for HbA1c of 36mmol/mol (5.4%) could predict diabetes with 45% sensitivity and 92% specificity. For HbA1c ≥39mmol/mol (≥5.7%), sensitivity, specificity, and positive predictive value were 30%, 97%, and 91%, respectively. In logistic regression analysis, adjusting for the diagnostic glucose concentration during pregnancy, HbA1c levels in the upper quartile (≥36mmol/mol) were associated with a 5.5-fold increased risk of diabetes. CONCLUSION Third-trimester HbA1c levels in the pre-diabetes range revealed women with post-partum diabetes with high specificity and high positive predictive value. HbA1c testing could be used as a strategy to select high-risk women for lifestyle interventions aimed at prevention of diabetes starting during pregnancy. The results should encourage further validation in other populations using new diagnostic criteria for GDM.
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Affiliation(s)
- Rickard Claesson
- Department of Clinical Sciences Malmö, Lund University, SE-205 02 Malmö, Sweden; Department of Obstetrics and Gynaecology, Office for Healthcare "Kryh", SE-271 82 Ystad, Sweden.
| | - Claes Ignell
- Department of Clinical Sciences Malmö, Lund University, SE-205 02 Malmö, Sweden; Department of Obstetrics and Gynaecology, Office for Healthcare "Sund", SE-251 87 Helsingborg, Sweden.
| | - Nael Shaat
- Department of Clinical Sciences Malmö, Lund University, SE-205 02 Malmö, Sweden; Department of Endocrinology, Skåne University Hospital, SE-205 02 Malmö, Sweden.
| | - Kerstin Berntorp
- Department of Clinical Sciences Malmö, Lund University, SE-205 02 Malmö, Sweden; Department of Endocrinology, Skåne University Hospital, SE-205 02 Malmö, Sweden.
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