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Hong JGS, Fadzleeyanna MYN, Omar SZ, Tan PC. HbA1c at term delivery and adverse pregnancy outcome. BMC Pregnancy Childbirth 2022; 22:679. [PMID: 36057557 PMCID: PMC9440566 DOI: 10.1186/s12884-022-05000-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background There are no obvious thresholds at which the risk of adverse pregnancy outcomes increases as a result of maternal hyperglycemia. HbA1c level which is representative of average blood glucose levels over the last 2–3 months is not as strongly predictive of adverse outcome compared to blood glucose values of oral glucose tolerance test. Data is sparse on the predictive value of HbA1c at term just prior to delivery on adverse outcome. We sought to evaluate HbA1c taken on admission for delivery at term on adverse outcomes of Cesarean delivery and large (≥ 90th centile) for gestational age (LGA) infants. Methods A prospective cross-sectional study was conducted in a university hospital in Malaysia from December 2017-August 2018. 1000 women at term whose deliveries were imminent were enrolled. Blood were drawn and immediately sent for HbA1c analysis at our hospital laboratory. Primary outcomes were Cesarean delivery and LGA. Results On crude analyses, Cesarean births (vs. vaginal births) were associated with significantly higher HbA1c (%) levels 5.4[5.2–5.7] vs. 5.3[5.1–5.6] P = < 0.001 but not for LGA vs. non-LGA 5.4[5.1–5.6] vs. 5.3[5.1–5.6] P = 0.17. After controlling for significant confounders identified on crude analysis (diabetes in pregnancy, parity, ethnicity, body mass index (BMI), previous cesarean, labor induction, Group B streptococcus (GBS) carriage and birth weight), HbA1c is independently predictive of Cesarean birth, adjusted odds ratio (AOR) 1.47 95% CI 1.06–2.06 P = 0.023 per HbA1c 1% increase. Following adjustment for significant confounders (BMI, predelivery anemia [hemoglobin < 11 g/dl] and GBS carriage), the impact of raised HbA1c level on LGA is AOR 1.43 95% CI 0.93–2.18 P = 0.101 per HbA1c 1% increase and non-significant. Conclusion Raised HbA1c level at term births in the general pregnant population is independently predictive of Cesarean delivery after adjustment for potential confounders including diabetes in pregnancy. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-05000-7.
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Affiliation(s)
- Jesrine Gek Shan Hong
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universiti Malaya, Jalan Profesor Diraja Ungku Aziz, 50603, Kuala Lumpur, Malaysia
| | - Mohd Yahaya Noor Fadzleeyanna
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universiti Malaya, Jalan Profesor Diraja Ungku Aziz, 50603, Kuala Lumpur, Malaysia
| | - Siti Zawiah Omar
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universiti Malaya, Jalan Profesor Diraja Ungku Aziz, 50603, Kuala Lumpur, Malaysia
| | - Peng Chiong Tan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universiti Malaya, Jalan Profesor Diraja Ungku Aziz, 50603, Kuala Lumpur, Malaysia.
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2
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Zhang Q, Lee CS, Zhang L, Wu Q, Chen Y, Chen D, Qi L, Liang Z. The Influence of HbA1c and Gestational Weight Gain on Pregnancy Outcomes in Pregnant Women With Gestational Diabetes Mellitus. Front Med (Lausanne) 2022; 9:842428. [PMID: 35721060 PMCID: PMC9204265 DOI: 10.3389/fmed.2022.842428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background To investigate the influence of HbA1c level and GWG on pregnancy outcomes in pregnant women with GDM. Methods A total of 2,171 pregnant women with GDM were retrospectively included and categorized as follows: (1) normal (HbA1c <6%) and elevated (HbA1c ≥6%) HbA1c groups according to the HbA1c level in the second trimester, and (2) inadequate, appropriate, and excessive GWG groups according to the IOM guidelines. Results In pregnant women with GDM, advanced age and high pre-pregnancy BMI were high-risk factors for elevated HbA1c. Pregnant women with elevated HbA1c had higher OGTT levels than those with normal HbA1c, and the risks of adverse pregnancy outcomes were higher (P < 0.05). The risks of primary cesarean section, hypertensive disorders during pregnancy, and macrosomia in pregnant women with excessive GWG were significantly higher than those with inadequate and appropriate GWG (P < 0.05). When GWG was appropriate, the risk of hypertensive disorders during pregnancy in the elevated HbA1c group was higher than that in the normal HbA1c group. When GWG was excessive, the risks of postpartum hemorrhage, macrosomia, and neonatal asphyxia in the elevated HbA1c group were significantly higher than in the normal HbA1c group (P < 0.05). Conclusion Monitoring and controlling blood glucose levels have shown effectiveness in reducing the adverse pregnancy outcomes in women with GDM, particularly for those who had excessive GWG.
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Affiliation(s)
- Qiuhong Zhang
- Obstetrical Department, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Nanxun District People's Hospital, Huzhou, China
| | - Chee Shin Lee
- Obstetrical Department, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lixia Zhang
- Obstetrical Department, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qi Wu
- Obstetrical Department, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yunyan Chen
- Obstetrical Department, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Huzhou Women and Children's Hospital, Huzhou, China
| | - Danqing Chen
- Obstetrical Department, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lu Qi
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Zhaoxia Liang
- Obstetrical Department, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
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Hannah W, Bhavadharini B, Beks H, Deepa M, Anjana RM, Uma R, Martin E, McNamara K, Versace V, Saravanan P, Mohan V. Global burden of early pregnancy gestational diabetes mellitus (eGDM): A systematic review. Acta Diabetol 2022; 59:403-427. [PMID: 34743219 DOI: 10.1007/s00592-021-01800-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/07/2021] [Indexed: 01/02/2023]
Abstract
AIMS Gestational diabetes mellitus (GDM) diagnosed during the first trimester of pregnancy is called 'early pregnancy Gestational Diabetes Mellitus' (eGDM). The burden of eGDM has only been studied sporadically. This review aims to understand the global burden of eGDM in terms of prevalence, risk factors, pregnancy outcomes, treatment and postpartum dysglycemia. METHODS: A review of epidemiologic studies reporting on early GDM screening as per Joanna Briggs Institute (JBI) methodology for prevalence reviews was conducted. A customized search strategy was used to search electronic databases namely, PubMed, CINAHL, EMBASE, Cochrane Library, Scopus, MEDLINE, Ovid, ScienceDirect, and Google Scholar. Three independent reviewers reviewed studies using Covidence software. Observational studies irrespective of study design and regardless of diagnostic criteria were included. Quality of evidence was appraised, and findings were synthesized. RESULTS Of 58 included studies, 41 reported a prevalence of eGDM, ranging from 0.7 to 36.8%. Body mass index (BMI), previous history of GDM, family history of diabetes and multiparity were reported as eGDM risk factors. Adverse pregnancy outcomes associated with eGDM were macrosomia, caesarean delivery, induction of labour, hypertension, preterm delivery, and shoulder dystocia. The incidence of postpartum dysglycemia and the need for insulin was higher in women with eGDM. The risk of bias was moderate. Heterogeneity of studies is a limitation. Meta-analysis was not performed. CONCLUSIONS There is heterogeneity in the prevalence of eGDM and intrapartum and postpartum ill effects for the mother and the offspring. There is a need to develop a universal screening protocol for eGDM.
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Affiliation(s)
- Wesley Hannah
- Madras Diabetes Research Foundation - ICMR Center for Advanced Research on Diabetes and Dr. Mohan's Diabetes Specialities Centre, No 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India
- Deakin University, Geelong, Australia
| | | | | | - Mohan Deepa
- Madras Diabetes Research Foundation - ICMR Center for Advanced Research on Diabetes and Dr. Mohan's Diabetes Specialities Centre, No 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India
| | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation - ICMR Center for Advanced Research on Diabetes and Dr. Mohan's Diabetes Specialities Centre, No 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India
| | - Ram Uma
- Seethapathy Clinic & Hospital, Chennai, India
| | | | | | | | - Ponnusamy Saravanan
- Populations, Evidence and Technologies, Warwick Medical School, Gibbet Hill, Division of Health Sciences, University of Warwick, Coventry, UK
- Department of Diabetes, Endocrinology and Metabolism, George Eliot Hospital NHS Trust, Nunetaon, UK
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation - ICMR Center for Advanced Research on Diabetes and Dr. Mohan's Diabetes Specialities Centre, No 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India.
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Yang Y, Wu N. Gestational Diabetes Mellitus and Preeclampsia: Correlation and Influencing Factors. Front Cardiovasc Med 2022; 9:831297. [PMID: 35252402 PMCID: PMC8889031 DOI: 10.3389/fcvm.2022.831297] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/20/2022] [Indexed: 12/16/2022] Open
Abstract
Gestational diabetes mellitus (GDM) and preeclampsia (PE) are common pregnancy complications with similar risk factors and pathophysiological changes. Evidence from previous studies suggests that the incidence of PE is significantly increased in women with GDM, but whether GDM is independently related to the occurrence of PE has remained controversial. GDM complicated by PE further increases perinatal adverse events with greater impact on the future maternal and offspring health. Identify factors associated with PE in women with GDM women, specifically those that are controllable, is important for improving pregnancy outcomes. This paper provides the findings of a review on the correlation between GDM and PE, factors associated with PE in women with GDM, possible mechanisms, and predictive markers. Most studies concluded that GDM is independently associated with PE in singleton pregnancy, and optimizing the treatment and management of GDM can reduce the incidence of PE, which is very helpful to improve pregnancy outcomes.
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Affiliation(s)
- Ying Yang
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Na Wu
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, China
- Clinical Skills Practice Teaching Center, Shengjing Hospital of China Medical University, Shenyang, China
- *Correspondence: Na Wu
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5
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Valadan M, Bahramnezhad Z, Golshahi F, Feizabad E. The role of first-trimester HbA1c in the early detection of gestational diabetes. BMC Pregnancy Childbirth 2022; 22:71. [PMID: 35086491 PMCID: PMC8793236 DOI: 10.1186/s12884-021-04330-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 12/14/2021] [Indexed: 11/12/2022] Open
Abstract
Background We aimed to assess the utility of HbA1c in the early detection of gestational diabetes (GDM) in the first trimester. Methods This prospective study was performed on 700 pregnant women in the perinatology clinic at a tertiary university hospital from March 2018 to March 2020. For all pregnant women, HbA1c and fasting blood glucose (FBG) levels were examined during the first trimester. Then, a GDM screening test was done within 24–28 weeks of pregnancy using a 100 g oral glucose tolerance test (OGTT) as the gold standard test. The GDM diagnosis was made according to the American Diabetes Association (ADA) criteria. Sensitivity, specificity, positive (PPV), and negative predictive value (NPV) of HbA1c and FBG were calculated using the receiver operating characteristic (ROC) curve. Results Of 700 participants, one hundred and fifteen (16.4%) women had GDM. The GDM patients were significantly older and had a higher pre-gestational body mass index and pregnancy weight gain compared to the non-GDM participants. The sensitivity and specificity for ruling out GDM at an HbA1c cut-off value of 4.85% was 92.2 and 32.8%, respectively, with a 95.5% NPV and a 21.2% PPV. Furthermore, sensitivity and specificity for diagnosing GDM at an HbA1c cut-off value of 5.45% was 54.8 and 96.8%, respectively, with a 91.5% NPV and a 76.8% PPV. Using HbA1c could decline OGTT in 40.4% of the pregnant women (28.7% with HbA1c < 4.85 and 11.7% with HbA1c ≥ 5.45%). Conclusion It seems that the first-trimester HbA1c cannot replace OGTT for the diagnosis of GDM because of its insufficient sensitivity and specificity. However, women with higher first-trimester HbA1c had a high risk for GDM incidence.
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Affiliation(s)
- Mehrnaz Valadan
- Department of Obstetrics and Gynecology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zeinab Bahramnezhad
- Department of Obstetrics and Gynecology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Golshahi
- Maternal, Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Yas Hospital, Tehran, Iran
| | - Elham Feizabad
- Department of Obstetrics and Gynecology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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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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7
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Yin B, Hu L, Meng X, Wu K, Zhang L, Zhu Y, Zhu B. Association of higher HbA1c within the normal range with adverse pregnancy outcomes: a cross-sectional study. Acta Diabetol 2021; 58:1081-1089. [PMID: 33768379 DOI: 10.1007/s00592-021-01691-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 02/22/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the association between a relatively high HbA1c level within the normal range and the risk of adverse pregnancy outcomes. METHODS This retrospective cohort study was conducted between March 2018 and March 2019 at Women's Hospital, School of Medicine, Zhejiang University. Multiple logistic regression models after adjusting for plausible confounders were implemented to assess the relationships between the level of HbA1c and adverse pregnancy outcomes. RESULTS A total of 8585 women were included in our study. The rates of preterm birth, macrosomia and preeclampsia were 4.4% (380/8585), 5.3% (457/8585) and 1.7% (149/8585), respectively. After adjusting for potential confounding variables, an HbA1c range of 5.5-5.9% (37-41 mmol/mol) remained significantly associated with an increased risk of preterm delivery (a-OR 2.27; 95% CI, 1.50-3.43), macrosomia (a-OR 1.97; 95% CI, 1.32-2.94) and preeclampsia (a-OR 3.70; 95% CI, 2.07-6.60). GDM-negative pregnant women with an HbA1c level in the range of 5.5-5.9% (37-41 mmol/mol) had an increased risk of preterm delivery (a-OR 2.84; 95% CI, 1.71-4.71) and preeclampsia (a-OR 3.82; 95% CI, 1.81-8.04). However, GDM-positive pregnant women had an increased risk of macrosomia (a-OR 2.12; 95% CI, 1.13-3.97) and preeclampsia (a-OR 2.62; 95% CI, 1.01-6.81). CONCLUSION A higher HbA1c level within the normal range is an independent risk factor for preterm delivery and preeclampsia, especially among GDM-negative women. Therefore, relevant medical staff should enhance the awareness of risk and prevention to strengthen pregnancy monitoring.
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Affiliation(s)
- Binbin Yin
- Department of Clinical Laboratory, School of Medicine, Women's Hospital, Zhejiang University, ZheJiang 310006, Hangzhou, China
| | - Lingwei Hu
- Department of Genetics and Metabolism, School of Medicine, The Children's Hospital, Zhejiang University, ZheJiang 310058, Hangzhou, China
| | - Xingjun Meng
- Department of Clinical Laboratory, School of Medicine, Women's Hospital, Zhejiang University, ZheJiang 310006, Hangzhou, China
| | - Kaiqi Wu
- Department of Clinical Laboratory, School of Medicine, Women's Hospital, Zhejiang University, ZheJiang 310006, Hangzhou, China
| | - Long Zhang
- Department of Clinical Laboratory, School of Medicine, Women's Hospital, Zhejiang University, ZheJiang 310006, Hangzhou, China
| | - Yuning Zhu
- Department of Clinical Laboratory, School of Medicine, Women's Hospital, Zhejiang University, ZheJiang 310006, Hangzhou, China.
| | - Bo Zhu
- Department of Clinical Laboratory, School of Medicine, Women's Hospital, Zhejiang University, ZheJiang 310006, Hangzhou, China.
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Minschart C, Beunen K, Benhalima K. An Update on Screening Strategies for Gestational Diabetes Mellitus: A Narrative Review. Diabetes Metab Syndr Obes 2021; 14:3047-3076. [PMID: 34262311 PMCID: PMC8273744 DOI: 10.2147/dmso.s287121] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/18/2021] [Indexed: 12/16/2022] Open
Abstract
Gestational diabetes mellitus (GDM) is a frequent medical complication during pregnancy. Screening and diagnostic practices for GDM are inconsistent across the world. This narrative review includes data from 87 observational studies and randomized controlled trials (RCTs), and aims to give an overview of the current evidence on screening strategies and diagnostic criteria for GDM. Screening in early pregnancy remains controversial and studies show conflicting results on the benefit of screening and treatment of GDM in early pregnancy. Implementing the one-step "International Association of Diabetes and Pregnancy Study Groups" (IADPSG) screening strategy at 24-28 weeks often leads to a substantial increase in the prevalence of GDM, without conclusive evidence regarding the benefits on pregnancy outcomes compared to a two-step screening strategy with a glucose challenge test (GCT). In addition, RCTs are needed to investigate the impact of treatment of GDM diagnosed with IADPSG criteria on long-term maternal and childhood outcomes. Selective screening using a risk-factor-based approach could be helpful in simplifying the screening algorithm but carries the risk of missing significant proportions of GDM cases. A two-step screening method with a 50g GCT and subsequently a 75g oral glucose tolerance test (OGTT) with IADPSG could be an alternative to reduce the need for an OGTT. However, to have an acceptable sensitivity to screen for GDM with the IADPSG criteria, the threshold of the GCT should be lowered from 7.8 to 7.2 mmol/L. A pragmatic approach to screen for GDM can be implemented during the COVID-19 pandemic, using fasting plasma glucose (FPG), HbA1c or even random plasma glucose (RPG) to reduce the number of OGTTs needed. However, usual guidelines and care should be resumed as soon as the COVID pandemic is controlled.
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Affiliation(s)
- Caro Minschart
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, 3000, Belgium
| | - Kaat Beunen
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, 3000, Belgium
| | - Katrien Benhalima
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, 3000, Belgium
- Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Leuven, 3000, Belgium
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9
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Zhang L, Zhai R, Huo Z, Wei Z, Zhang Z, Wei R, Man D. Association of Normal-Range Hemoglobin A1c Value During Midpregnancy with Adverse Birth Outcomes. Int J Gen Med 2021; 14:3049-3057. [PMID: 34234533 PMCID: PMC8256093 DOI: 10.2147/ijgm.s313952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/10/2021] [Indexed: 11/23/2022] Open
Abstract
Background The midpregnancy normal-range HbA1c value and adverse birth outcomes were controversial. To address this lack of data, we examined the associations between midpregnancy normal-range HbA1c value and adverse birth outcomes. Objective To evaluate whether an association exists between the midpregnancy normal-range HbA1c value and adverse birth outcomes. Materials and Methods A total of 8389 women in their midpregnancy with normal gestational HbA1c value from the Affiliated Hospital of Jining Medical University in China participated in this study from January to December 2019. Subjects were stratified on the basis of their midpregnancy HbA1c value, and multivariate logistic regression was implemented to investigate the association between different HbA1c values and adverse birth outcomes. Results Incidence of preterm birth, macrosomia, and large for gestational age (LGA) for 8389 subjects were 4.8%, 6.3% and 16.5%, respectively. The multivariate logistic regression model demonstrated that the risk of preterm birth (adjusted odds ratio [OR]: 1.71 and 95% confidence interval [CI]: 1.25–2.34), macrosomia (OR: 1.68 and 95% CI: 1.26–2.22), and LGA (OR: 1.53 and 95% CI: 1.28–1.83) increase for every increase of 1% maternal HbA1c. Women with a prepregnancy body mass index (BMI) of < 25 kg/m2 have a stronger correlation with HbA1c values and adverse birth outcomes than women with a prepregnancy BMI of ≥25 kg/m2. Conclusion Our results indicated that the midpregnancy normal-range HbA1c level within the normal range is associated with adverse birth outcomes. Monitoring and controlling HbA1c may reduce the risk of adverse birth outcomes.
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Affiliation(s)
- Lihua Zhang
- Department of Obstetrics, Affiliated Hospital of Jining Medical University, Jining, Shandong, People's Republic of China.,College of Clinical Medicine, Jining Medical University, Jining, Shandong, People's Republic of China
| | - Ruixia Zhai
- Department of Obstetrics, Affiliated Hospital of Jining Medical University, Jining, Shandong, People's Republic of China
| | - Zhiyu Huo
- Department of Obstetrics, Affiliated Hospital of Jining Medical University, Jining, Shandong, People's Republic of China
| | - Zhenyan Wei
- Department of Obstetrics, Affiliated Hospital of Jining Medical University, Jining, Shandong, People's Republic of China
| | - Ziheng Zhang
- College of Clinical Medicine, Jining Medical University, Jining, Shandong, People's Republic of China
| | - Ruirui Wei
- Department of Obstetrics, Affiliated Hospital of Jining Medical University, Jining, Shandong, People's Republic of China
| | - Dongmei Man
- Department of Obstetrics, Affiliated Hospital of Jining Medical University, Jining, Shandong, People's Republic of China.,College of Clinical Medicine, Jining Medical University, Jining, Shandong, People's Republic of China
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Carris NW, Nwabuobi C, He W, Bullers K, Wilson RE, Louis JM, Magness RR. Review of Prediabetes and Hypertensive Disorders of Pregnancy. Am J Perinatol 2021; 38:428-435. [PMID: 31707724 PMCID: PMC7227138 DOI: 10.1055/s-0039-1698831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Obesity and diabetes increase hypertensive disorders of pregnancy (HDP) risk, thus preventive interventions are heavily studied. How pregestational prediabetes and related interventions impact HDP risk is less characterized. Therefore, we searched and reviewed the literature to assess the impact on HDP risk of prediabetes and varied interventions. We identified 297 citations related to pregnancy, prediabetes, and early pregnancy interventions. We also reviewed the references and citations of included articles. We included five studies assessing HDP outcomes in women with first trimester hemoglobin A1c in the prediabetes range (5.7-6.4%). One prospective observational study demonstrated first trimester hemoglobin A1c (5.9-6.4%) is associated with increased HDP risk, while another prospective observational study and one retrospective observational study had similar trends without statistical significance. A small and underpowered randomized controlled trial demonstrated initiating gestational diabetes mellitus treatment (i.e., diet, monitoring, ± insulin) in response to first trimester hemoglobin A1c (5.7-6.4%) did not statistically reduce HDP compared with standard care. One retrospective observational study suggested metformin, when started early, may reduce HDP risk in patients with prediabetes. Pregestational prediabetes appears to increase HDP risk. Interventions (i.e., metformin, diet/glucose monitoring, and/or exercise) to reduce HDP risk require additional study with long-term follow-up.
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Affiliation(s)
- Nicholas W. Carris
- University of South Florida; College of Pharmacy, Department of Pharmacotherapeutics and Clinical Research; Morsani College of Medicine, Department of Family Medicine
| | - Chinedu Nwabuobi
- University of South Florida; Morsani College of Medicine, Department of Obstetrics and Gynecology
| | - Weiwei He
- University of South Florida; College of Public Health, Department of Epidemiology & Biostatistics
| | - Krystal Bullers
- University of South Florida; Shimberg Health Sciences Library
| | - Roneé E. Wilson
- University of South Florida; College of Public Health, Department of Epidemiology & Biostatistics
| | - Judette M. Louis
- University of South Florida; Morsani College of Medicine, Department of Obstetrics and Gynecology
| | - Ronald R. Magness
- University of South Florida; Morsani College of Medicine, Department of Obstetrics and Gynecology
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11
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Liu X, Wu N, Al-Mureish A. A Review on Research Progress in the Application of Glycosylated Hemoglobin and Glycated Albumin in the Screening and Monitoring of Gestational Diabetes. Int J Gen Med 2021; 14:1155-1165. [PMID: 33833555 PMCID: PMC8019620 DOI: 10.2147/ijgm.s296316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/08/2021] [Indexed: 12/16/2022] Open
Abstract
Glycosylated hemoglobin (HbA1C) and glycated albumin (GA) can be used for blood glucose management of a person with diabetes as a result of their convenience and stability. However, there is no corresponding standard for the application of glycosylated hemoglobin and glycosylated albumin in gestational diabetes mellitus (GDM). In this review, we summarize the published research and discuss three aspects of the significance of HBA1C and GA in GDM patients: screening of gestational diabetes mellitus, blood glucose monitoring and the relationship with pregnancy outcome. At present, studies suggest that HBA1C can be used as a screening indicator for pregnant women, but it cannot completely replace OGTT. HbA1C and GA can be used for blood glucose management in patients with GDM to reduce the incidence of GDM complications. However, the application of HBA1C and GA in GDM still needs more research and clinical practice support.
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Affiliation(s)
- Xinyan Liu
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, 110004, People's Republic of China
| | - Na Wu
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, 110004, People's Republic of China.,Clinical Skills Practice Teaching Center, Shengjing Hospital of China Medical University, Shenyang, 110004, People's Republic of China
| | - Abdulrahman Al-Mureish
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, 110004, People's Republic of China
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12
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Screening for Gestational Diabetes Mellitus in Early Pregnancy: What Is the Evidence? J Clin Med 2021; 10:jcm10061257. [PMID: 33803650 PMCID: PMC8003050 DOI: 10.3390/jcm10061257] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 12/12/2022] Open
Abstract
The incidence of gestational diabetes mellitus (GDM) is increasing worldwide. This has a significant effect on the health of the mother and offspring. There is no doubt that screening for GDM between 24 and 28 weeks is important to reduce the risk of adverse pregnancy outcomes. However, there is no consensus about diagnosis and treatment of GDM in early pregnancy. In this narrative review on the current evidence on screening for GDM in early pregnancy, we included 37 cohort studies and eight randomized controlled trials (RCTs). Observational studies have shown that a high proportion (15–70%) of women with GDM can be detected early in pregnancy depending on the setting, criteria used and screening strategy. Data from observational studies on the potential benefit of screening and treatment of GDM in early pregnancy show conflicting results. In addition, there is substantial heterogeneity in age and BMI across the different study populations. Smaller RCTs could not show benefit but several large RCTs are ongoing. RCTs are also necessary to determine the appropriate cut-off for HbA1c in pregnancy as there is limited evidence showing that an HbA1c ≥6.5% has a low sensitivity to detect overt diabetes in early pregnancy.
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13
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Juvinao-Quintero DL, Starling AP, Cardenas A, Powe CE, Perron P, Bouchard L, Dabelea D, Hivert MF. Epigenome-wide association study of maternal hemoglobin A1c in pregnancy and cord blood DNA methylation. Epigenomics 2021; 13:203-218. [PMID: 33406918 DOI: 10.2217/epi-2020-0279] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Background: Gestational hyperglycemia is associated with adverse perinatal outcomes and long-term offspring metabolic programming, likely through dysregulation of DNA methylation (DNAm). Materials & methods: We tested associations between maternal HbA1c and cord blood DNAm among 412 mother-child pairs in the genetics of glucose regulation in gestation and growth (Gen3G) and implemented Mendelian randomization to infer causality. We sought replication in an independent sample from Healthy Start. Results: Higher second trimester HbA1c levels were associated with lower DNAm at cg21645848 (p = 3.9 × 10-11) near URGCP. Mendelian randomization and replication analyses showed same direction of effect between HbA1c and DNAm at cg21645848, but did not reach statistical significance. Conclusion: We found that higher maternal glycemia reflected by HbA1c is associated with cord blood DNAm at URGCP, a gene related with inflammatory pathways.
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Affiliation(s)
- Diana L Juvinao-Quintero
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, MA 02215, USA
| | - Anne P Starling
- Department of Epidemiology & Lifecourse Epidemiology of Adiposity & Diabetes (LEAD) Center, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, CO 80045, USA
| | - Andres Cardenas
- Division of Environmental Health Sciences, School of Public Health & Center for Computational Biology, University of California, Berkeley, CA 94720-7360, USA
| | - Camille E Powe
- Diabetes Unit, Massachusetts General Hospital, Boston, MA 02114, USA.,Harvard Medical School, Boston, MA 02115, USA.,Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Patrice Perron
- Centre de Recherche du CHUS, Sherbrooke, QC J1H 5N4, CA.,Department of Medicine, Université de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada
| | - Luigi Bouchard
- Centre de Recherche du CHUS, Sherbrooke, QC J1H 5N4, CA.,Department of Medical Biology, CIUSSS Saguenay-Lac-Saint-Jean, Hôpital Universitaire de Chicoutimi, Saguenay, QC G7H 5H6, Canada.,Department of Biochemistry & Functional Genomics, Université de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada
| | - Dana Dabelea
- Department of Epidemiology & Lifecourse Epidemiology of Adiposity & Diabetes (LEAD) Center, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, CO 80045, USA
| | - Marie-France Hivert
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, MA 02215, USA.,Diabetes Unit, Massachusetts General Hospital, Boston, MA 02114, USA
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14
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Leonco L, Kallel H, Nacher M, Thelusme L, Dueymes M, Mhiri R, Lalanne-Mistrih ML, Sabbah N. Does Universal Screening for Gestational Diabetes Mellitus Improve Neonatal Outcomes in a Socially Vulnerable Population: A Prospective Study in French Guiana. Front Endocrinol (Lausanne) 2021; 12:644770. [PMID: 34093431 PMCID: PMC8176854 DOI: 10.3389/fendo.2021.644770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/27/2021] [Indexed: 12/15/2022] Open
Abstract
AIMS/INTRODUCTION French Guiana has a high prevalence of metabolic diseases, which are risk factors for gestational diabetes mellitus. Despite routine screening for gestational diabetes, treatment is still challenging because of health inequalities and different cultural representations of disease and pregnancy. This study was conducted to assess the role of early and universal GDM screening on obstetrical and neonatal complications in a socially deprived population. MATERIALS AND METHODS A prospective study was conducted, in the level III maternity in French Guiana. Of 2136 deliveries, 223 had gestational diabetes mellitus, 110 of whom were followed-up for 6 month to detail their social and laboratory parameters. RESULTS The prevalence of gestational diabetes in French Guiana (Cayenne Hospital) was estimated at 10.3%. The study population was very precarious with 70% of patients on welfare (universal health coverage or state medical assistance). The following obstetrical complications were observed: cesarean delivery (32%), history of miscarriage (26%) and preeclampsia (7.4%). Nevertheless, neonatal complications were rarely present and included hypoglycemia (2.8%) and macrosomia (2.8%). CONCLUSION In French Guiana, gestational diabetes mellitus is very common. However, in a context of widespread poverty and diverse cultural representations, universal screening and monitoring limited the risk of macrosomia.
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Affiliation(s)
- Loic Leonco
- Department of Endocrinology and Metabolic Diseases, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Hatem Kallel
- Department of Intensive Care, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Mathieu Nacher
- Clinical Investigation Center, West Indies, French Guiana (INSERM CIC 14 24), Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Liliane Thelusme
- Department of Endocrinology and Metabolic Diseases, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Maryvonne Dueymes
- Department of Biology, Immunology and Parasitology, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Raoudha Mhiri
- Department of Gynecology and Obstetrics, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Marie Laure Lalanne-Mistrih
- Department of Nutrition (UTDN-CSO), Centre Hospitalier Universitaire de Guadeloupe, Pointe à Pitre, Guadeloupe, France
| | - Nadia Sabbah
- Department of Endocrinology and Metabolic Diseases, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
- Clinical Investigation Center, West Indies, French Guiana (INSERM CIC 14 24), Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
- EA3593, Amazon Ecosystems and Tropical Diseases, Université de Guyane, Cayenne, French Guiana, France
- *Correspondence: Nadia Sabbah,
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15
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Rasmussen KV, Nielsen KK, Pedersen ML. No association between early maternal HbA1c and offspring birthweight among women without pre-existing diabetes in Greenland. Int J Circumpolar Health 2020; 79:1702798. [PMID: 31825748 PMCID: PMC6913641 DOI: 10.1080/22423982.2019.1702798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Studies of the association between maternal blood glucose measured by glycated haemoglobin (HbA1c) during pregnancy and the offspring’s birthweight have been heterogeneous. The aim of this study was to examine the association between maternal HbA1c level before gestational week 20 and the offspring’s birthweight among predominantly indigenous women in Greenland. A retrospective cohort study including all women (n = 503) and their offspring delivered from September 2015 to September 2016 at Queen Ingrid’s Hospital in Nuuk was conducted. Data were obtained from the electronic medical record. Linear regression models were used to analyse the effect of maternal HbA1c on the offspring’s birthweight with adjustment and stratification for relevant confounders and effect modifiers. Birthweight increased with 3.3 g per mmol/mol increase in HbA1c. Yet, no significant association between maternal HbA1c and the offspring’s birthweight was found after adjustment for maternal age, ethnicity, residence, smoking, and parity (β = 0.058, p = 0.711). Among obese women, a borderline significant positive association (β = 0.657, p = 0.059) was found. For term newborns, this corresponded to an increase in birthweight of 31 g per mmol/mol increase in HbA1c. Based on the current study, the use of HbA1c during pregnancy to detect the risk of delivering a newborn with macrosomia is not recommended in Greenland. Abbreviation: HbA1c: glycosylated haemoglobin; GA: gestational age; SD: standard deviation; CI: confidence interval.
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Affiliation(s)
| | - Karoline Kragelund Nielsen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Health Promotion, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Michael Lynge Pedersen
- Queen Ingrid Primary Health Care Center, Nuuk, Greenland.,Greenland Center for Health Research, Institute of Nursing and Health Science, University of Greenland, Nuuk, Greenland
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16
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Dumesic DA, Hoyos LR, Chazenbalk GD, Naik R, Padmanabhan V, Abbott DH. Mechanisms of intergenerational transmission of polycystic ovary syndrome. Reproduction 2020; 159:R1-R13. [PMID: 31376813 DOI: 10.1530/rep-19-0197] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 08/01/2019] [Indexed: 12/20/2022]
Abstract
Developmental origins of adult disease (DoHAD) refers to critical gestational ages during human fetal development and beyond when the endocrine metabolic status of the mother can permanently program the physiology and/or morphology of the fetus, modifying its susceptibility to disease after birth. The aim of this review is to address how DoHAD plays an important role in the phenotypic expression of polycystic ovary syndrome (PCOS), the most common endocrinopathy of women characterized by hyperandrogenism, oligo-anovulation and polycystic ovarian morphology. Clinical studies of PCOS women are integrated with findings from relevant animal models to show how intergenerational transmission of these central components of PCOS are programmed through an altered maternal endocrine-metabolic environment that adversely affects the female fetus and long-term offspring health. Prenatal testosterone treatment in monkeys and sheep have been particularly crucial in our understanding of developmental programming of PCOS because organ system differentiation in these species, as in humans, occurs during fetal life. These animal models, along with altricial rodents, produce permanent PCOS-like phenotypes variably characterized by LH hypersecretion from reduced steroid-negative feedback, hyperandrogenism, ovulatory dysfunction, increased adiposity, impaired glucose-insulin homeostasis and other metabolic abnormalities. The review concludes that DoHAD underlies the phenotypic expression of PCOS through an altered maternal endocrine-metabolic environment that can induce epigenetic modifications of fetal genetic susceptibility to PCOS after birth. It calls for improved maternal endocrine-metabolic health of PCOS women to lower their risks of pregnancy-related complications and to potentially reduce intergenerational susceptibility to PCOS and its metabolic derangements in offspring.
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Affiliation(s)
- Daniel A Dumesic
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Luis R Hoyos
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Gregorio D Chazenbalk
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Rajanigandha Naik
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | | | - David H Abbott
- Department of Obstetrics and Gynecology and Wisconsin National Primate Research Center, University of Wisconsin, Madison, Wisconsin, USA
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17
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Manoharan V, Wong VW. Impact of comorbid polycystic ovarian syndrome and gestational diabetes mellitus on pregnancy outcomes: a retrospective cohort study. BMC Pregnancy Childbirth 2020; 20:484. [PMID: 32831037 PMCID: PMC7444192 DOI: 10.1186/s12884-020-03175-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) and polycystic ovarian syndrome (PCOS) have been associated with adverse maternal and neonatal outcomes, but the evidence on the impact of coexistent PCOS and GDM is rather limited and inconclusive. We investigated the impact of comorbid PCOS on pregnancy outcomes among women with GDM. METHODS This retrospective cohort study included women diagnosed with GDM on 75 g oral glucose tolerance test on routine antenatal screening tests at Liverpool Hospital between February 2015 and January 2019. Women were then grouped into those with and without PCOS based on the Rotterdam criteria. The demographic details, clinical data and pregnancy outcomes were compared between the two groups. RESULTS Among the 1545 women with GDM included in the study, there were 326 women with PCOS. Women with GDM and PCOS (GDM+PCOS+) were younger (29.5 years vs 31.5 years, p < 0.001), more likely to be primigravidae (31.9% vs 20%, p < 0.001), as well as of Caucasian descent (37.4% vs 21.7%, p < 0.001). PCOS was an independent risk factor for the development of preeclampsia on regression analysis (OR 2.06, p = 0.021). Women with PCOS and GDM had a higher body mass index (31.5 kg/m2 vs 27.7 kg/m2, p < 0.001), significant gestational weight gain (12.6 kg vs 11.5 kg, p = 0.016), and more frequent use of pharmacotherapies to manage their GDM (57.7% vs 45.2%, p < 0.001). There was no statistically significant difference in the rates of adverse neonatal outcomes in both the groups. CONCLUSION Among women with GDM, PCOS was an independent risk factor for the development of preeclampsia and significant gestational weight gain, warranting vigilant monitoring of blood pressure, blood glucose levels and body weight, and implementing timely interventions to improve obstetric and neonatal outcomes.
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Affiliation(s)
- Varun Manoharan
- Diabetes and Endocrine Service, Liverpool Hospital, Sydney, NSW, Australia. .,South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia.
| | - Vincent W Wong
- Diabetes and Endocrine Service, Liverpool Hospital, Sydney, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
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18
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Ciangura C, Coupaye M, Deruelle P, Gascoin G, Calabrese D, Cosson E, Ducarme G, Gaborit B, Lelièvre B, Mandelbrot L, Petrucciani N, Quilliot D, Ritz P, Robin G, Sallé A, Gugenheim J, Nizard J. Clinical Practice Guidelines for Childbearing Female Candidates for Bariatric Surgery, Pregnancy, and Post-partum Management After Bariatric Surgery. Obes Surg 2020; 29:3722-3734. [PMID: 31493139 DOI: 10.1007/s11695-019-04093-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Emerging evidence suggests that bariatric surgery improves pregnancy outcomes of women with obesity by reducing the rates of gestational diabetes, pregnancy-induced hypertension, and macrosomia. However, it is associated with an increased risk of a small-for-gestational-age fetus and prematurity. Based on the work of a multidisciplinary task force, we propose clinical practice recommendations for pregnancy management following bariatric surgery. They are derived from a comprehensive review of the literature, existing guidelines, and expert opinion covering the preferred type of surgery for women of childbearing age, timing between surgery and pregnancy, contraception, systematic nutritional support and management of nutritional deficiencies, screening and management of gestational diabetes, weight gain during pregnancy, gastric banding management, surgical emergencies, obstetrical management, and specific care in the postpartum period and for newborns.
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Affiliation(s)
- Cécile Ciangura
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Departments of Nutrition and Diabetology, Institute of Cardiometabolism and Nutrition (ICAN), Sorbonne University, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
| | - Muriel Coupaye
- Assistance Publique-Hôpitaux de Paris, Louis Mourier Hospital, Department of Explorations Fonctionnelles, Colombes, University Paris Diderot, Paris, France.,Association Française d'Etude et de Recherche sur l'Obésité (AFERO), Paris, France
| | - Philippe Deruelle
- Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France.,Collège National des Gynécologues et Obstétriciens Français (CNGOF), Paris, France
| | - Géraldine Gascoin
- Department of Neonatal Medicine, Angers University Hospital, Angers, France.,Société Française de Néonatologie et Société Française de Pédiatrie, Paris, France
| | - Daniela Calabrese
- Assistance Publique-Hôpitaux de Paris, Louis Mourier Hospital, Department of Digestive Surgery, Colombes, University Paris Diderot, Paris, France
| | - Emmanuel Cosson
- Assistance Publique-Hôpitaux de Paris, Jean Verdier Hospital, Department of Endocrinology-Diabetology-Nutrition, Bondy, 10 UMR U557 INSERM/U11125 INRA/CNAM, University Paris13, Bobigny, France.,Société Francophone du Diabète (SFD), Paris, France
| | - Guillaume Ducarme
- Department of Obstetrics and Gynecology, Departemental Hospital, La Roche-sur-Yon, France
| | - Bénédicte Gaborit
- Association Française d'Etude et de Recherche sur l'Obésité (AFERO), Paris, France.,Assistance Publique-Hôpitaux de Marseille, Department of Endocrinology, Metabolic Diseases and Nutrition, Marseille, INSERM, INRA, C2VN, Aix Marseille University, Marseille, France
| | - Bénédicte Lelièvre
- Laboratory of Pharmacology and Toxicology, Angers University Hospital, Angers, France
| | - Laurent Mandelbrot
- Assistance Publique-Hôpitaux de Paris, Louis Mourier Hospital, Department of Gynecology and Obstetrics, Colombes, University Paris Diderot, Paris, France
| | - Niccolo Petrucciani
- Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, Division of Digestive Surgery and Liver Transplantation, UPEC University, Créteil, France
| | - Didier Quilliot
- Department of Diabetology-Endocrinology-Nutrition, CHRU Nancy, INSERM 954, University of Lorraine, Nancy, France.,Société Francophone Nutrition Clinique et Métabolisme (SFNCM), Paris, France
| | - Patrick Ritz
- Department of Endocrinology, Metabolic Diseases and Nutrition, Toulouse University Hospital, UMR1027, Paul Sabatier University, Toulouse, France
| | - Geoffroy Robin
- Collège National des Gynécologues et Obstétriciens Français (CNGOF), Paris, France.,Department of Medical Gynecology, and Sexology and Department of Assisted Reproductive Technologies and Fertility Preservation, Jeanne de Flandre Hospital, Lille, EA4308 "gametogenesis and gamete quality", Lille University, Lille, France
| | - Agnès Sallé
- Department of Diabetology-Endocrinology-Nutrition, Angers University Hospital, Angers, France
| | - Jean Gugenheim
- Division of Digestive Surgery and Liver Transplantation, Nice University Hospital, University of Nice, Nice, France.,Société Française et Francophone de Chirurgie de l'Obésité et des Maladies Métaboliques (SOFFCOMM), Porte des Pierres Dorées, France
| | - Jacky Nizard
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Gynecology and Obstetrics, Sorbonne University, Paris, France
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19
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Codina M, Corcoy R, Goya MM. Update of the hyperglycemia Gestational diagnosis during the COVID-19 pandemic. ACTA ACUST UNITED AC 2020; 67:545-552. [PMID: 32553745 PMCID: PMC7236733 DOI: 10.1016/j.endinu.2020.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Mercè Codina
- Endocrinología, Hospital Son Espases, Palma de Mallorca, España
| | - Rosa Corcoy
- Endocrinología, Hospital Santa Creu i Sant Pau, Barcelona, España
| | - María M Goya
- Obstetricia, Hospital Universitari Vall d'Hebron, Barcelona, España.
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20
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Huvinen E, Eriksson JG, Stach-Lempinen B, Tiitinen A, Koivusalo SB. Heterogeneity of gestational diabetes (GDM) and challenges in developing a GDM risk score. Acta Diabetol 2018; 55:1251-1259. [PMID: 30221319 DOI: 10.1007/s00592-018-1224-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 09/03/2018] [Indexed: 02/07/2023]
Abstract
AIMS Gestational diabetes (GDM) affects a growing number of women and identification of individuals at risk, e.g., with risk prediction models, would be important. However, the performance of GDM risk scores has not been optimal. Here, we assess the impact of GDM heterogeneity on the performance of two top-rated GDM risk scores. METHODS This is a substudy of the RADIEL trial-a lifestyle intervention study including women at high GDM risk. We assessed the GDM risk score by Teede and that developed by Van Leeuwen in our high-risk cohort of 510 women. To investigate the heterogeneity of GDM, we further divided the women according to GDM history, BMI, and parity. With the goal of identifying novel predictors of GDM, we further analyzed 319 women with normal glucose tolerance in the first trimester. RESULTS Both risk scores underestimated GDM incidence in our high-risk cohort. Among women with a BMI ≥ 30 kg/m2 and/or previous GDM, 49.4% developed GDM and 37.4% received the diagnosis already in the first trimester. Van Leeuwen score estimated a 19% probability of GDM and Teede succeeded in risk identification in 61%. The lowest performance of the risk scores was seen among the non-obese women. Fasting plasma glucose, HbA1c, and family history of diabetes were predictors of GDM in the total study population. Analysis of subgroups did not provide any further information. CONCLUSIONS Our findings suggest that the marked heterogeneity of GDM challenges the development of risk scores for detection of GDM.
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Affiliation(s)
- Emilia Huvinen
- Department of Obstetrics and Gynaecology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
- Unit of General Practice and Primary Health Care, University of Helsinki, Tukholmankatu 8 B, P.O. Box 20, 00014, Helsinki, Finland.
| | - Johan G Eriksson
- Unit of General Practice and Primary Health Care, University of Helsinki, Tukholmankatu 8 B, P.O. Box 20, 00014, Helsinki, Finland
- Folkhälsan Research Centre, Helsinki, Finland
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
| | - Beata Stach-Lempinen
- Department of Obstetrics and Gynaecology, South-Karelia Central Hospital, Lappeenranta, Finland
| | - Aila Tiitinen
- Department of Obstetrics and Gynaecology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Saila B Koivusalo
- Department of Obstetrics and Gynaecology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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21
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Poo ZX, Wright A, Ruochen D, Singh R. Optimal first trimester HbA1c threshold to identify Singaporean women at risk of gestational diabetes mellitus and adverse pregnancy outcomes: A pilot study. Obstet Med 2018; 12:79-84. [PMID: 31217812 DOI: 10.1177/1753495x18795984] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 07/27/2018] [Indexed: 01/26/2023] Open
Abstract
This pilot study examined the use of early HbA1c in screening for gestational diabetes mellitus and adverse pregnancy outcomes in Singapore. One hundred and fifty-one pregnant women with a gestational age of under 14 weeks had an HbA1c test measured with their antenatal bloods prior to a second trimester oral glucose tolerance test. Patient characteristics and pregnancy outcome data were collected. Gestational diabetes mellitus prevalence was 11%. A receiver operating characteristic curve showed an HbA1c level of 5.2% (33 mmol/mol), had an 82% sensitivity, 72% specificity, 97% negative predictive value and 27% positive predictive value to predict gestational diabetes mellitus. Women with HbA1c of 5.2% (33 mmol/mol) or over 5.2% (33 mmol/mol) were older, had higher BMI and were less likely to be Chinese than those with HbA1c less than 5.2% (33 mmol/mol). There was no difference in pregnancy outcomes. Early HbA1c less than 5.2% (33 mmol/mol) may be useful to exclude low-risk Singaporean women from further testing, while those with HbA1c of 5.2% (33 mmol/mol) or greater would still need a oral glucose tolerance test between 24 and 28 weeks' gestation.
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Affiliation(s)
- Zi X Poo
- KK Women's and Children's Hospital, Singapore, Singapore
| | - Ann Wright
- KK Women's and Children's Hospital, Singapore, Singapore
| | - Du Ruochen
- KK Women's and Children's Hospital, Singapore, Singapore
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22
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Poor Sleep Quality Is Associated with Higher Hemoglobin A1c in Pregnant Women: A Pilot Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15102287. [PMID: 30340366 PMCID: PMC6210387 DOI: 10.3390/ijerph15102287] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/12/2018] [Accepted: 10/14/2018] [Indexed: 02/07/2023]
Abstract
We hypothesized that poor sleep quality exacerbates glucose intolerance manifested as elevated glycosylated hemoglobin (HbA1c), which increases the risk for gestational diabetes. To test this, 38 pregnant and 22 non-pregnant (age, 18–35 years; body-mass index, 20–35 kg/m2) otherwise healthy women were enrolled in the study. Sleep quality was assessed during gestational week 24 (pregnant), or outside of the menstrual period (non-pregnant), using qualitative (Pittsburgh Sleep Quality Index) and objective (actigraphic wrist-watch) measures. Blood glucose, total cortisol, and depression status were evaluated. Eight pregnant and one non-pregnant women were lost to follow-up, or withdrew from the study. There was a higher incidence of poor sleep quality in pregnant (73%) relative to non-pregnant women (43%). Although actigraphic data revealed no differences in actual sleep hours between pregnant and non-pregnant women, the number of wake episodes and sleep fragmentation were higher in pregnant women. Poor sleep quality was positively correlated with higher HbA1c in both pregnant (r = 0.46, n = 26, p = 0.0151) and non-pregnant women (r = 0.50, n = 19, p = 0.0217), reflecting higher average blood glucose concentrations. In contrast, poor sleep was negatively correlated with cortisol responses in pregnant women (r = −0.46, n = 25, p = 0.0167). Three pregnant women had elevated one-hour oral glucose tolerance test results (>153 mg/dL glucose). These same pregnant women exhibited poor sleep quality. These results support the suggestion that poor sleep quality is an important risk factor that is associated with glucose intolerance and attendant health complications in pregnancy.
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Reece SW, Parihar HS, Martinez M. Retrospective Review of Maternal and Fetal Outcomes in Patients With Gestational Diabetes Mellitus in an Indigent Prenatal Clinic. Diabetes Spectr 2018; 31:200-205. [PMID: 29773943 PMCID: PMC5951231 DOI: 10.2337/ds17-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Sara W Reece
- Philadelphia College of Osteopathic Medicine-Georgia Campus School of Pharmacy, Suwanee, GA
| | - Harish S Parihar
- Philadelphia College of Osteopathic Medicine-Georgia Campus School of Pharmacy, Suwanee, GA
| | - Mark Martinez
- Philadelphia College of Osteopathic Medicine-Georgia Campus School of Pharmacy, Suwanee, GA
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Joseph M, Das Gupta R, Shetty S, Ramachandran R, Antony G, Mathews J, Benjamin S, Anoop S, Rani JV, Thomas N. How Adequate are Macro- and Micronutrient Intake in Pregnant Women with Diabetes Mellitus? A Study from South India. J Obstet Gynaecol India 2017; 68:400-407. [PMID: 30224846 DOI: 10.1007/s13224-017-1069-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 10/26/2017] [Indexed: 11/26/2022] Open
Abstract
Background Diabetes is the most common condition in pregnancy with a worldwide prevalence of 16.9%. Aim To determine the adequacy of the nutrient intake of pregnant women with diabetes mellitus. Methods This is a cross-sectional study of 85 pregnant women who met the diagnostic inclusion criteria for diabetes mellitus (gestational and pre-gestational diabetes mellitus) and who were being managed at the outpatient clinic of a tertiary care teaching hospital. Their demography, clinical characteristics (from updated medical records), anthropometric measures (using standard procedures), nutrient intake and meal pattern (obtained using 24 h recall, food frequency and their log diaries) were collected. Results The mean age of the group was 29.9 + 4.5 years, 54% were in the second trimester of pregnancy with a mean glycosylated haemoglobin level of 6.3 + 1.4%. The mean BMI indicated that 47% of them were in the obese grade 1 category. Insulin was used in one-third of the population. The overall macronutrient and micronutrient intakes of the population were below the recommended daily allowances for Indians (60-70% of RDA). There was a deficit in the intake of calories, fibre, proteins, iron, calcium, carotene, folic acid, thiamine, riboflavin and niacin. Between the two groups, the pre-GDM women had a significantly better nutrient intake and this could be attributed to a greater exposure to nutrition counselling that they have received during the earlier part of their diabetes care. Conclusion The gestational period should be viewed as a window of opportunity to modify dietary patterns and introduce healthy lifestyle practices for the woman and her family.
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Affiliation(s)
- Mini Joseph
- 1Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, Tamil Nadu 632004 India
| | - Riddhi Das Gupta
- 1Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, Tamil Nadu 632004 India
| | - Sahana Shetty
- 1Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, Tamil Nadu 632004 India
| | - Roshna Ramachandran
- 1Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, Tamil Nadu 632004 India
| | - Geethu Antony
- 1Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, Tamil Nadu 632004 India
| | - Jiji Mathews
- 2Department of Gynaecology and Obstetrics, Christian Medical College and Hospital, Vellore, Tamil Nadu 632004 India
| | - Santhosh Benjamin
- 2Department of Gynaecology and Obstetrics, Christian Medical College and Hospital, Vellore, Tamil Nadu 632004 India
| | - Shajith Anoop
- 1Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, Tamil Nadu 632004 India
| | - Jansi Vimala Rani
- 1Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, Tamil Nadu 632004 India
| | - Nihal Thomas
- 1Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, Tamil Nadu 632004 India
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Cosson E, Carbillon L, Valensi P. High Fasting Plasma Glucose during Early Pregnancy: A Review about Early Gestational Diabetes Mellitus. J Diabetes Res 2017; 2017:8921712. [PMID: 29181414 PMCID: PMC5664285 DOI: 10.1155/2017/8921712] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 09/19/2017] [Indexed: 01/20/2023] Open
Abstract
Fasting plasma glucose (FPG) is nowadays routinely measured during early pregnancy to detect preexisting diabetes (FPG ≥ 7 mmol/L). This screening has concomitantly led to identify early intermediate hyperglycemia, defined as FPG in the 5.1 to 6.9 mmol/L range, also early gestational diabetes mellitus (eGDM). Early FPG has been associated with poor pregnancy outcomes, but the recommendation by the IADPSG to refer women with eGDM for immediate management is more pragmatic than evidence based. Although eGDM is characterized by insulin resistance and associated with classical risk factors for type 2 diabetes and incident diabetes after delivery, it is not necessarily associated with preexisting prediabetes. FPG ≥ 5.1 mmol/L in early pregnancy is actually poorly predictive of gestational diabetes mellitus diagnosed after 24 weeks of gestation. An alternative threshold should be determined but may vary according to ethnicity, gestational age, and body mass index. Finally, observational data suggest that early management of intermediate hyperglycemia may improve prognosis, through reduced gestational weight gain and potential early introduction of hypoglycemic agents. Considering all these issues, we suggest an algorithm for the management of eGDM based on early FPG levels that would be measured in case of risk factors. Nevertheless, interventional randomized trials are still missing.
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Affiliation(s)
- E. Cosson
- Department of Endocrinology-Diabetology-Nutrition, AP-HP, Jean Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, CRNH-IdF, CINFO, Bondy, France
- Sorbonne Paris Cité, UMR U1153 Inserm/U1125 Inra/Cnam/Université Paris 13, Bobigny, France
| | - L. Carbillon
- Department of Gynecology-Obstetrics, AP-HP, Jean Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, Bondy, France
| | - P. Valensi
- Department of Endocrinology-Diabetology-Nutrition, AP-HP, Jean Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, CRNH-IdF, CINFO, Bondy, France
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