Top

08-07-2018 | Gestational diabetes | Article

Gestational diabetes mellitus: different management strategies should be adopted for different subsets of patients diagnosed by oral glucose tolerance test

Journal: Endocrine

Authors: Maria Joana Santos, Vera Fernandes, The Portuguese Pregnancy and Diabetes Study Group

Abstract

Purpose

To compare women diagnosed with gestational diabetes mellitus (GDM) according to the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) diagnostic criteria based on the number of OGTT diagnostic criteria, which OGTT parameters are altered and the glycemic deviation from proposed diagnostic cutoffs.

Methods

Cross-sectional, multicentric study of women diagnosed with GDM between 24–28 weeks of pregnancy according to the IADPSG criteria, in Portugal, between 2012–2014. Primary outcomes: large for gestational age (LGA) and maternal glucose metabolism status after delivery. Secondary outcome: small for gestational age (SGA).

Results

Three-thousand three-hundred fourteen patients were included; 67% had 1 OGTT altered value; 3.6% had LGA and 13% had SGA newborns; 7% had prediabetes/diabetes after delivery. Three diagnostic criteria in OGTT (OR 3.02; p < 0.001), a diagnostic value at 0 min (OR 2.09; p = 0.002) and 60 min (OR 1.70; p = 0.022) and glucose deviation at 0 min (OR 1.02; p = 0.014) were predictors of LGA. Having 2 (OR 1.94; p < 0.001) or 3 (OR 3.93; p < 0.001) diagnostic criteria in OGTT, a diagnostic value at 0 min (OR 1.76; p = 0.002), at 60 min (OR 1.57; p = 0.007) and at 120 min (OR 3.11; p < 0.001), the glucose deviation at 0 (OR 1.02; p = 0.017) and 120 min (OR 1.02; p < 0.001) were predictors of prediabetes/diabetes after delivery. Insufficient weight gain in pregnancy (OR 1.49; p < 0.001) and lower maternal BMI (OR 0.97; p = 0.024) were associated with SGA.

Conclusion

IADPSG diagnostic criteria include a heterogeneous group of women, for whom different management strategies should be adopted to obtain ideal pregnancy outcomes.

American Diabetes, A., 2. Classification and diagnosis of diabetes. Diabetes Care 40(Suppl 1), S11–S24 (2017). https://doi.org/10.2337/dc17-S005 CrossRef

H.S.C.R. Group, B.E. Metzger, L.P. Lowe, A.R. Dyer, E.R. Trimble, U. Chaovarindr, D.R. Coustan, D.R. Hadden, D.R. McCance, M. Hod, H.D. McIntyre, J.J. Oats, B. Persson, M.S. Rogers, D.A. Sacks, Hyperglycemia and adverse pregnancy outcomes. N. Engl. J. Med. 358(19), 1991–2002 (2008). https://doi.org/10.1056/NEJMoa0707943 CrossRef

International Association of Diabetes and Pregnancy Study Groups Consensus Panel, B.E. Metzger, S.G. Gabbe, B. Persson, T.A. Buchanan, P.A. Catalano, P. Damm, A.R. Dyer, A. Leiva, M. Hod, J.L. Kitzmiler, L.P. Lowe, H.D. McIntyre, J.J. Oats, Y. Omori, M.I. Schmidt, International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 33(3), 676–682 (2010). https://doi.org/10.2337/dc09-1848 CrossRefPubMedCentral

M. Hanefeld, C. Koehler, K. Fuecker, E. Henkel, F. Schaper, T. Temelkova-Kurktschiev, Insulin secretion and insulin sensitivity pattern is different in isolated impaired glucose tolerance and impaired fasting glucose: the risk factor in Impaired Glucose Tolerance for Atherosclerosis and Diabetes study. Diabetes Care 26(3), 868–874 (2003)CrossRefPubMed

K.M. Rasmussen, A.L. Yaktine (eds.) Weight Gain During Pregnancy: Reexamining the Guidelines. (The National Academies Collection: Reports funded by National Institutes of Health, Washington (DC), 2009)

T.R. Fenton, J.H. Kim, A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr. 13, 59 (2013). https://doi.org/10.1186/1471-2431-13-59 CrossRefPubMedPubMedCentral

M.H. Black, D.A. Sacks, A.H. Xiang, J.M. Lawrence, Clinical outcomes of pregnancies complicated by mild gestational diabetes mellitus differ by combinations of abnormal oral glucose tolerance test values. Diabetes Care 33(12), 2524–2530 (2010). https://doi.org/10.2337/dc10-1445 CrossRefPubMedPubMedCentral

H. Feng, W.W. Zhu, H.X. Yang, Y.M. Wei, C. Wang, R.N. Su, M. Hod, E. Hadar, Relationship between oral glucose tolerance test characteristics and adverse pregnancy outcomes among women with gestational diabetes mellitus. Chin. Med. J. (Engl.). 130(9), 1012–1018 (2017). https://doi.org/10.4103/0366-6999.204928 CrossRefPubMedPubMedCentral

H.S.C.R. Group, Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study: associations with neonatal anthropometrics. Diabetes 58(2), 453–459 (2009). https://doi.org/10.2337/db08-1112 CrossRef

10.

K. Brankica, V.N. Valentina, S.K. Slagjana, J.M. Sasha, Maternal 75-g OGTT glucose levels as predictive factors for large-for-gestational age newborns in women with gestational diabetes mellitus. Arch. Endocrinol. Metab. 60(1), 36–41 (2016). https://doi.org/10.1590/2359-3997000000126 CrossRef

11.

E. Disse, J. Graeppi-Dulac, G. Joncour-Mills, O. Dupuis, C. Thivolet, Heterogeneity of pregnancy outcomes and risk of LGA neonates in Caucasian females according to IADPSG criteria for gestational diabetes mellitus. Diabetes Metab. 39(2), 132–138 (2013). https://doi.org/10.1016/j.diabet.2012.09.006 CrossRefPubMed

12.

H.S.C.R. Group, Hyperglycaemia and Adverse Pregnancy Outcome (HAPO) Study: associations with maternal body mass index. BJOG 117(5), 575–584 (2010). https://doi.org/10.1111/j.1471-0528.2009.02486.x CrossRef

13.

A.M. Stuebe, M.B. Landon, Y. Lai, C.Y. Spong, M.W. Carpenter, S.M. Ramin, B. Casey, R.J. Wapner, M.W. Varner, D.J. Rouse, A. Sciscione, P. Catalano, M. Harper, G. Saade, Y. Sorokin, A.M. Peaceman, J.E. Tolosa, Eunice Kennedy Shriver National Institute of Child and Human Development Maternal-FetalMedicine Units Network, Bethesda, MD, Maternal BMI, glucose tolerance, and adverse pregnancyoutcomes. Am. J. Obstet. Gynecol 207(1), 62e61–62e67 (2012). https://doi.org/10.1016/j.ajog.2012.04.035 CrossRef

14.

P.M. Catalano, H.D. McIntyre, J.K. Cruickshank, D.R. McCance, A.R. Dyer, B.E. Metzger, L.P. Lowe, E.R. Trimble, D.R. Coustan, D.R. Hadden, B. Persson, M. Hod, J.J. Oats, H.S.C.R. Group, The hyperglycemia and adverse pregnancy outcome study: associations of GDM and obesity with pregnancy outcomes. Diabetes Care 35(4), 780–786 (2012). https://doi.org/10.2337/dc11-1790 CrossRefPubMedPubMedCentral

15.

S.J. Herring, E. Oken, Obesity and diabetes in mothers and their children: can we stop the intergenerational cycle? Curr. Diab. Rep. 11(1), 20–27 (2011). https://doi.org/10.1007/s11892-010-0156-9 CrossRefPubMedPubMedCentral

16.

O. Kalter-Leibovici, L.S. Freedman, L. Olmer, N. Liebermann, A. Heymann, O. Tal, L. Lerner-Geva, N. Melamed, M. Hod, Screening and diagnosis of gestational diabetes mellitus: critical appraisal of the new International Association of Diabetes in Pregnancy Study Group recommendations on a national level. Diabetes Care 35(9), 1894–1896 (2012). https://doi.org/10.2337/dc12-0041 CrossRefPubMedPubMedCentral

17.

F. Pallardo, L. Herranz, T. Garcia-Ingelmo, C. Grande, P. Martin-Vaquero, M. Janez, A. Gonzalez, Early postpartum metabolic assessment in women with prior gestational diabetes. Diabetes Care 22(7), 1053–1058 (1999)CrossRefPubMed