Vol 89, No 7 (2018)
Research paper
Published online: 2018-07-31
Gestational diabetes mellitus (GDM) — do the number of fulfilled diagnostic criteria predict the perinatal outcome?
Abstract
Objectives: The aim of the study was to check whether the number of fulfilled diagnostic criteria of gestational diabetes mellitus (GDM) had any association with patients’ characteristics and pregnancy outcomes. Material and methods: A total of 756 women with single pregnancies and GDM who gave birth at the 2nd Department of Obstetrics and Gynecology of the Medical University of Warsaw between 01.2013-12.2016 were included in a retrospective analysis. Patients were divided into 2 groups: A - 499 patients diagnosed with GDM on the basis of one diagnostic criterion, B - 257 patients diagnosed with GDM on the basis of more than one diagnostic criterion. Results: Patients from group A had lower pre-pregnancy BMI than those from group B (median 24.9 kg/m2 vs. 26.5 kg/m2, p=0.0003). Women from group A were less frequently treated with insulin than women from group B (19.1% vs. 32.7%; p=0.00002). Group A had lower median OGTT levels than group B (85.9 mg/dL vs. 94.1 mg/dL, p=0,0001; 160.2 mg/dL vs. 197.6 mg/dL, p=0.0001; 144.8 mg/dL vs. 167.0 mg/dL,p=0.0001; respectively). Moreover, in group B the average week of labor was earlier than in group A (mean 38,1 and 38,5 weeks of gestation, p=0,0006). Conclusions: Patients who fulfilled more than one diagnostic criterion for GDM may have worse pregnancy outcome. We think that a number of fulfilled diagnostic criteria for GDM may be an important risk factor for insulin therapy during pregnancy and earlier gestational age at delivery.
Keywords: gestational diabetes mellitusoral glucose tolerance testbody mass indexinsulin therapy
References
- World Health Organization. Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications. Part 1: Diagnosis and Classification of Diabetes Mellitus. WHO/NCD/NCS/99.2 ed. Geneva: World Health Organization. ; 1999.
- American Diabetes Association. Standards of Medical Care in Diabetes 2017. Sec. 2. Classification and diagnosis of diabetes. Diabetes Care. 2017; 40: 11–24.
- Hyperglycemia and Adverse Pregnancy Outcomes. New England Journal of Medicine. 2008; 358(19): 1991–2002.
- Benhalima K, Mathieu C, Van Assche A, et al. Survey by the European Board and College of Obstetrics and Gynaecology on screening for gestational diabetes in Europe. Eur J Obstet Gynecol Reprod Biol. 2016; 201: 197–202.
- Akgöl E, Abuşoğlu S, Gün FD, et al. Prevalence of gestational diabetes mellitus according to the different criterias. Turk J Obstet Gynecol. 2017; 14(1): 18–22.
- Adam S, Rheeder P. Screening for gestational diabetes mellitus in a South African population: Prevalence, comparison of diagnostic criteria and the role of risk factors. S Afr Med J. 2017; 107(6): 523–527.
- Ekeroma AJ, Chandran GS, McCowan L, et al. Impact of using the International Association of Diabetes and Pregnancy Study Groups criteria in South Auckland: prevalence, interventions and outcomes. Aust N Z J Obstet Gynaecol. 2015; 55(1): 34–41.
- Wong VW, Lin A, Russell H. Adopting the new World Health Organization diagnostic criteria for gestational diabetes: How the prevalence changes in a high-risk region in Australia. Diabetes Res Clin Pract. 2017; 129: 148–153.
- Guariguata L, Linnenkamp U, Beagley J, et al. The IDF Diabetes Atlas methodology for estimating global prevalence of hyperglycaemia in pregnancy. Diabetes Res Clin Pract. 2014; 103(2): 186–196.
- Eades CE, Cameron DM, Evans JMM. Prevalence of gestational diabetes mellitus in Europe: A meta-analysis. Diabetes Res Clin Pract. 2017; 129: 173–181.
- Polish Society of Gynecologists and Obstetricians. Polish Society of Gynecologists standards of medical care in management of women with diabetes. Ginekol Pol. 2011; 82(6): 474–479.
- Polish Society of Gynecologists and Obstetricians. Polish Society of Gynecologists standards of medical care in management of women with diabetes – actualization. Ginekol Pol. 2014; 85: 476–478.
- Sacks DB, Arnold M, Bakris GL, et al. National Academy of Clinical Biochemistry, National Academy of Clinical Biochemistry, Evidence-Based Laboratory Medicine Committee of the American Association for Clinical Chemistry. Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus. Diabetes Care. 2011; 34(6): e61–e99.
- Diabetes Poland. 2017 Guidelines on the management of diabetic patients. A position of Diabetes Poland. Chapter 23. Diabetes and pregnancy. Clinical Diabetology. ; 2017: A51–A54.
- Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy: A World Health Organization Guideline. Diabetes Research and Clinical Practice. 2014; 103(3): 341–363.
- Pietrzak Z, Krasomski G. Neonatal birth weight percentile born between 24 – 42 week of pregnancy as a tool to predict fetal macrosomy in single pregnancies. Gin Pol 2007;78. (Sup1): 9–4.
- Black MH, Sacks DA, Xiang AH, et al. Clinical outcomes of pregnancies complicated by mild gestational diabetes mellitus differ by combinations of abnormal oral glucose tolerance test values. Diabetes Care. 2010; 33(12): 2524–2530.
- Feng H, Zhu WW, Yang HX, et al. Relationship between Oral Glucose Tolerance Test Characteristics and Adverse Pregnancy Outcomes among Women with Gestational Diabetes Mellitus. Chin Med J (Engl). 2017; 130(9): 1012–1018.
- Karcaaltincaba D, Calis P, Ocal N, et al. Prevalence of gestational diabetes mellitus evaluated by universal screening with a 75-g, 2-hour oral glucose tolerance test and IADPSG criteria. Int J Gynaecol Obstet. 2017; 138(2): 148–151.
- Ketumarn N, Boriboonhirunsarn D. Characteristics of abnormal oral glucose tolerance test in GDM diagnosis and clinical correlation. J Matern Fetal Neonatal Med. 2018; 31(16): 2109–2114.
- Park TC, Lee BH, Norwitz ER, et al. Maternal hyperglycemia and the 100-g oral glucose tolerance test. Taiwan J Obstet Gynecol. 2015; 54(2): 137–142.
- Landon MB, Mele L, Spong CY, et al. Eunice Kennedy Shriver National Institute of Child Health, and Human Development (NICHD) Maternal–Fetal Medicine Units (MFMU) Network. The relationship between maternal glycemia and perinatal outcome. Obstet Gynecol. 2011; 117(2 Pt 1): 218–224.
- Blickstein I, Doyev R, Trojner Bregar A, et al. The effect of gestational diabetes, pre-gravid maternal obesity, and their combination ('diabesity') on outcomes of singleton gestations. J Matern Fetal Neonatal Med. 2018; 31(5): 640–643.
- Danieli-Gruber S, Maayan-Metzger A, Schushan-Eisen I, et al. Outcome of preterm infants born to overweight and obese mothers†. J Matern Fetal Neonatal Med. 2017; 30(4): 402–405.
- Gao X, Yan Y, Xiang S, et al. The mutual effect of pre-pregnancy body mass index, waist circumference and gestational weight gain on obesity-related adverse pregnancy outcomes: A birth cohort study. PLoS One. 2017; 12(6): e0177418.
- Miao M, Dai M, Zhang Y, et al. Influence of maternal overweight, obesity and gestational weight gain on the perinatal outcomes in women with gestational diabetes mellitus. Sci Rep. 2017; 7(1): 305.
- Li W, Wang L, Li N, et al. Maternal Prepregnancy BMI and Glucose Level at 24-28 Gestational Weeks on Offspring's Overweight Status within 3 Years of Age. Biomed Res Int. 2017; 2017: 7607210.
- Watanabe M, Katayama A, Kagawa H, et al. Risk Factors for the Requirement of Antenatal Insulin Treatment in Gestational Diabetes Mellitus. J Diabetes Res. 2016; 2016: 9648798.
- Mitra S, Nayak PK, Sahoo J, et al. Predictors for antenatal insulin requirement in gestational diabetes. Gynecol Endocrinol. 2014; 30(8): 565–568.
- Kösüs N, Kösüs A, Duran M, et al. Effect of number of abnormal oral glucose tolerance test (OGTT) values on birthweight in women with gestational diabetes. Indian J Med Res. 2013; 137(1): 95–101.
- Landon M, Spong C, Thom E, et al. A Multicenter, Randomized Trial of Treatment for Mild Gestational Diabetes. New England Journal of Medicine. 2009; 361(14): 1339–1348.
- Crowther CA, Hiller JE, Moss JR, et al. Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial Group. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med. 2005; 352(24): 2477–2486.
