scholarly journals A Study on Glycosylated Haemoglobin Values at 6 - 12 Weeks of Pregnancy as an Early Predictor of Gestational Diabetes Mellitus

2021 ◽  
Vol 10 (31) ◽  
pp. 2485-2489
Author(s):  
Staeny Rex ◽  
Preet Agarwal ◽  
Sarmishta Murugesan ◽  
Rajeshwari K.S
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
First Trimester ◽  
Glycosylated Haemoglobin ◽  
Morbidity And Mortality ◽  
World Health ◽  
Screening Methods ◽  
Oral Glucose ◽  
Major Health Problem

BACKGROUND Gestational diabetes mellitus (GDM) is a major health problem arising due to insulin resistance in pregnant women. It is associated with multiple maternal complications which may cause end organ failure, complicated labour and delivery and thereby increasing the maternal morbidity and mortality. The foetus is also at risk for problems beginning from in utero and extending into the neonatal period and adult life. We wanted to correlate first trimester HbA1c values with the subsequent development of gestational diabetes mellitus and identify if glycosylated haemoglobin can be used as an adjunct with other screening methods. METHODS It is a prospective cohort study. This study was conducted from August 2015 to August 2017. All women of gestational age 6 to 12 weeks who came to Sri Ramachandra University outpatient department were taken for this study. Informed consent was obtained and a detailed history taking was done as per proforma. Along with routine antenatal investigations, Glycosylated haemoglobin (HbA1c) was also done. Oral Glucose Tolerance Test was to be performed at 24 - 28 weeks as per the World Health Organisation –with 75gm criteria and the results were tabulated and analysed to know the significance of Glycosylated haemoglobin (HbA1c) in the outcome of gestational diabetes mellitus. Further a fasting and postprandial blood sugar was done in the 3rd trimester for all patients as a secondary screening tool for gestational diabetes mellitus. Secondary outcomes of obstetric and neonatal complications were also studied. RESULTS In the present study a total of 323 patients were screened for HbA1c during the first trimester and followed till delivery. Only 21.9 % developed gestational diabetes mellitus. Elevated Glycosylated haemoglobin (HbA1c) value of 5.7 - 6.4 % was seen in 5.9 %. CONCLUSIONS Most of the patients with elevated Glycosylated Haemoglobin in the first trimester had high chance of developing gestational diabetes mellitus. Glycosylated haemoglobin is indeed a simple way of screening, but its solitary use remains controversial and hence could possibly be tried as an adjunct with other screening methods. KEY WORDS Glycosylated Haemoglobin, Gestational Diabetes Mellitus, Glycaemic Control, Maternal and Foetal Morbidity and Mortality

scholarly journals Comparative analysis of current diagnostic criteria for gestational diabetes mellitus

2012 ◽  
Vol 5 (2) ◽  
pp. 71-77 ◽  
Author(s):  
Mariya V Boyadzhieva ◽  
Iliana Atanasova ◽  
Sabina Zacharieva ◽  
Tsvetalina Tankova ◽  
Violeta Dimitrova
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Diagnostic Criteria ◽  
International Association ◽  
Study Groups ◽  
World Health ◽  
Oral Glucose ◽  
Significant Difference ◽  
Iadpsg Criteria

Background To compare current guidelines for diagnosis of gestational diabetes mellitus (GDM) and to identify the ones that are the most relevant for application among pregnant Bulgarian population. Methods A total of 800 pregnant women at high risk for GDM underwent 75 g oral glucose tolerance test between 24 and 28 weeks of gestation as antenatal screening. The results were interpreted and classified according to the guidelines of the International Association of Diabetes and Pregnancy Study Groups (IADPSG), American Diabetes Association (ADA), Australasian Diabetes in Pregnancy Society, Canadian Diabetes Association, European Association for the Study of Diabetes, New Zealand Society for the study of Diabetes and World Health Organization. Results The application of different diagnostic criteria resulted in prevalences of GDM between 10.8% and 31.6%. Using any two sets of criteria, women who were classified differently varied between 0.1% and 21.1% ( P < 0.001).The IADPSG criteria were the most inclusive criteria and resulted in the highest prevalence of GDM. There was a significant difference in the major metabolic parameters between GDM and control groups, regardless of which of the diagnostic criteria applied. GDM diagnosed according to all criteria resulted in increased proportion of delivery by caesarean section (CS). However, only ADA and IADPSG criteria identified both increased macrosomia (odds ratio, 2.36; 2.29) and CS rate. Conclusion The need for GDM screening is indisputable. In our view, the new IADPSG guidelines offer a unique opportunity for a unified national and global approach to GDM.

scholarly journals Comparison of the American Diabetes Association and World Health Organization criteria for gestational diabetes mellitus and the outcomes of pregnancy

2009 ◽  
Vol 2 (4) ◽  
pp. 149-153 ◽  
Author(s):  
Latika Sahu ◽  
R Satyakala ◽  
Reddi Rani
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
World Health Organization ◽  
American Diabetes Association ◽  
Mode Of Delivery ◽  
World Health ◽  
Oral Glucose ◽  
Who Criteria ◽  
Health Organization

Two to five percent of pregnancies are complicated by diabetes, of which 90% are classified as gestational diabetes mellitus.The aims and objectives of this study were to analyse the screening and diagnostic procedure for gestational diabetes mellitus (GDM) recommended by American Diabetes Association (ADA) in comparison with the World Health Organization (WHO) criteria and to study the outcome of GDM diagnosed by both the criteria. This prospective study was carried out in the Department of Obstetrics and Gynaecology, JIPMER between August 2006 and July 2008. Three-hundred-and-fifty antenatal cases of gestational age ≥24 weeks attending the outpatient department, with any one of the risk factors for GDM, were included in the study. A seventy-five gram oral glucose tolerance test (GTT) was performed on each subject. Results were interpreted using both ADA and WHO criteria. Antenatal complications of GDM, mode of delivery, intrapartum or postnatal maternal and neonatal complications in cases diagnosed with GDM by either criterion were noted. The data collected were analysed using the SPSS software program. The prevalence of GDM was 4% by ADA criteria versus 19.4% by WHO criteria. The diagnostic pick-up rate was approximately five times more with WHO than with ADA criteria. In total, 43% (ADA) and 29% (WHO) of GDM cases had antenatal complications. Seventy-four percent of mothers with macrosomic babies were identified by WHO criteria whereas only 26% of mothers with macrosomic babies were diagnosed by ADA criteria. ADA criteria identify more severe cases of GDM but mild cases diagnosed by WHO are missed. The GTT by WHO criteria was abnormal in a greater percentage of women with adverse outcomes especially macrosomia, than the GTT using ADA criteria.

scholarly journals Use of glycosylated HbA1c and random blood sugar as a screening tool for gestational diabetes mellitus in first trimester

2018 ◽  
Vol 7 (2) ◽  
pp. 524 ◽  
Author(s):  
Shaiesta Amreen ◽  
Anjali Suneel ◽  
Ananya Shetty ◽  
Akhila Vasudeva ◽  
Pratap Kumar
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Pregnant Women ◽  
Screening Tool ◽  
Tertiary Care ◽  
Multiple Pregnancy ◽  
First Trimester ◽  
Screening Methods ◽  
Early Screening

Background: GDM cases go unidentified with inadequate screening methods in first trimester which in turn increases the maternal and neonatal morbidity which is preventable. The purpose of the study was to find out a cut off level for HbA1c and RBS at first trimester for screening Gestational diabetes mellitus (GDM).Methods: Observational study on pregnant women in a tertiary care teaching institution. Early screening with HbA1c and RBS at booking visit and followed up to second trimester GTT at 24-28 weeks. Pregnant women were divided into 2 groups based on GTT results. Pregnant women with overt diabetes and multiple pregnancy were not included in the study.Results: Out of the 151 subjects, 76 cases were diagnosed with GDM while the other 75 were found to be non-GDM by following the 75g GTT approved by IADPSG. According to our study optimal cut-off for HbA1C was found to be 5.496±0.48 %, as it gives a sensitivity of 80% and specificity of 55.3%. Optimal cut-off for RBS was found to be 112±0.77 mg/dl, as it gives a sensitivity of 35.55 and specificity of 94.7%.Conclusions: Glyco Hb A1c and RBS can be used as screening tool for the diagnosis of GDM.  The likelihood of having GDM at a cutoff of Glyco HbA1c 5.5% is 1.8 times and RBS level 112mg/dl is 7 times in pregnant women.

scholarly journals Gestational Diabetes Mellitus and its Relation to Pre-pregnancy Body Mass Index

2020 ◽  
Author(s):  
Veena Thamban ◽  
Kavana G Venkatappa
Keyword(s):  
Diabetes Mellitus ◽  
Insulin Resistance ◽  
Body Mass Index ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Body Mass ◽  
World Health ◽  
Oral Glucose ◽  
Care Hospital ◽  
Care Clinic

Introduction: Obesity mediates a systemic inflammatory response in our body which includes insulin resistance and glucose dysregulation. Increased Body Mass Index (BMI) associated with Gestational Diabetes Mellitus (GDM) leads to a state of insulin resistance additive to insulin resistance of GDM. Aim: To assess the relationship between GDM and pre-pregnancy BMI. Materials and Methods: This case-control study enrolled 64 women with GDM and 64 without GDM, attending antenatal care clinic at a Tertiary Care Hospital, after obtaining their informed consent. Obstetric history, pre-pregnancy BMI and Oral Glucose Tolerance Test (OGTT) values were noted. Diabetes in Pregnancy Study Group in India (DIPSI) criterion was used for diagnosing GDM. The BMI was categorised according to World Health Organisation (WHO) criterion. Data obtained was statistically analysed. Results: Out of 44, 41 (93.2%) women with GDM had pre-pregnancy BMI ≥25 kg/m2 (overweight and obese) compared to 3 (6.8%) in controls (Χ2 value=50.01, p≤0.001). Mean±SD of pre-pregnancy BMI in women with GDM was significantly higher (26.38±2.74 kg/m2) compared to controls i.e., 22.26±1.54 kg/m2(unpaired t-test: p≤0.001). Conclusion: GDM was found to be significantly associated with pre-pregnancy BMI. Appropriate interventions and risk factor modifications are recommended to prevent GDM and its complications.

scholarly journals Prevalence and associated factors of gestational diabetes mellitus among rural pregnant women in southern Tanzania

2020 ◽  
Vol 54 (2) ◽  
pp. 82-87
Author(s):  
Fabian Mghanga ◽  
Elia Maduhu ◽  
Helmut Nyawale
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Pregnant Women ◽  
Past History ◽  
Statistical Significance ◽  
World Health ◽  
Oral Glucose ◽  
Degree Relative ◽  
History Of

Introduction: Gestational diabetes mellitus (GDM) is a potential risk factor for both maternal and foetal complications during pregnancy. This study aimed to determine the prevalence and factors associated with GDM among pregnant women in Southern Tanzania.Methods: A cross-sectional study was conducted among 612 randomly selected pregnant women attending routine antenatal clinics in Southern Tanzania from September to October 2017. Detailed medical and gynaecological history was taken using pre-tested questionnaires. Blood samples were collected for fasting and oral glucose tolerance tests. We diagnosed GDM using the World Health Organization 2013 diagnostic criteria for diabetes mellitus. We performed statistical analysis using SPSS v24.0. Possible associations and statistical significance were measured using odds ratio at 95% confidence interval, and p-values of <0.05 were considered statistically significant.Results: The mean age and standard deviation of the study subjects was 24.5±6.9 years. The prevalence of GDM was 4.3%. GDM was significantly associated with: being overweight or obese (p<0.001), past history of pre-term delivery (p<0.001), past history of stillbirths (p<0.001), history of macrosmia (p<0.001), alcohol consumption (p=0.001), and having a first degree relative with diabetes mellitus (p<0.001). Conclusion: Prevalence of Gestational Diabetes Mellitus is low in this study setting. We recommend close attentionto at risk women to prevent development of GDM.Keywords: Diabetes mellitus; Gestational diabetes mellitus; risk factors.Funding: None declared

scholarly journals C-reactive protein as a screening test for gestational diabetes mellitus in first-trimester of pregnancy: a prospective cohort study

2018 ◽  
Vol 7 (12) ◽  
pp. 4798 ◽  
Author(s):  
Tarek A. Farghaly ◽  
Neveen A. Helmy ◽  
Ahmed M. Abbas ◽  
Abdel Ghaffar M. Ahmed
Keyword(s):  
Diabetes Mellitus ◽  
Cohort Study ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
First Trimester ◽  
Oral Glucose ◽  
C Reactive Protein ◽  
Reactive Protein

Background: The current study aims to determine if increased inflammation identified by increased C-reactive protein (CRP) level is associated with the subsequent development of gestational diabetes mellitus (GDM).Methods: A prospective cohort study conducted at a tertiary University Hospital included 496 booking for their antenatal care visit between 10-12 weeks of gestation. They were tested for presence of CRP in blood. All women without a history of antenatal type 1 or type 2 diabetes undergo routine GDM screening with the 50-g oral glucose-loading test (GLT) between 24 and 28 weeks 'gestation. Women whose 1-h post-loading plasma glucose level >7.8 mmol/l (>140 mg/dl) undergo a diagnostic, fasting, 100-g, 3-h oral glucose tolerance test (OGTT) within 1-2 weeks following the GLT.Results: Among these 496 women, a total of 27 women (5.4%) were diagnosed as GDM and 10 women (2.0%) were diagnosed as IGT at week 24-28. The CRP was positive and higher in the GDM diagnosed group (p=0.000) compared to those who did not develop GDM. CRP was positively correlated with diagnosis of GDM (r=0.438, p=0.012).Conclusions: There is an association between first-trimester inflammation, marked by increased CRP levels and subsequent risk of GDM.

scholarly journals Prediction of Glucose Intolerance in Early Postpartum in Women with Gestational Diabetes Mellitus Based on the 2013 WHO Criteria

2019 ◽  
Vol 8 (3) ◽  
pp. 383 ◽  
Author(s):  
Katrien Benhalima ◽  
Paul Van Crombrugge ◽  
Carolien Moyson ◽  
Johan Verhaeghe ◽  
Sofie Vandeginste ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Glucose Intolerance ◽  
Challenge Test ◽  
Area Under The Curve ◽  
World Health ◽  
High Risk Population ◽  
Oral Glucose ◽  
Who Criteria

Predictors for glucose intolerance postpartum were evaluated in women with gestational diabetes mellitus (GDM) based on the 2013 World Health Organization (WHO) criteria. 1841 women were tested for GDM in a prospective cohort study. A postpartum 75g oral glucose tolerance test (OGTT) was performed in women with GDM at 14 ± 4.1 weeks. Of all 231 mothers with GDM, 83.1% (192) had a postpartum OGTT of which 18.2% (35) had glucose intolerance. Women with glucose intolerance were more often of Asian origin [15.1% vs. 3.7%, OR 4.64 (1.26–17.12)], had more often a recurrent history of GDM [41.7% vs. 26.7%, OR 3.68 (1.37–9.87)], higher fasting glycaemia (FPG) [5.1 (4.5–5.3) vs. 4.6 (4.3–5.1) mmol/L, OR 1.05 (1.01–1.09)], higher HbA1c [33 (31–36) vs. 32 (30–33) mmol/mol, OR 4.89 (1.61–14.82)], and higher triglycerides [2.2 (1.9–2.8) vs. 2.0 (1.6–2.5) mmol/L, OR 1.00 (1.00–1.01)]. Sensitivity of glucose challenge test (GCT) ≥7.2 mmol/l for glucose intolerance postpartum was 80% (63.1%–91.6%). The area under the curve to predict glucose intolerance was 0.76 (0.65–0.87) for FPG, 0.54 (0.43–0.65) for HbA1c and 0.75 (0.64–0.86) for both combined. In conclusion, nearly one-fifth of women with GDM have glucose intolerance postpartum. A GCT ≥7.2 mmol/L identifies a high risk population for glucose intolerance postpartum.

scholarly journals OR08-01 One-Step Versus Two-Step Approach for Gestational Diabetes Mellitus Screening: Comparison of Maternal and Fetal Outcomes in a Canadian Population

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Fanny Goyette ◽  
Bi Lan Wo ◽  
Marie-Hélène Iglesias ◽  
Evelyne Rey ◽  
Ariane Godbout
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Screening Method ◽  
Large For Gestational Age ◽  
Screening Methods ◽  
Oral Glucose ◽  
Neonatal Hypoglycemia ◽  
Borderline Patients ◽  
One Step

Abstract Screening for gestational diabetes mellitus (GDM) is internationally recommended however there is no universal approach. Impact of the different diagnostic strategies on maternal and neonatal complications’ rates and cost-effectiveness need to be studied. Objective To compare maternal and neonatal outcomes between the two supported screening methods for GDM; the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) 75g one-step oral glucose tolerance test (OGTT) versus the 50g two-step OGTT. Methods A retrospective cohort study was performed regrouping all deliveries between 2016 and 2018 in two centers, each using one different screening method. GDM was diagnosed in center A when meeting IADPSG odds ratio (OR) 1.75 cut-offs values after a one-step 75g-OGTT. Center B used a two-step strategy and diagnosed GDM with 50g-OGTT 1hr glycemic value ≥11.1 mmol/L or failed 50g followed by 75g-OGTT results over the IADPSG OR 2.0 cut-offs. Primary outcome was the rate of large for gestational age (LGA) babies. Outcomes were analysed for singleton pregnancies with deliveries &gt;32 weeks. Subgroup analysis of borderline GDM women (OGTT results in between IADPSG OR 1.75 and 2.0 values) were done. Group A’s borderline patients were treated as per GDM patients. Group B’s borderline patients were not considered diabetic and had normal pregnancy care. Results were adjusted for maternal age, BMI and gestational weight gain. Results At interim analysis for the year 2016, a total of 6188 pregnancies, 2664 women in center A (one-step) and 3524 in center B (two-step) were included. The prevalence of GDM was 17.1% in center A (n=456) and 14.8% in center B (n=520). Both populations were comparable in terms of risk factors for LGA except for its ethnic distribution and proportion of obese women (13.1 vs 21.6%). GDM women in center B compared to center A had significant increase in rates of LGA neonates (adjusted OR (ORa) 2.1, p=0.012); neonatal hypoglycemia (ORa 2.1, p=0.0001) and neonatal intensive care unit (NICU) admission (2.1, p=0.048). Gestational hypertension’s rate was more prevalent in center B (ORa 2.1, p=0.020) and there was a non statistical trend towards increased rate of caesareans (1.6, p=0.084). Regular prenatal care for borderline women in center B (n=94) compared to GDM care in center A (n=150) resulted in increased rate of LGA babies (ORa 3.2, p=0.049). Worse maternal outcomes were identified for gestational hypertension (9.7 vs 1.3%, p=0.035) and preeclampsia (4.3 vs 0%, p=0.021) in group B vs A, respectively. Conclusions Choosing the one-step IADPSG criteria’s for GDM screening is associated with lower rates of LGA, neonatal hypoglycemia and NICU admissions, at the expense of increased prevalence in our population. The ongoing study will include a cost-benefit evaluation to assess if improved outcomes overbalance the increased prevalence inherent to lower diagnostic criteria.

scholarly journals Maternal Subclinical Hypothyroidism in the first trimester is not Associated with Gestational Diabetes Mellitus

2019 ◽  
Author(s):  
Ping Li ◽  
Xinjuan Chen ◽  
Jinhui Cui ◽  
Zhaoran Meng ◽  
Jianhui Fan ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Subclinical Hypothyroidism ◽  
First Trimester ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Free T4 ◽  
Chi Square ◽  
Tsh Levels

Abstract Background: To explore the association between subclinical hypothyroidism (SCH) during the first trimester and gestational diabetes mellitus (GDM) that was happened later on in our cohort. Methods: A total of 6530 pregnant women who first visited before 13 +6 gestational weeks and accepted routinely prenatal services in the third affiliated hospital of Sun Yat-Sen University from January 2015 to September 2018 were finally met the inclusion criteria and recruited. Thyroid functions (TSH, free T4 (FT4) and TPOAb) were performed at the first visit and a 2h 75-g oral glucose tolerance test was performed between 24-28 weeks. Chi-square test and multivariate logistic regression were used to evaluate the association between SCH and GDM. Results: Though SCH group was divided into subgroups according TPOAb status and TSH levels, the incidence of GDM was no change when compared with the normal group (all P > 0.05). No matter adjusting or not for maternal age, maternal pregestational body max index, parity and educational level, the results showed elevated TSH was not associated GDM (all P > 0.05). TPOAb status also had no effect on the incidence of GDM either before or after adjustment ( P > 0.05). Conclusion: Maternal SCH in the first trimester was not associated with GDM, regardless of the TPOAb status or the TSH levels.

Sign in / Sign up

Export Citation Format

Share Document