Uncovering the Risks: Investigating the Impact of Abnormal 50 g Results of Two-Step Gestational Diabetes Mellitus Screening in Pregnant Women

Year 2024, , 306 - 312, 30.06.2024

Sakine Rahımlı Ocakoglu , Bayram Ali Dorum , Zeliha Atak , Özlem Özgün Uyanıklar , Gökhan Ocakoğlu

https://doi.org/10.54005/geneltip.1396561

Abstract

Background/Aims: Gestational Diabetes Mellitus (GDM) is a prevalent medical concern among pregnant women. Timely identification and management of GDM can mitigate the potential for maternal and fetal complications. The present study aimed to explore the maternal characteristics that may result in an isolated elevation in the 50 g Glucose Challenge Test (GCT) results (Pre-GDM condition) and to assess the impact of Pre-GDM status on fetal and neonatal outcomes.
Methods: This retrospective trial included 177 pregnant women and 177 infants. All pregnant women who applied to the antenatal clinic were screened for GDM. Patients were divided into two groups: patients with abnormal GCT (50 g levels) but normal 100 g-OGTT results (study or Pre-GDM group) and those with normal 50 g results (control group).
Results: The advanced maternal age (AMA) rate was higher in the study group. (14.80% vs. 4.80%, p=0.028). There was a difference between the groups in maternal weight measurements at the first pregnancy visit. The rate of overweighted patients (more than 80 kg at the first pregnancy visit) was higher in the Pre-GDM group (35.20% vs. 5.80%, p<0.001). The rate of fetal macrosomia was higher in the Pre-GDM group (10.20% vs. 0, p<0.05). It was determined that the neonate's head circumference (HC) was larger in the Pre-GDM group (35.15 vs. 34.69, p=0.029) Emergent (primary) cesarean section (C/S) rate with cephalopelvic disproportion (CPD) indication was higher in the fetal macrosomia group (p<0.05). The power of the current study was determined as 87%
Conclusions : According to study result the patients in the Pre-GDM group is at risk of fetal macrosomia, which increases the risk of C/S. In overweighted and patients over 35 years old, 75 g OGTT may be more sensitive in detecting glucose metabolism disorders.

Keywords

Macrosomia, pre-gestational diabetes mellitus, screening.

Risklerin Ortaya Çıkarılması: Gebe Kadınlarda İki Adımlı Gestasyonel Diabetes Mellitus Taramasının Anormal 50 gr Sonuçlarının Araştırılması

Abstract

Amaç: Gestasyonel Diabetes Mellitus (GDM) hamile kadınlar arasında yaygın görülen bir tıbbi sorundur. GDM'nin zamanında tanımlanması ve yönetimi, anne ve fetusa ait komplikasyon potansiyelini azaltabilir. Bu çalışmanın amacı, 50 g Glukoz Challenge Testi (GCT) sonuçlarında (Pre-GDM) izole bir yükselmeye neden olabilecek anne özelliklerini araştırmak ve Pre-GDM fetal ve neonatal sonuçlar üzerindeki etkisini değerlendirmektir.
Gereç ve Yöntemler: Bu retrospektif çalışmaya 177 hamile kadın ve 177 bebek dahil edildi. Doğum öncesi kliniğine başvuran tüm gebelere GDM taraması yapıldı. Hastalar iki gruba ayrıldı: anormal GCT (50 g düzeyleri) olup, ancak 100 g-OGTT sonuçları normal olan hastalar (Pre-GDM) ve normal 50 g sonuçları olan hastalar (kontrol grubu).
Bulgular: İleri anne yaşı (AMA) oranı çalışma grubunda daha yüksekti. (%14,80'e karşılık %4,80, p=0,028). İlk trimester maternal kilosu ölçümlerinde gruplar arasında fark vardı. Aşırı kilolu (ilk gebelik muayenesinde 80 kg'ın üzerinde) hasta oranı Pre-GDM grubunda daha yüksekti (%35,20 vs. %5,80, p<0,001). Pre-GDM grubunda fetal makrozomi oranı daha yüksekti (%10,20 vs. 0, p<0,05). Yenidoğanın baş çevresinin (HC) Pre-GDM grupta daha büyük olduğu belirlendi (35,15 vs. 34,69, p=0,029). Baş-pelvik uyumsuzluk (CPD) endikasyonu ile acil (primer) sezaryen (C/S) oranının daha yüksek olduğu belirlendi fetal makrozomi grubunda (p<0.05). Mevcut çalışmanın gücü %87 olarak belirlendi
Sonuç : Çalışma sonucuna göre Pre-GDM grubundaki hastalar fetal makrozomi açısından risk altındadır ve bu da sezaryen riskini artırmaktadır. Aşırı kilolu ve 35 yaş üstü hastalarda 75 g OGTT glukoz metabolizması bozukluklarının tespitinde daha duyarlı olabileceği düşünmekteyiz.

Keywords

Makrozomi, pregestasyonel diyabet, tarama

References

• Sharma AK, Yerrabelli D, Sagili H, Sahoo JP, Gaur GS, Kumar A. Relationship between advanced glycated end products and maternal cognition in gestational diabetes: a case control study. The Journal of Maternal-Fetal & Neonatal Medicine. 2022;35(25):7806-11.
• Ozyurt R, Asicioglu O, Gultekin T, Gungorduk K, Boran B. The prevalence of gestational diabetes mellitus in pregnant women who were admitted to Istanbul Teaching and Research Hospital Obstetric and Gynecology Department. JOPP Derg. 2013;5(1):7-12.
• Ashwal E, Hod M. Gestational diabetes mellitus: Where are we now? Clinica chimica acta. 2015;451:14-20.
• Buchanan TA, Xiang AH, Page KA. Gestational diabetes mellitus: risks and management during and after pregnancy. Nature Reviews Endocrinology. 2012;8(11):639.
• Esakoff TF, Cheng YW, Caughey AB. Screening for gestational diabetes: different cut-offs for different ethnicities? American journal of obstetrics and gynecology. 2005;193(3):1040-4.
• Hartling L, Dryden DM, Guthrie A, Muise M, Vandermeer B, Aktary WM, et al. Screening and diagnosing gestational diabetes mellitus. Evidence report/technology assessment. 2012(210):1.
• Bardenheier BH, Imperatore G, Devlin HM, Kim SY, Cho P, Geiss LS. Trends in pre-pregnancy diabetes among deliveries in 19 US states, 2000− 2010. American journal of preventive medicine. 2015;48(2):154-61.
• Seval MM, Cavkaytar S, Atak Z, Cagman M. Should we interpret the results of ‘two-step’glucose screening again according to the obstetric outcomes? Journal of Obstetrics and Gynaecology. 2016;36(6):705-9.
• Sauer MV. Reproduction at an advanced maternal age and maternal health. Fertility and sterility. 2015;103(5):1136-43.
• Division UNDoEaSAP. World Fertility Patterns 2015–Data Booklet (ST/ESA/SER. A/370)2015.
• Frick AP. Advanced maternal age and adverse pregnancy outcomes. Best Practice & Research Clinical Obstetrics & Gynaecology. 2021;70:92-100.
• Bulletins C. ACOG Practice Bulletin No. 190: Gestational Diabetes Mellitus2018. e49-64 p.
• Kautzky-Willer A, Winhofer Y, Kiss H, Falcone V, Berger A, Lechleitner M, et al. Gestationsdiabetes (GDM)(Update 2023). Wiener klinische Wochenschrift. 2023;135(Suppl 1):115-28.
• Dabelea D, Snell-Bergeon JK, Hartsfield CL, Bischoff KJ, Hamman RF, McDuffie RS. Increasing prevalence of gestational diabetes mellitus (GDM) over time and by birth cohort: Kaiser Permanente of Colorado GDM Screening Program. Diabetes care. 2005;28(3):579-84.
• Akter S, Jesmin S, Rahman MM, Islam MM, Khatun MT, Yamaguchi N, et al. Higher gravidity and parity are associated with increased prevalence of metabolic syndrome among rural Bangladeshi women. PloS one. 2013;8(8):e68319.
• Kearney R, Fitzpatrick M, Brennan S, Behan M, Miller J, Keane D, et al. Levator ani injury in primiparous women with forceps delivery for fetal distress, forceps for second stage arrest, and spontaneous delivery. International Journal of Gynecology & Obstetrics. 2010;111(1):19-22.
• Heilbrun ME, Nygaard IE, Lockhart ME, Richter HE, Brown MB, Kenton KS, et al. Correlation between levator ani muscle injuries on magnetic resonance imaging and fecal incontinence, pelvic organ prolapse, and urinary incontinence in primiparous women. American journal of obstetrics and gynecology. 2010;202(5):488. e1-. e6.
• Neilson J, Lavender T, Quenby S, Wray S. Obstructed labour: reducing maternal death and disability during pregnancy. British medical bulletin. 2003;67(1):191-204.
• Pavličev M, Romero R, Mitteroecker P. Evolution of the human pelvis and obstructed labor: new explanations of an old obstetrical dilemma. American journal of obstetrics and gynecology. 2020;222(1):3-16.
• Twells LK, Gregory DM, Reddigan J, Midodzi WK. Current and predicted prevalence of obesity in Canada: a trend analysis. Canadian Medical Association Open Access Journal. 2014;2(1):E18-E26.
• Ayenew AA. Incidence, causes, and maternofetal outcomes of obstructed labor in Ethiopia: systematic review and meta-analysis. Reproductive health. 2021;18(1):1-14.
• Diabetes IAo, Panel PSGC. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy2010. 676-82 p.
• Olagbuji BN, Aderoba AK, Kayode OO, Awe CO, Akintan AL, Olagbuji YW, Group‐Nigeria GDS. Accuracy of 50‐g glucose challenge test to detect International Association of Diabetes and Pregnancy Study Groups criteria‐defined hyperglycemia. International Journal of Gynecology & Obstetrics. 2017;139(3):312-7.