Prevalance of impaired glucose tolerance and its association with adverse perinatal outcomes in non-gestational diabetes pregnancies

Year 2023, , 169 - 176, 30.12.2023

Akın Usta , Meryem Hocaoğlu , Cagla Bulbul , Ceyda Usta

https://doi.org/10.17944/interdiscip.1347548

Abstract

Objective: Gestational diabetes mellitus (GDM) is characterized by glucose intolerance with onset during pregnancy and is one of the most common metabolic disorders complicating pregnancy. The aim of this study was to evaluate the risk of maternal and neonatal outcomes in non-gestational diabetes pregnancies with abnormal glucose challenge test (GCT) and abnormal glucose tolerance test (GTT) results.

Methods: In this retrospective cohort study of 2982 singleton pregnancies, all patients underwent a non-fasting 50 g GCT at 24 to 28 weeks of gestation. A GCT cutoff of ≥ 140 mg/dl was selected. Women with an elevated GCT underwent prompt diagnostic testing with a 3-hour GTT. Subjects were divided into four groups according to GCT and GTT results.

Results: There was an impaired glucose tolerance in 19.2 % of patients and 14.7 % of them had mild glucose intolerance and 4.5 % of them had moderate glucose intolerance. As expected, there was statistically significant difference in fetal macrosomia, neonatal hypoglicemia, PE, primary CS, and preterm birth between secreening negative and GDM patients (p < 0.0001). We also observed statistically significant difference in neonatal hypoglicemia (p = 0.0001) and PE (p = 0.0277) between screning negative and mild glucose intolerance group. Moreover, there was a significant difference in fetal macrosomia (p=0.0480) between mild glucose intolerance and moderate glucose intolerance groups.

Conclusion: Compared with screening negative group, mild and moderate glucose intolerance are associated with increased adverse maternal and neonatal outcomes even in the absence of GDM.

Keywords

Gestational diabetes mellitus, Fetal macrosomia, Neonatal hypoglicemia, Cesarean section, Glucose intolerance

References

• Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin No. 190: Gestational Diabetes Mellitus. Obstet Gynecol. 2018;131(2):e49-e64. https://doi.org/10.1097/AOG.0000000000002501
• Zhou T, Du S, Sun D et al. Prevalence and trends in gestational diabetes mellitus among women in the United States, 2006–2017: a population-based study. Frontiers in Endocrinology. 2022;13. https://www.frontiersin.org/articles/10.3389/fendo.2022.868094
• Nigatu B, Workneh T, Mekuria T, et al. Prevalence of Gestational Diabetes Mellitus among pregnant women attending antenatal care clinic of St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia. Clinical diabetes and endocrinology. 2022;8(1):1-6. https://doi.org/10.1186/s40842-022-00139-w
• Johns EC, Denison FC, Norman JE, Reynolds RM. Gestational diabetes mellitus: mechanisms, treatment, and complications. Trends in Endocrinology & Metabolism. 2018;29(11):743-754.
• Malaza N, Masete M, Adam S, Dias S, Nyawo T, Pheiffer C. A Systematic Review to Compare Adverse Pregnancy Outcomes in Women with Pregestational Diabetes and Gestational Diabetes. International Journal of Environmental Research and Public Health. 2022;19(17):10846. https://doi.org/10.3390/ijerph191710846.
• Billionnet C, Mitanchez D, Weill A, et al. Gestational diabetes and adverse perinatal outcomes from 716,152 births in France in 2012. Diabetologia. 2017;60:636-644.
• Ugwudike B, Kwok MH. Update on gestational diabetes and adverse pregnancy outcomes. Current Opinion in Obstetrics and Gynecology. 2023.https://doi.org/10.1097/GCO.0000000000000901.
• Wendland EM, Torloni MR, Falavigna M, et al. Gestational diabetes and pregnancy outcomes-a systematic review of the World Health Organization (WHO) and the International Association of Diabetes in Pregnancy Study Groups (IADPSG) diagnostic criteria. BMC pregnancy and childbirth. 2012;12:1-13.
• Fadl HE, Östlund IKM, Magnuson AFK, Hanson US. Maternal and neonatal outcomes and time trends of gestational diabetes mellitus in Sweden from 1991 to 2003. Diabetic Medicine. 2010;27(4):436-441.
• Prevention C for DC and. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. Atlanta, GA: US department of health and human services, centers for disease control and prevention. 2011;201(1):2568-2569.
• Catalano PM, Kirwan JP, Haugel-de Mouzon S, King J. Gestational diabetes and insulin resistance: role in short-and long-term implications for mother and fetus. The Journal of nutrition. 2003;133(5):1674S-1683S.
• Parlakgumus HA, Durukan T. The relationship between cardiac adaptation to uteroplacental Doppler flow and perinatal outcome in pregnant women with diabetes. Clinical & Experimental Obstetrics & Gynecology. 2010;37(1):39.
• Buckley BS, Harreiter J, Damm P, et al. Gestational diabetes mellitus in Europe: prevalence, current screening practice and barriers to screening. A review. Diabetic medicine. 2012;29(7):844-854.
• Savvato K, Wafa A, Anwar A, Hanan A, Sofia C. Self-management and self-efficacy of women with gestational diabetes mellitus: a systematic review. Global Health Action.2022;15:1, https://doi.org/10.1080/16549716.2022.2087298.
• Metzger BE, Gabbe SG, Persson B, et al. International Association of Diabetes and Pregnancy Study Groups Recommendations on the Diagnosis and Classification of Hyperglycemia in Pregnancy: Response to Weinert. Diabetes Care. 2010;33(7):e98. https://doi.org/10.2337/dc10-0719
• Aung YY, Sowter M, Kenealy T, Herman J, Ekeroma A. Gestational diabetes mellitus screening, management and outcomes in the Cook Islands. Published online 2015.
• Huhn EA, Rossi SW, Hoesli I, Göbl CS. Controversies in screening and diagnostic criteria for gestational diabetes in early and late pregnancy. Frontiers in endocrinology. 2018;9:696.
• Bonomo M, Corica D, Mion E. et al. Evaluating the therapeutic approach in pregnancies complicated by borderline glucose intolerance: a randomized clinical trial. Diabetic Medicine, 2005;22(11), 1536-1541. https://doi.org/10.1111/j.1464-5491.2005.01690.x
• Punnose J, Malhotra RK, Sukhija K, Choudhary N, Sharma A, Vij P, Bahl P. Gestational diabetes mellitus in early pregnancy amongst Asian Indian women: Evidence for poor pregnancy outcomes despite treatment. Diabetic Medicine.2023;40(1): e14993. https://doi.org/10.1111/dme.14993.
• Seo N, Lee YM, Kim YJ, Sung JH, Hur KY, Choi SJ, Roh CR, Oh SY. Obesity Is Associated With Higher Risk of Adverse Maternal and Neonatal Outcomes Than Supervised Gestational Diabetes. J Korean Med Sci. 2023 Aug;38(33):e268. https://doi.org/10.3346/jkms.2023.38.e268.
• Dodd JM, Crowther CA, Antoniou G, Baghurst P, Robinson JS. Screening for gestational diabetes: the effect of varying blood glucose definitions in the prediction of adverse maternal and infant health outcomes. Australian and New Zealand Journal of Obstetrics and Gynaecology. 2007;47(4):307-312.
• Stamilio DM, Olsen T, Ratcliffe S, Sehdev HM, Macones GA. False-positive 1-hour glucose challenge test and adverse perinatal outcomes. Obstetrics & Gynecology. 2004;103(1):148-156.
• Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol. 2013;122(5):1122-1131. doi:10.1097/01.AOG.0000437382.03963.88
• Bonomo M, Corica D, Mion E, et al. Evaluating the therapeutic approach in pregnancies complicated by borderline glucose intolerance: a randomized clinical trial. Diabetic Medicine. 2005;22(11):1536-1541.
• Sermer M, Naylor CD, Gare DJ, et al. Impact of increasing carbohydrate intolerance on maternal-fetal outcomes in 3637 women without gestational diabetes: the Toronto Tri-Hospital Gestational Diabetes Project. American journal of obstetrics and gynecology. 1995;173(1):146-156.
• Savona-Ventura AS. Risk factors for gestational impaired glucose tolerance in the Maltese population: a cross-sectional study. Journal of Obstetrics and Gynaecology. 2001;21(6):591-594.
• Tallarigo L, Giampietro O, Penno G, Miccoli R, Gregori G, Navalesi R. Relation of glucose tolerance to complications of pregnancy in nondiabetic women. New England Journal of Medicine. 1986;315(16):989-992.
• Carpenter MW, Coustan DR. Criteria for screening tests for gestational diabetes. American journal of obstetrics and gynecology. 1982;144(7):768-773.
• Arbib N, Gabbay-Benziv R, Aviram A, et al. Third trimester abnormal oral glucose tolerance test and adverse perinatal outcome. The Journal of Maternal-Fetal & Neonatal Medicine. 2017;30(8):917-921. doi:10.1080/14767058.2016.1190825
• ACOG Committee on Obstetric Practice. ACOG practice bulletin. Diagnosis and management of preeclampsia and eclampsia. Number 33, January 2002. American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet. 2002;77(1):67-75.
• Fuka F, Osuagwu UL, Agho K, Gyaneshwar R, et al. Factors associated with macrosomia, hypoglycaemia and low Apgar score among Fijian women with gestational diabetes mellitus. BMC Pregnancy and Childbirth, 2020;20(1), 1-14. https://doi.org/10.1186/s12884-020-2821-6
• Ji J, Sundquist J, Sundquist K. Stillbirth and neonatal death among female cancer survivors: A national cohort study. International Journal of Cancer. 2016;139(5):1046-1052. doi:10.1002/ijc.30156
• Lavery J, Friedman A, Keyes K, Wright J, Ananth C. Gestational diabetes in the United States: temporal changes in prevalence rates between 1979 and 2010. BJOG: An International Journal of Obstetrics & Gynaecology. 2017;124(5):804-813. doi:10.1111/1471-0528.14236
• Metzger BE, Contreras M, Sacks DA, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358:1991–2002. https://doi.org/10.1056/NEJMoa0707943
• García‐Moreno RM, Benítez‐Valderrama P, Barquiel B, González Pérez‐de‐Villar N, Hillman N, Lora Pablos D, Herranz L. Efficacy of continuous glucose monitoring on maternal and neonatal outcomes in gestational diabetes mellitus: a systematic review and meta‐analysis of randomized clinical trials. Diabetic Medicine. 2022;39(1). https://doi.org/10.1111/dme.14703.
• Feig DS, Hwee J, Shah BR, Booth GL, Bierman AS, Lipscombe LL. Trends in Incidence of Diabetes in Pregnancy and Serious Perinatal Outcomes: A Large, Population-Based Study in Ontario, Canada, 1996–2010. Diabetes Care. 2014;37(6):1590-1596. doi:10.2337/dc13-2717
• IDF Diabetes Atlas. Accessed March 26, 2020. https://www.idf.org/e-library/epidemiology-research/diabetes-atlas/19-atlas-6th-edition.html
• Ramezani Tehrani F, Farzadfar F, Hosseinpanah F, Rahmati M, Firouzi F et al. Does fasting plasma glucose values 5.1-5.6 mmol/l in the first trimester of gestation a matter?. Frontiers in Endocrinology. 2023;14. https://doi.org/10.3389/fendo.2023.1155007.
• Diabetes Canada | Clinical Practice Guidelines - 2018 Full Guidelines. http://guidelines.diabetes.ca/cpg. Accessed 26 Mar 2022
• 2018 Surveillance of Diabetes in Pregnancy: Management from Preconception to the Postnatal Period (NICE Guideline NG3). National Institute for Health and Care Excellence (UK); 2018. Accessed March 26, 2020. http://www.ncbi.nlm.nih.gov/books/NBK550982/