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Zafrir-Danieli H, Houri O, Rotem R, Weinberg-Almog D, Bercovich O, Hadar E, Berezowsky A. Gestational diabetes mellitus - Can we do better with postpartum diabetes screening? Eur J Obstet Gynecol Reprod Biol 2024; 303:153-158. [PMID: 39481251 DOI: 10.1016/j.ejogrb.2024.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 09/19/2024] [Accepted: 10/05/2024] [Indexed: 11/02/2024]
Abstract
OBJECTIVE This study aimed to assess the accuracy of measuring fasting plasma glucose (FPG) within 24-48 h postpartum in women with gestational diabetes mellitus (GDM) as a predictor for abnormal 6-12-week postpartum oral glucose tolerance test (OGTT). STUDY DESIGN A retrospective cohort study (2012-2021) included women with GDM and singleton pregnancies who had FPG levels recorded 24-28 h postpartum and underwent a 6-12-week OGTT. The study compared the predictive accuracy of these FPG readings with the OGTT results. RESULTS Among 3128 GDM patients, 1163 (37.2 %) had a postpartum OGTT, with 935 (80.2 %) showing normal FPG (<100 mg/dL). In low-risk GDM cases (managed by lifestyle modifications), 86.15 % had normal postpartum FPG. Normal 24-48 h FPG readings, especially in low-risk GDM cases, had a high negative predictive value (NPV of 99.3 %) for type-2 diabetes at the 6-12-week OGTT, but a lower NPV (85.8 %) for predicting future glucose intolerance. DISCUSSION Immediate postpartum FPG testing effectively excludes low-risk GDM women with regards to future type-2 diabetes and reasonably excluded future glucose intolerance in this group. Due to low compliance with standard OGTT, postpartum FPG could be a more practical predictive tool for diabetes in low-risk GDM cases.
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Affiliation(s)
- Hadas Zafrir-Danieli
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel.
| | - Ohad Houri
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel
| | - Reut Rotem
- Department of Urogynecology, Cork University Maternity Hospital, Cork, Ireland; Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Dror Weinberg-Almog
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel
| | - Or Bercovich
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel
| | - Eran Hadar
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel
| | - Alexandra Berezowsky
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel.
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Barbosa M, Moreira Gomes P, Monteiro AM, Matos C, Lopes Pereira M, Fernandes V. Postpartum reclassification test in gestational diabetes: can the test be reduced to 1 hour? Hormones (Athens) 2022; 21:287-293. [PMID: 35288881 DOI: 10.1007/s42000-022-00359-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 02/22/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE In gestational diabetes mellitus (GDM), a postpartum oral glucose tolerance test (OGTT) is recommended. However, poor adherence to this procedure has been described, and the time required is one of the reasons. Our aims were to identify predictive factors for abnormal 2-h reclassification OGTT values, including OGTT 1-h glucose, and, if it was a factor, to determine the 1-h cutoff point that best identifies abnormal values at 2 h. METHODS This was a retrospective study of 769 patients diagnosed with GDM between 2014 and 2019 in a tertiary center. The sample was divided into two groups according to the presence/absence of abnormal 2-h reclassification values, and predictive factors were studied. To determine the 1-h glycemia cutoff point capable of identifying 2-h changes, a ROC curve was drawn and the Youden index was used. RESULTS The mean age of included women was 33.6 ± 4.95 years: 70 of them (9.1%) had an abnormal 2-h test result. Women with a history of GDM (OR = 3.41, p = .012) and higher 1-h glycemia value (OR = 1.05, p < .001) had a higher risk of developing an abnormal 2-h test result. One-hour glycemia ≥ 142 mg/dL had a sensitivity of 91.4% and specificity of 75.1% to identify changes in the test at 2 h; area under the curve to predict 2-h changes was 0.90 (CI 95%: 0.86 - 0.93). CONCLUSION Glucose measurement at 1 h predicts alterations at 2 h in the reclassification test with excellent diagnostic accuracy, and the cutoff point of ≥ 142 mg/dL presents high sensitivity. These findings could serve as a foundation for a possible future redefinition of the OGTT procedure, but further investigation is required.
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Affiliation(s)
- Mariana Barbosa
- Endocrinology Department, Braga Hospital, Sete Fontes - São Victor, 4710-243, Braga, Portugal.
| | | | - Ana Margarida Monteiro
- Endocrinology Department, Braga Hospital, Sete Fontes - São Victor, 4710-243, Braga, Portugal
| | - Catarina Matos
- Endocrinology Department, Braga Hospital, Sete Fontes - São Victor, 4710-243, Braga, Portugal
| | - Maria Lopes Pereira
- Endocrinology Department, Braga Hospital, Sete Fontes - São Victor, 4710-243, Braga, Portugal
| | - Vera Fernandes
- Endocrinology Department, Braga Hospital, Sete Fontes - São Victor, 4710-243, Braga, Portugal
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Sun J, Kim GR, Lee SJ, Kim HC. Gestational diabetes mellitus and the role of intercurrent type 2 diabetes on long-term risk of cardiovascular events. Sci Rep 2021; 11:21140. [PMID: 34707209 PMCID: PMC8551203 DOI: 10.1038/s41598-021-99993-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 10/01/2021] [Indexed: 01/01/2023] Open
Abstract
Recent studies have shown that gestational diabetes mellitus (GDM) is associated with an increased risk for cardiovascular disease. GDM has also been shown to be a risk factor for type 2 diabetes (T2DM) after pregnancy. However, there is limited evidence regarding the role of intercurrent T2DM on the relationship between GDM and future CVD. Thus, we investigated the risks of incident cardiovascular events among women with GDM during pregnancy compared to women without GDM and whether the increased CVD risk is dependent on intercurrent development of T2DM. We conducted a population-based retrospective cohort study using the Korean National Health Insurance Service claims database. Outcomes were the first occurrence of any CVD (myocardial infarction, treatment with coronary revascularization, heart failure, and cerebrovascular disease). Cox proportional hazard models were used to assess the association between GDM and incident CVD events, using landmark analysis at 4 years. A total of 1,500,168 parous women were included in the analysis, of which 159,066 (10.60%) had GDM. At a median follow-up of 12.8 years, 13,222 incident cases of total CVD were observed. Multivariable-adjusted hazard ratio for total CVD among women with prior GDM, compared with those without GDM, was 1.08 (95% CI 1.02-1.14). Further classifying GDM by progression to T2DM in relation to total CVD risk indicated a positive association for GDM with progression to T2DM vs no GDM or T2DM (HR 1.74; 95% CI 1.40-2.15), and no statistically significant association for GDM only (HR 1.06; 95% CI 1.00-1.12). GDM with subsequent progression to T2DM were linked with an increased risk of cardiovascular diseases. These findings highlight the need for more vigilant postpartum screening for diabetes and the implementation of diabetes interventions in women with a history of GDM to reduce future CVD risk.
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Affiliation(s)
- Jiyu Sun
- Medical Research Collaborating Center, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Gyu Ri Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Health Services Research, Yonsei University, Seoul, Korea
| | - Su Jin Lee
- Department of Internal Medicine, Seoul Red Cross Hospital, Seoul, Korea.
| | - Hyeon Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.
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Shankar M, Chan CS, Frayne SM, Panelli DM, Phibbs CS, Shaw JG. Postpartum Transition of Care: Racial/Ethnic Gaps in Veterans' Re-Engagement in VA Primary Care after Pregnancy. Womens Health Issues 2021; 31:603-609. [PMID: 34229932 DOI: 10.1016/j.whi.2021.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 05/28/2021] [Accepted: 06/04/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Pregnancy presents an opportunity to engage veterans in health care. Guidelines recommend primary care follow-up in the year postpartum, but loss to follow-up is common, poorly quantified, and especially important for those with gestational diabetes (GDM) and hypertension. Racial maternal inequities are well-documented and might be exacerbated by differential postpartum care. This study explores variation in postpartum re-engagement in U.S. Department of Veteran Affairs health care system (VA) primary care to identify potential racial/ethnic inequities in this care transition. METHODS We conducted a complete case analysis of the 2005-2014 national VA birth cohort (n = 18,414), and subcohorts of veterans with GDM (n = 1,253), and hypertensive disorders of pregnancy (HDP; n = 2,052) using VA-reimbursed discharge claims and outpatient data. Outcomes included incidence of any VA primary care visit in the postpartum year; in age-adjusted logistic regression, we explored race/ethnicity as a primary predictor. RESULTS In the year after a VA-covered birth, the proportion of veterans with one or more primary care visit was 53.8% overall, and slightly higher in the GDM (56.0%) and HDP (57.4%) subcohorts. In adjusted models, the odds of VA primary care follow-up were significantly lower for Black/African American (odds ratio, 0.87; 95% confidence interval, 0.81-0.93), Asian (odds ratio, 0.76; 95% confidence interval, 0.61-0.95), and Hawaiian/other Pacific Islander (odds ratio, 0.73; 95% confidence interval, 0.55-0.96) veterans, compared with White veterans. Among the subcohorts with GDM or HDP, there were no significant associations between primary care and race/ethnicity. CONCLUSIONS One-half of veterans re-engage in VA primary care after childbirth, with significant racial differences in this care transition. Re-engagement for those with the common pregnancy complications of HDP and GDM is only slightly higher, and less than 60%. The potential for innovations like VA maternity care coordinators to address such gaps merits attention.
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Affiliation(s)
- Megha Shankar
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, California; Stanford University Center for Primary Care and Outcomes Research (PCOR) and Center for Health Policy (CHP), Stanford, California
| | - Caitlin S Chan
- Health Economics Research Center and Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California
| | - Susan M Frayne
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, California; Stanford University Center for Primary Care and Outcomes Research (PCOR) and Center for Health Policy (CHP), Stanford, California; Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
| | - Danielle M Panelli
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Stanford University, Palo Alto, California
| | - Ciaran S Phibbs
- Stanford University Center for Primary Care and Outcomes Research (PCOR) and Center for Health Policy (CHP), Stanford, California; Health Economics Research Center and Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California; Department of Pediatrics, Division of Neonatal & Developmental Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Jonathan G Shaw
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, California; Stanford University Center for Primary Care and Outcomes Research (PCOR) and Center for Health Policy (CHP), Stanford, California; Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California.
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Quansah DY, Gross J, Mbundu-Ilunga R, Puder JJ. The utility of diagnostic tests in the detection and prediction of glucose intolerance in the early and late postpartum period in women after gestational diabetes: a longitudinal cohort study. Diabetol Metab Syndr 2021; 13:31. [PMID: 33731202 PMCID: PMC7966915 DOI: 10.1186/s13098-021-00650-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/04/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Due to diverging international recommendations, the unclear role of HbA1c and the lack of longitudinal data, we investigated the accuracy of diagnostic tests in the early and late postpartum in women with gestational diabetes (GDM) especially to predict future glucose-intolerance. METHODS This longitudinal cohort included 967 women with GDM from 2011 to 2020. A 75-g oGTT and HbA1c were performed at 4-12 weeks (early) postpartum. FPG and HbA1c were measured at 1 and 3-year (late) postpartum. ADA criteria were used as gold standards. At all time-points (4-12 weeks, 1-year and 3-year postpartum) women with diabetes and prediabetes were grouped together and referred to as glucose-intolerant, because at most 3% of the entire cohort population had diabetes at any time-point. RESULTS The prevalence of glucose-intolerance in the early postpartum was higher using FPG and HbA1c (27.5%) than oGTT criteria (18.2%). Only 48-80% of women diagnosed with glucose-intolerance in the early postpartum actually remained intolerant. This was especially low when FPG or oGTT were combined with HbA1c (1-year: ≤ 62% and 3-years: ≤ 50%). Regardless of the test used, 1/3 of women with initially normal glucose-tolerance became glucose-intolerant in the late postpartum. HbA1c was unrelated to iron status/intake, remained stable throughout, but poorly predicted future glucose-intolerance. In the longitudinal analyses, all diagnostic tests in the early postpartum showed acceptable specificities (74-96%) but poor sensitivities (all < 38%) to predict glucose-intolerance after only 10-months. At 1-year postpartum however, the combination of FPG and HbA1c could best predict glucose-intolerance 2-years later. CONCLUSIONS Combining FPG with HbA1c at 1-year postpartum represents a reliable choice to predict future glucose-intolerance. Given the poor prediction of tests including oGTT in the early postpartum, focus should rather be on continuous long-term screening.
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Affiliation(s)
- Dan Yedu Quansah
- Obstetric Service, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne Switzerland Avenue de la Sallaz, CH-1011 Lausanne, Switzerland
| | - Justine Gross
- Obstetric Service, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne Switzerland Avenue de la Sallaz, CH-1011 Lausanne, Switzerland
- Service of Endocrinology, Diabetes and Metabolism, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Richard Mbundu-Ilunga
- Service of Endocrinology, Diabetes and Metabolism, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Jardena J. Puder
- Obstetric Service, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne Switzerland Avenue de la Sallaz, CH-1011 Lausanne, Switzerland
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Oh TJ, Kim YG, Kang S, Moon JH, Kwak SH, Choi SH, Lim S, Park KS, Jang HC, Hong JS, Cho NH. Oral Glucose Tolerance Testing Allows Better Prediction of Diabetes in Women with a History of Gestational Diabetes Mellitus. Diabetes Metab J 2019; 43:342-349. [PMID: 30604595 PMCID: PMC6581542 DOI: 10.4093/dmj.2018.0086] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 08/09/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND We aimed to identify the postpartum metabolic factors that were associated with the development of diabetes in women with a history of gestational diabetes mellitus (GDM). In addition, we examined the role of the oral glucose tolerance test (OGTT) in the prediction of future diabetes. METHODS We conducted a prospective study of 179 subjects who previously had GDM but did not have diabetes at 2 months postpartum. The initial postpartum examination including a 75-g OGTT and the frequently sampled intravenous glucose tolerance test (FSIVGTT) was performed 12 months after delivery, and annual follow-up visits were made thereafter. RESULTS The insulinogenic index (IGI30) obtained from the OGTT was significantly correlated with the acute insulin response to glucose (AIRg) obtained from the FSIVGTT. The disposition indices obtained from the OGTT and FSIVGTT were also significantly correlated. Women who progressed to diabetes had a lower insulin secretory capacity including IGI30, AIRg, and disposition indices obtained from the FSIVGTT and OGTT compared with those who did not. However, the insulin sensitivity indices obtained from the OGTT and FSIVGTT did not differ between the two groups. Multivariate logistic regression analysis showed that the 2-hour glucose and disposition index obtained from the FSIVGTT were significant postpartum metabolic risk factors for the development of diabetes. CONCLUSION We identified a crucial role of β-cell dysfunction in the development of diabetes in Korean women with previous GDM. The 2-hour glucose result from the OGTT is an independent predictor of future diabetes. Therefore, the OGTT is crucial for better prediction of future diabetes in Korean women with previous GDM.
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Affiliation(s)
- Tae Jung Oh
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yeong Gi Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sunyoung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Joon Ho Moon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Soo Heon Kwak
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sung Hee Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Soo Lim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kyong Soo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hak C Jang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
| | - Joon Seok Hong
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Nam H Cho
- Department of Preventive Medicine, Ajou University School of Medicine, Suwon, Korea
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Agarwal MM. Consensus in Gestational Diabetes MELLITUS: Looking for the Holy Grail. J Clin Med 2018; 7:E123. [PMID: 29843401 PMCID: PMC6025068 DOI: 10.3390/jcm7060123] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 05/21/2018] [Accepted: 05/23/2018] [Indexed: 12/17/2022] Open
Abstract
The world's pre-eminent diabetes, obstetric, endocrine, and health organizations advocate a plethora of diverse algorithms for the screening, diagnosis, management, and follow-up of gestational diabetes mellitus (GDM). Additionally, there are regional recommendations of local health societies. Several of these proposals for GDM are contentious because some of them were developed from unscientific studies, based on expert-opinion, catered to preserve resources, and subjectively modified for convenience. Due to the wide variety of choices available, the approach to GDM can be extremely diverse even within the same hospital. This lack of consensus creates major problems in addressing prevalence, complications, efficacy of treatment, and follow-up of GDM. Moreover, it becomes nearly impossible to compare the numerous studies. Furthermore, the lack of consensus confuses the health care providers of obstetric health who look to the experts for guidance. Therefore, a clear, objective, "evidence-based" global approach, which is simple, easy to follow, and validated by corroborative research, is crucial. We contend that, despite decades of research, a single acceptable global guideline is not yet on the horizon.
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Affiliation(s)
- Mukesh M Agarwal
- Departments of Pathology and Medical Education, School of Medicine, California University of Science & Medicine, San Bernardino, CA 92408, USA.
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Kapaya H, May L, Jacques R, Madhuvrata P. Sensitivity of postnatal fasting plasma glucose in identifying impaired glucose tolerance in women with gestational diabetes - 25 Years' data. Obstet Med 2017; 10:125-131. [PMID: 29051780 PMCID: PMC5637997 DOI: 10.1177/1753495x17702786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 03/09/2017] [Indexed: 11/17/2022] Open
Abstract
Objective To assess the uptake of postnatal oral glucose tolerance test and to determine the sensitivity of fasting postnatal blood sugar in predicting 2-h impaired glucose tolerance. Methods Retrospective study of 1961 women diagnosed with gestational diabetes mellitus. All women were offered oral glucose tolerance test six weeks post-delivery. Results Of 1961 women, 1090 (56%) returned for postpartum oral glucose tolerance test. A fasting plasma glucose of ≥6.1 mmol/l identified only 76 of 167 women with impaired glucose tolerance detected by a 2-h oral glucose tolerance test (sensitivity of 45.5%; 95%CI: 38.1–53.1). We observed a normal fasting glucose but an impaired 2-h glucose tolerance in 91 out of 968 (9.4%) women. Asian ethnicity, admission on special care baby unit and antenatal insulin therapy strongly predicted 2-h impaired postnatal blood glucose levels (P < 0.05). Conclusion Although fasting plasma glucose is a convenient method, it lacks sensitivity in identifying women with impaired glucose tolerance postnatally.
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Affiliation(s)
- Habiba Kapaya
- Department of Human Metabolism, Academic Unit of Reproductive & Developmental Medicine, Sheffield Teaching Hospital, Sheffield, UK
| | - Lucy May
- Jessop Wing Sheffield Teaching Hospital, Sheffield, UK
| | - Richard Jacques
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Agarwal MM. Gestational diabetes mellitus: Screening with fasting plasma glucose. World J Diabetes 2016; 7:279-89. [PMID: 27525055 PMCID: PMC4958688 DOI: 10.4239/wjd.v7.i14.279] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 05/30/2016] [Accepted: 06/27/2016] [Indexed: 02/05/2023] Open
Abstract
Fasting plasma glucose (FPG) as a screening test for gestational diabetes mellitus (GDM) has had a checkered history. During the last three decades, a few initial anecdotal reports have given way to the recent well-conducted studies. This review: (1) traces the history; (2) weighs the advantages and disadvantages; (3) addresses the significance in early pregnancy; (4) underscores the benefits after delivery; and (5) emphasizes the cost savings of using the FPG in the screening of GDM. It also highlights the utility of fasting capillary glucose and stresses the value of the FPG in circumventing the cumbersome oral glucose tolerance test. An understanding of all the caveats is crucial to be able to use the FPG for investigating glucose intolerance in pregnancy. Thus, all health professionals can use the patient-friendly FPG to simplify the onerous algorithms available for the screening and diagnosis of GDM - thereby helping each and every pregnant woman.
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Dulipsingh L, Cooney S, Whitaker M, Demarest C, Patel D, Roy M, Spurrier W. Haemoglobin A 1c
as a screening tool to identify pre-diabetes and diabetes in postpartum women with gestational diabetes. PRACTICAL DIABETES 2016. [DOI: 10.1002/pdi.2037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Latha Dulipsingh
- Center for Diabetes and Metabolic Care; Saint Francis Hospital and Medical Center; Hartford Connecticut USA
| | - Sally Cooney
- Center for Diabetes and Metabolic Care; Saint Francis Hospital and Medical Center; Hartford Connecticut USA
| | - Margaret Whitaker
- Center for Diabetes and Metabolic Care; Saint Francis Hospital and Medical Center; Hartford Connecticut USA
| | - Carole Demarest
- Center for Diabetes and Metabolic Care; Saint Francis Hospital and Medical Center; Hartford Connecticut USA
| | - Dhruv Patel
- Center for Diabetes and Metabolic Care; Saint Francis Hospital and Medical Center; Hartford Connecticut USA
| | - Michele Roy
- Center for Diabetes and Metabolic Care; Saint Francis Hospital and Medical Center; Hartford Connecticut USA
| | - Wendy Spurrier
- Center for Diabetes and Metabolic Care; Saint Francis Hospital and Medical Center; Hartford Connecticut USA
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Duke A, Yap C, Bradbury R, Hng TM, Kim C, Wansbrough A, Cheung NW. The discordance between HbA1c and glucose tolerance testing for the postpartum exclusion of diabetes following gestational diabetes. Diabetes Res Clin Pract 2015; 108:72-7. [PMID: 25661662 DOI: 10.1016/j.diabres.2015.01.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 11/20/2014] [Accepted: 01/14/2015] [Indexed: 01/31/2023]
Abstract
AIMS To assess the concordance between the HbA1c and the oral glucose tolerance test (OGTT) for the diagnosis of diabetes and prediabetes following gestational diabetes (GDM) in an ethnically diverse population. METHODS Women with GDM underwent a concurrent OGTT and HbA1c test 6-12 weeks postpartum. RESULTS There were 114 women with GDM who had a 75 g 2-h OGTT and HbA1c at 9.0 ± 3.2 weeks postpartum. Five subjects had diabetes using OGTT criteria, and 4 by HbA1c criteria. No subjects had diabetes on both criteria. The overall concordance between the OGTT and HbA1c for the diagnosis of diabetes, prediabetes, or normal glucose tolerance was only 54% (κ coefficient 0.058, p=0.41). Gravidity, the 2-h glucose level on the OGTT during pregnancy, and the 3rd trimester HbA1c predicted discordance between the postpartum OGTT and HbA1c. CONCLUSIONS There is poor concordance between the OGTT and HbA1c for the diagnosis of diabetes and prediabetes following GDM. This reflects that the two tests measure different aspects of dysglycemia. In the post-GDM population, the HbA1c misses cases of diabetes as identified by the OGTT. We recommend that the OGTT be retained for postpartum diabetes testing following GDM.
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Affiliation(s)
- Anna Duke
- Centre for Diabetes & Endocrinology Research, Westmead Hospital, Westmead 2145, NSW, Australia; Dept of Diabetes & Endocrinology, Blacktown Hospital, Blacktown 2148, NSW, Australia; University of Sydney, Sydney, NSW, Australia.
| | - Constance Yap
- Centre for Diabetes & Endocrinology Research, Westmead Hospital, Westmead 2145, NSW, Australia; University of Sydney, Sydney, NSW, Australia
| | - Rachel Bradbury
- Centre for Diabetes & Endocrinology Research, Westmead Hospital, Westmead 2145, NSW, Australia; University of Sydney, Sydney, NSW, Australia
| | - Tien M Hng
- Dept of Diabetes & Endocrinology, Blacktown Hospital, Blacktown 2148, NSW, Australia; University of Western Sydney, Sydney, NSW, Australia
| | - Catherine Kim
- Departments of Medicine and Obstetrics & Gynecology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Anne Wansbrough
- Centre for Diabetes & Endocrinology Research, Westmead Hospital, Westmead 2145, NSW, Australia
| | - N Wah Cheung
- Centre for Diabetes & Endocrinology Research, Westmead Hospital, Westmead 2145, NSW, Australia; University of Sydney, Sydney, NSW, Australia
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Chamberlain C, Fredericks B, McLean A, Oldenburg B, Mein J, Wolfe R. Associations with low rates of postpartum glucose screening after gestational diabetes among Indigenous and non-Indigenous Australian women. Aust N Z J Public Health 2015; 39:69-76. [PMID: 25377028 DOI: 10.1111/1753-6405.12285] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 06/01/2014] [Accepted: 07/01/2014] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To explore factors associated with postpartum glucose screening among women with Gestational Diabetes Mellitus (GDM). METHODS A retrospective study using linked records from women with GDM who gave birth at Cairns Hospital in Far North Queensland, Australia, from 1 January 2004 to 31 December 2010. RESULTS The rates of postpartum Oral Glucose Tolerance Test (OGTT) screening, while having increased significantly among both Indigenous* and non-Indigenous women from 2004 to 2010 (HR 1.15 per year, 95%CI 1.08-1.22, p<0.0001), remain low, particularly among Indigenous women (10% versus 27%, respectively at six months postpartum). Indigenous women in Cairns had a longer time to postpartum OGTT than Indigenous women in remote areas (HR 0.58, 0.38-0.71, p=0.01). Non-Indigenous women had a longer time to postpartum OGTT if they: were born in Australia (HR 0.76, 0.59-1.00, 0.05); were aged <25 years (HR 0.45, 0.23-0.89, p=0.02); had parity >5 (HR 0.33, 0.12-0.90, p=0.03); smoked (HR 0.48, 0.31-0.76, p=0.001); and did not breastfeed (HR 0.09, 0.01-0.64, p=0.02). CONCLUSIONS Postpartum diabetes screening rates following GDM in Far North Queensland are low, particularly among Indigenous women, with lower rates seen in the regional centre; and among non-Indigenous women with indicators of low socioeconomic status. IMPLICATIONS Strategies are urgently needed to improve postpartum diabetes screening after GDM that reach women most at risk.
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Affiliation(s)
- Catherine Chamberlain
- Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria; Onemda VicHealth Koori Health Unit, School of Population and Global Health, University of Melbourne, Victoria
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Tandon N, Gupta Y, Kalra S. Postpartum screening after gestational diabetes mellitus: Aiming for universal coverage. Indian J Endocrinol Metab 2015; 19:1-4. [PMID: 25593818 PMCID: PMC4287751 DOI: 10.4103/2230-8210.144634] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Yashdeep Gupta
- Department of Medicine, Government Medical College and Hospital, Sector 32, Chandigarh, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India
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Affiliation(s)
- Yashdeep Gupta
- Department of Medicine, Government Medical College and Hospital, Sector 32, Chandigarh 160030, India.
| | - Anu Gupta
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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