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Risk stratification in early pregnancy for women at increased risk of gestational diabetes

  • C.L. Harrison
    Affiliations
    Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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  • C.B. Lombard
    Affiliations
    Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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  • C. East
    Affiliations
    Monash Women's Maternity Services, Monash Health, Melbourne, Australia
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  • J. Boyle
    Affiliations
    Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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  • H.J. Teede
    Correspondence
    Corresponding author at: School of Public Health and Preventive Medicine—Monash University Level 1, 43–51 Kanooka Grove, Clayton VIC 31168, Australia. Tel.: +61 3 9594 7532; fax: +61 3 9594 7550.
    Affiliations
    Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia

    Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Australia
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Published:September 29, 2014DOI:https://doi.org/10.1016/j.diabres.2014.09.006

      Highlights

      • A two-step GDM risk prediction strategy is explored in high-risk women.
      • When applied with a validated risk prediction tool, fasting glucose predicts GDM.
      • A 10 fold increased risk is demonstrated on IADPSG criteria.
      • Results present an accurate, feasible strategy for early pregnancy risk detection.

      Summary

      Aim

      To evaluate the addition of fasting glucose and lipids to a simple, validated risk prediction tool for gestational diabetes (GDM) applied in early pregnancy.

      Methods

      Women at risk of developing GDM on a validated risk prediction tool were recruited in early pregnancy into a large randomised controlled trial. Outcome measures included fasting biochemical markers (glucose, lipids) at 12–15 weeks gestation and GDM diagnosis (28 weeks gestation). Multivariable logistic regression was used to identify additional predictive biochemical variables for GDM, with corresponding receiver operator characteristic (ROC) curves generated. Unadjusted and adjusted models were derived for both the Australasian Diabetes in Pregnancy (ADIPS) and the International Association for Diabetes in Pregnancy Study Group (IADPSG) GDM diagnostic criteria.

      Results

      51 (23%) Women were diagnosed with GDM based on ADIPS criteria, with 60 (30%) diagnosed based on IADPSG criteria. In all four regression models, fasting glucose was the strongest predictor for GDM development with an odds ratio range of 4.7–6.3 (ADIPS) and 8.8–10 (IADPSG). ROC curves revealed an area under the curve of 0.79 (95% CI: 0.72–0.86) for ADIPS criteria and 0.83 (95% CI: 0.77–0.90) for IADPSG criteria for adjusted models.

      Conclusions

      In a two-step approach, when applied with a validated risk prediction tool, fasting glucose in early pregnancy was predictive of GDM and incrementally improved risk identification, presenting potential for an early pregnancy, GDM risk screening strategy for streamlining of pregnancy care and opportunity for preventive intervention.

      Keywords

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      References

        • Diagnosis and Classification of Diabetes Mellitus (2011)
        Position Statement American Diabetes Association.
        Diabetes Care. 2012; 33: S9-S62
        • VanDorsten J.P.
        • Dodson W.C.
        • Espeland M.A.
        • Grobman W.A.
        • Guise J.M.
        • Mercer B.M.
        • et al.
        National institutes of health consensus development conference statement: diagnosing gestational diabetes mellitus.
        NIH Consensus State Statements. 2013; 29: 1-30
        • Flack J.
        • Ross G.P.
        • Ho S.
        • McElduff A.
        Recommended changes to diagnostic criteria for gestational diabetes: impact on workload.
        Aust N Z J Obstet Gynaecol. 2010; 50: 439-443
        • Crowther C.
        • Hiller J.E.
        • Moss J.R.
        • McPhee A.J.
        • Jeffries W.S.
        • Robinson J.S.
        Effect of treatment of gestational diabetes mellitus on pregnancy outcomes.
        N Engl J Med. 2005; 352: 2477-2486
        • Ohno M.S.
        • Sparks T.N.
        • Cheng Y.W.
        • Caughey A.B.
        Treating mild gestational diabetes mellitus: a cost-effectiveness analysis.
        Am J Obstet Gynecol. 2011; 205: 282.e1-282.e7
        • Homer C.S.E.
        • Davis G.K.
        • Brodie P.M.
        • Sheehan A.
        • Barclay L.M.
        • Wills J.
        • et al.
        Collaboration in maternity care: a randomised controlled trial comparing community-based continuity of care with standard hospital care.
        BJOG. 2001; 108: 16-22
        • Sandall J.
        • Soltani H.
        • Gates S.
        • Shennan A.
        • Devane D.
        Midwife-led continuity models versus othermodels of care for childbearing women.
        Cochrane Database Syst Rev. 2013; https://doi.org/10.1002/14651858.CD004667.pub3
        • Oteng-Ntim E.
        • Varma R.
        • Croker H.
        • Poston L.
        • Doyle P.
        Lifestyle interventions for overweight and obese pregnant women to improve pregnancy outcome: systematic review and meta-analysis.
        BMC Med. 2012; 10: 47
        • Quinlivan J.A.
        • Lam L.T.
        • Fisher J.
        A randomised trial of a four-step multidisciplinary approach to the antenatal care of obese pregnant women.
        Aust N Z J Obstet Gynaecol. 2011; 51: 141-146
        • Thangaratinam S.
        • Rogozińska E.
        • Jolly K.
        • Glinkowski S.
        • Roseboom T.
        • Tomlinson J.W.
        • et al.
        Effects of interventions in pregnancy on maternal weight and obstetric outcomes: meta-analysis of randomised evidence.
        BMJ. 2012; 344: e2088https://doi.org/10.1136/bmj.e2088
        • Harrison C.
        • Lombard C.B.
        • Strauss B.J.
        • Teede H.J.
        Optimizing healthy gestational weight gain in women at high risk of gestational diabetes: a randomized controlled trial.
        Obesity (Silver Spring). 2013; 21: 904
        • Ratner R.E.
        • Christophi C.A.
        • Metzger B.E.
        • Dabelea D.
        • Bennett P.H.
        • Pi-Sunyer X.
        • et al.
        • The Diabetes Prevention Program Research Group
        Prevention of diabetes in women with a history of gestational diabetes: effects of metformin and lifestyle interventions.
        J Clin Endocrinol Metab. 2008; 93: 4774-4779
        • Thériault S.
        • Forest J-C.
        • Massé J.
        • Giguère Y.
        Validation of early risk-prediction models for gestational diabetes based on clinical characteristics.
        Diabetes Res Clin Pract. 2014; 103: 419-425
        • Teede H.
        • Harrison C.L.
        • Teh W.T.
        • Paul E.
        • Allan C.A.
        Gestational diabetes: development of an early risk prediction tool to facilitate opportunities for prevention.
        Aust N Z J Obstet Gynaecol. 2011; 51: 499-504
        • Smirnakis K.V.
        • Plati A.
        • Wolf M.
        • Thadhani R.
        • Ecker J.L.
        Predicting gestational diabetes: choosing the optimal early serum marker.
        Am J Obstet Gynecol. 2007; 196: 410e1-410e7
        • Riskin-Mashiah S.
        • Damti A.
        • Younes G.
        • Auslender R.
        First trimester fasting hyperglycemia as a predictor for the development of gestational diabetes mellitus.
        Eur J Obstet Gynecol Reprod Biol. 2010; 152: 163-167
        • Savvidou M.
        • Nelson S.M.
        • Makgoba M.
        • Messow C.-M.
        • Sattar N.
        • Nicolaides K.
        First-Trimester prediction of gestational diabetes mellitus: examining the potential of combining maternal characteristics and laboratory measures.
        Diabetes. 2010; 59: 3017-3022
        • Panteghini M.
        The future of laboratory medicine: understanding the new pressures.
        Clin Biochem Rev. 2004; 25: 207-215
        • Hutchison S.K.
        • Stepto N.K.
        • Harrison C.L.
        • Moran L.J.
        • Strauss B.J.
        • Teede H.J.
        Effects of exercise on insulin resistance and body composition in overweight and obese women with and without polycystic ovary syndrome.
        J Clin Endocrinol Metab. 2010; 96: E48-E56
        • Hoffmann L.
        • Nolan C.
        • Wilson J.D.
        • Oats J.J.N.
        • Simmons D.
        Gestational diabetes mellitus: management guidelines.
        MJA. 1998; 169: 93-97
        • Metzger B.E.
        • Gabbe S.G.
        • Persson B.
        • Buchanan T.A.
        • Catalano P.A.
        • Damm P.
        • et al.
        International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy.
        Diabetes Care. 2010; 33: 676-682
        • McCarthy E.A.
        • Strauss B.J.G.
        • Walker S.P.
        • Permezel M.
        Determination of maternal body composition in pregnancy and its relevance to perinatal outcomes.
        Obstet Gynecol Surv. 2004; 59: 731-742
        • van Leeuwen M.
        • Opmeer B.C.
        • Zweers E.J.K.
        • van Ballegooie E.
        • ter Brugge H.G.
        • de Valk H.W.
        • et al.
        Estimating the risk of gestational diabetes mellitus: a clinical prediction model based on patient characteristics and medical history.
        BJOG. 2010; 117: 69-75
        • Caliskan E.
        • Kayikcioglu F.
        • Öztürk N.
        • Koc S.
        • Haberal A.
        A population-based risk factor scoring will decrease unnecessary testing for the diagnosis of gestational diabetes mellitus.
        Acta Obstet Gynecol Scand. 2004; 83: 524-530
        • American Diabetes Association
        Standards of Medical Care in Diabetes—2014.
        Diabetes Care. 2014; 37: S14-S80
        • Griffin M.E.
        • Coffey M.
        • Johnson H.
        • Scanlon P.
        • Foley M.
        • Stronge J.
        • et al.
        Universal vs. risk factor-based screening for gestational diabetes mellitus: detection rates, gestation at diagnosis and outcome.
        Diabet Med. 2000; 17: 26-32
      1. Rasmussen K. Yaktine A.L. Institute of Medicine and National Research Council Committee to Reexamine IOM Pregnancy Weight Guidelines. Weight Gain During Pregnancy: Reexamining the Guidelines. National Academic Press, Washington, DC2009
        • Chu S.Y.
        • Callaghan W.M.
        • Bish C.L.
        • D’Angelo D.
        Gestational weight gain by body mass index among US women delivering live births, 2004–2005: fueling future obesity.
        Am J Obstet Gynecol. 2009; 200: 271.e1-271.e7
        • Black M.H.
        • Sacks D.A.
        • Xiang A.H.
        • Lawrence J.M.
        The relative contribution of prepregnancy overweight and obesity, gestational weight gain, and IADPSG-defined gestational diabetes mellitus to fetal overgrowth.
        Diabetes Care. 2013; 36: 56-62
        • Harrison C.L.
        • Teede H.J.
        • Lombard C.B.
        How effective is self-weighing in the setting of a lifestyle intervention to reduce gestational weight gain and postpartum weight retention?.
        Aust N Z J Obstet Gynaecol. 2014; 54: 382-438
        • Phelan S.
        Pregnancy: a teachable moment for weight control and obesity prevention.
        Am J Obstet Gynecol. 2010; 202: 135.e1-135.e8
        • Bottalico J.N.
        Recurrent gestational diabetes: risk factors, diagnosis, management, and implications.
        Semin Perinatol. 2007; 31: 176-184
        • American Diabetes Association
        Standards of Medical Care in Diabetes—2013.
        Diabetes Care. 2013; 36: S67-S74