Highlights
- •Evidence-based criteria for the diagnosis of early gestational diabetes (GDM) are not available.
- •We performed early-pregnancy oral glucose tolerance testing (OGTT) in a large unselected cohort.
- •Using late-pregnancy-derived OGTT thresholds at 12–16 weeks, the frequency of early GDM was ~15%.
- •Distinct differences between early- and late-gestation OGTT results were observed.
- •Gestational-age-specific OGTT criteria need to be generated for optimal early GDM diagnosis.
Abstract
Aims
To analyze early-pregnancy oral glucose tolerance test (OGTT) results and differences
between early- and late-pregnancy OGTT results in a population-based cohort.
Methods
From 3/2013 to 12/2016, pregnant women in South Karelia, Finland, were invited to
undergo a 2-hour 75 g OGTT at 12–16 weeks’ gestation (OGTT1) and, if normal, repeat
testing at 24–28 weeks (OGTT2). Early and late gestational diabetes (GDM) were diagnosed
using the same nationally endorsed criteria (fasting [FPG], 1- or 2-hour plasma glucose
≥5.3, ≥10.0 or ≥8.6 mmol/L, respectively).
Results
In OGTT1 (n = 1401), the mean (SD) FPG, 1- and 2-hour values were 4.85 (0.34), 6.63
(1.73) and 5.60 (1.28) mmol/L, respectively. Early GDM was diagnosed in 209 (14.9%).
In OGTT2 (n = 1067), late GDM was diagnosed in 114 (10.6%). In women without GDM (n = 953),
the mean FPG values were higher and post-load values lower in OGTT1 vs. OGTT2. No interaction effects of gestational timepoint and maternal BMI on OGTT results
were detected, except for the 2-hour value. In women with late GDM, both mean FPG
and post-load values were lower in OGTT1 vs. OGTT2. Results were similar employing the IADPSG GDM criteria.
Conclusions
Our findings suggest that gestational-age specific OGTT thresholds for early GDM diagnosis
need to be generated.
Keywords
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References
- Gestational diabetes mellitus in Europe: prevalence, current screening practice and barriers to screening. A review.Diabet Med. 2012; 29: 844-854
- Frequency of gestational diabetes mellitus at collaborating centers based on IADPSG consensus panel-recommended criteria: the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study.Diabetes Care. 2012; 35: 526-528
- Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis.Lancet. 2009; 373: 1773-1779
- The hyperglycemia and adverse pregnancy outcome study: associations of GDM and obesity with pregnancy outcomes.Diabetes Care. 2012; 35: 780-786
- The predisposition to obesity and diabetes in offspring of diabetic mothers.Diabetes Care. 2007; 30: S169-S174
- Hyperglycemia and adverse pregnancy outcomes.N Engl J Med. 2008; 358: 1991-2002
- Effect of treatment of gestational diabetes mellitus: a systematic review and meta-analysis.PLoS ONE. 2014; 9: e92485
- Perspectives on diagnostic strategies for hyperglycaemia in pregnancy – dealing with the barriers and challenges: Europe.Diabetes Res Clin Pract. 2018; 145: 67-72
International Association of Diabetes and Pregnancy Study Groups Consensus Panel. Metzger BE, Gabbe SG, Persson B, Buchanan TA, et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010;33:676–82.
- Criteria for the oral glucose tolerance test in pregnancy.Diabetes. 1964; 13: 278-285
- Diagnosis of GDM: a suggested consensus.Best Pract Res Clin Obstet Gynaecol. 2015; 29: 194-205
American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2019. Diabetes Care. 2019;42:S13-s28.
- Screening and treatment for early-onset gestational diabetes mellitus: a systematic review and meta-analysis.Curr Diab Rep. 2017; 17: 115
- Accelerated fetal growth prior to diagnosis of gestational diabetes mellitus: a prospective cohort study of nulliparous women.Diabetes Care. 2016; 39: 982-987
- Gestational diabetes mellitus diagnosed during early pregnancy.Am J Obstet Gynecol. 2000; 182: 346-350
- Research gaps in gestational diabetes mellitus: executive summary of a national institute of diabetes and digestive and kidney diseases workshop.Obstet Gynecol. 2018; 132: 496-505
- Cellular mechanisms for insulin resistance in normal pregnancy and gestational diabetes.Diabetes Care. 2007; 30: S112-S119
- Issues with the diagnosis and classification of hyperglycemia in early pregnancy.Diabetes Care. 2016; 39: 53-54
Gestational diabetes. Current Care Guidelines. Working group set up by the Finnish Medical Society Duodecim, the Finnish Diabetes Associations Medical Advisory Board and the Finnish Society of Obstetrics and Gynaecology. Helsinki: The Finnish Medical Society Duodecim; https://www.kaypahoito.fi/hoi50068, 2013, [accessed Jan 17 2020].
Diagnostic Criteria and Classification of Hyperglycaemia First Detected in Pregnancy. Geneva, Switzerland: World Health Organization; 2013.
IDF GDM Model of Care Implementation Protocol Guidelines For Healthcare Professionals. Belgium: International Diabetes Federation; 2015. p. 20.
- The International Federation of Gynecology and Obstetrics (FIGO) initiative on gestational diabetes mellitus: a pragmatic guide for diagnosis, management, and care.Int J Obstet Gynecol. 2015; 131: S173-S211
- Diabetes and pregnancy: an endocrine society clinical practice guideline.J Clin Endocrinol Metab. 2013; 98: 4227-4249
- Metabolic changes in pregnancy.Clin Obstet Gynecol. 2007; 50: 938-948
- Epidemiology of gestational diabetes mellitus according to IADPSG/WHO 2013 criteria among obese pregnant women in Europe.Diabetologia. 2017; 60: 1913-1921
- Gestational diabetes mellitus in Sardinia: results from an early, universal screening procedure.Diabetes Care. 2006; 29: 1713-1714
- Before the beginning: nutrition and lifestyle in the preconception period and its importance for future health.Lancet. 2018; 391: 1830-1841
- Nat Clin Pract Endocrinol Metab. 2007; 3: 696-704https://doi.org/10.1038/ncpendmet0616
- IADPSG and WHO 2013 gestational diabetes mellitus criteria identify obese women with marked insulin resistance in early pregnancy.Diabetes Care. 2016; 39: e90-e92
- Physiological reduction in fasting plasma glucose concentration in the first trimester of normal pregnancy: the diabetes in early pregnancy study.Metabolism. 1998; 47: 1140-1144
- Normal fasting plasma glucose levels during pregnancy: a hospital-based study.J Perinat Med. 2011; 39: 209-211
- A serial study of changes occurring in the oral glucose tolerance test during pregnancy.J Obstet Gynaecol Br Commonw. 1973; 80: 1033-1039
- Evaluation of the value of fasting plasma glucose in the first prenatal visit to diagnose gestational diabetes mellitus in china.Diabetes Care. 2013; 36: 586-590
- Carbohydrate metabolism during pregnancy in control subjects and women with gestational diabetes.Am J Physiol. 1993; 264: E60-E67
- Elevated insulin sensitivity and beta-cell function during pregnancy in mothers of growth-restricted newborns.Am J Physiol Endocrinol Metab. 2011; 301: E25-E30
- Longitudinal changes in glucose metabolism during pregnancy in obese women with normal glucose tolerance and gestational diabetes mellitus.Am J Obstet Gynecol. 1999; 180: 903-916
- Longitudinal changes in insulin release and insulin resistance in nonobese pregnant women.Am J Obstet Gynecol. 1991; 165: 1667-1672
- Glucose levels and insulin secretion during a 75 g glucose challenge test in normal pregnancy.J Intern Med. 1996; 240: 303-309
- Gestaatiodiabeteksen esiintyvyys ja seulonta.University of Kuopio, Kuopio Finland1991
Article info
Publication history
Published online: February 11, 2020
Accepted:
February 10,
2020
Received in revised form:
January 21,
2020
Received:
November 1,
2019
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.
