DOI: http://dx.doi.org/10.18203/2349-3933.ijam20200027

Screening of gestational diabetes mellitus using fasting plasma glucose before the 24th gestational week in women with different pre-pregnancy body mass index

Sambit Das, Mahesh Rath, Lipsa Das, Kasturi Bharadwaj

Abstract


Background: Gestational Diabetes Mellitus (GDM) is usually diagnosed between 24th and 28th gestational week using the 75-g Oral Glucose Tolerance Test (OGTT). It is controversial that if FPG ≥92 mg/dL before 24th gestational week should be intervened or not. The aim of this study was to evaluate the value of FPG to screen GDM before 24th gestational week in women with different pre-pregnancy Body Mass Index (BMI).

Methods: This was a hospital based retrospective cohort study done at CHC Balipatna, Khurdha, Odisha. Women who had a singleton live birth between June 20, 2016 and June 30, 2019, resided in Balipatna block area and received prenatal care in the Community Health Centre, were included in this study. Pre-pregnancy BMI, FPG before the 24th gestational week, and one-step GDM screening with 75 g-OGTT at the 24th to 28th gestational weeks were extracted from medical records and analyzed. The pregnant women were classified into four groups based on pre-pregnancy BMI: Group A (underweight), Group B (normal), Group C (overweight) and Group D (obesity). Statistical analysis using independent sample t-test, Analysis of Variance (ANOVA) and Pearson Chi-square test was done.

Results: The prevalence of GDM was 20.0% (68/341) in the study population. FPG decreased gradually as the gestational age increased in all pre-pregnancy BMI groups until the 19th gestational week. The incidence of GDM in women with FPG ≥92 mg/dL in the 19th to 24th gestational weeks and pre-pregnancy overweight or obesity was significantly higher than that in women with FPG ≥92 mg/dL and pre-pregnancy BMI <24.0 kg/m2.

Conclusions: FPG decreased gradually as the gestational age increased in all pre-pregnancy BMI groups until the 19th gestational week. Pre-pregnancy overweight or obesity was associated with an increased FPG value before the 24th gestational week. FPG ≥92 mg/dL between 19 and 24 gestational weeks should be treated as GDM in women with pre-pregnancy overweight and obesity.


Keywords


Body mass index, Diabetes, Fasting plasma glucose, Gestational diabetes mellitus, Odisha, Pregnancy

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References


International Diabetes Federation. IDF Diabetes Atlas. 8th ed. Brussels, Belgium, International Diabetes Federation, 2017.

Yajnik CS, Deshmukh US. Maternal nutrition, intrauterine programming and consequential risks in the offspring. Revi Endo Metab Dis. 2008 Sep 1;9(3):203.

Waters TP, Dyer AR, Scholtens DM, Dooley SL, Herer E, Lowe LP, et al. Maternal and neonatal morbidity for women who would be added to the diagnosis of GDM using IADPSG criteria: a secondary analysis of the hyperglycemia and adverse pregnancy outcome study. Diabe Care. 2016 Dec 1;39(12):2204-10.

Yumei W, Huixia Y, Weiwei Z, Hongyun Y, Haixia L, Jie Y, et al. International Association of Diabetes and Pregnancy Study Group criteria is suitable for gestational diabetes mellitus diagnosis: further evidence from China. Chinese Med J. 2014 Oct 20;127(20):3553-6.

Zhu W, Yang H, Wei Y, Wang Z, Li X, Wu H, et al. Comparing the diagnostic criteria for gestational diabetes mellitus of World Health Organization 2013 with 1999 in Chinese population. Chinese Med J. 2015 Jan 5;128(1):125.

Song G, Wang C, Yang HX. Diabetes management beyond pregnancy. Chinese Med J. 2017 May 5;130(9):1009.

Diagnosis and management of Gestational Diabetes Mellitus - Technical and Operational Guidelines. Maternal Health Division, Ministry of Health and Family Welfare, Government of India; 2018.

Zhu WW, Yang HX, Wei YM, Yan J, Wang ZL, Li XL, et al. Evaluation of the value of fasting plasma glucose in the first prenatal visit to diagnose gestational diabetes mellitus in China. Diabe Care. 2013 Mar 1;36(3):586-90.

Fraen F, Friberg IK, Lawn JE, Bhutta ZA, Pattinson RC, Allanson ER. Ending preventable stillbirths 1, Stillbirths: progress and unfinished business. Lancet. 2016;387(10018):574-86.

Yang W, Lu J, Weng J, Jia W, Ji L, Xiao J, et al. Prevalence of diabetes among men and women in China. New Eng J Med. 2010 Mar 25;362(12):1090-101.

Zhang C, Qiu C, Hu FB, David RM, Van Dam RM, Bralley A, et al. Maternal plasma 25-hydroxyvitamin D concentrations and the risk for gestational diabetes mellitus. PloS One. 2008 Nov 18;3(11):e3753.

International Association of Diabetes and Pregnancy Study Groups Consensus Panel. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabe Care. 2010 Mar 1;33(3):676-82.

Association AD. Standards of medical care in diabetes‐‐2015: summary of revisions. Diabe Care. 2015;38(1):S4.

Akabori HP. E1 in lipid microspheres ameliorates diabetic peripheral neuropathy: clinieal usefulness of Semmes-Weinstein monofilaments for evaluating diabetic sensory abnormality. Diabe Res Clin Pract. 2004;64(3):153-9.

Hod M, Kapur A, Sacks DA, Hadar E, Agarwal M, Di Renzo GC, et al. The International Federation of Gynecology and Obstetrics (FIGO) Initiative on gestational diabetes mellitus: A pragmatic guide for diagnosis, management, and care#. Inter J Gynecol Obstetr. 2015 Oct;131:S173-211.

Li P, Yin Y, Lin S, Cui J, Zhou S, Li L, et al. Utility of pregestational body mass index and initial fasting plasma glucose in predicting gestational diabetes mellitus. Am J Med Sci. 2016 Apr 1;351(4):420-5.

Ozgu-Erdinc AS, Yilmaz S, Yeral MI, Seckin KD, Erkaya S, Danisman AN. Prediction of gestational diabetes mellitus in the first trimester: comparison of C-reactive protein, fasting plasma glucose, insulin and insulin sensitivity indices. J Matern Fetal Neonatal Med. 2015;28:1957-62.

Jesmin S, Akter S, Akashi H, Al-Mamun A, Rahman MA, Islam MM, et al. Screening for gestational diabetes mellitus and its prevalence in Bangladesh. Diabe Res Clin Pract. 2014 Jan 1;103(1):57-62.

Yeral MI, Ozgu-Erdinc AS, Uygur D, Seckin KD, Karsli MF, Danisman AN. Prediction of gestational diabetes mellitus in the first trimester, comparison of fasting plasma glucose, two-step and one-step methods: a prospective randomized controlled trial. Endocrine. 2014 Aug 1;46(3):512-8.