• This record comes from PubMed

Development of a New Risk Score for Stratification of Women with Gestational Diabetes Mellitus at High Risk of Persisting Postpartum Glucose Intolerance Using Routinely Assessed Parameters

. 2021 May 23 ; 11 (6) : . [epub] 20210523

Status PubMed-not-MEDLINE Language English Country Switzerland Media electronic

Document type Journal Article

Grant support
16-28040A Ministry of Health, Czech Republic

The aims of the study were (i) to find predictive factors for early postpartum conversion of gestational diabetes mellitus (GDM) into persisting glucose intolerance (PGI), (ii) to evaluate potential differences in adverse perinatal outcomes in GDM women with and without early postpartum PGI and, finally, (iii) to establish a risk score to predict postpartum PGI. A cross-sectional study comprised 244 GDM patients with known age, parity, positive family history of diabetes, pre-gestational BMI, comorbidities, smoking history, results of mid-trimester oral glucose tolerance test, HbA1c, obstetric complications, neonatal outcomes and mode of delivery. A risk score was calculated using parameters with highest odds ratios in a statistic scoring model. Significant differences between women with and without PGI postpartum were ascertained for mid-trimester fasting plasma glucose (p < 0.001), HbA1c above 42 mmol/mol (p = 0.035), prevalence of obesity (p = 0.007), hypothyroidism, family history of diabetes and smoking. We also observed higher incidence of prolonged and complicated delivery in PGI group (p = 0.04 and 0.007, respectively). In conclusion, this study identified several parameters with predictive potential for early PGI and also adverse peripartal outcomes. We established a simple risk-stratification score for PGI prediction applicable for GDM affected women prior their leaving maternity ward. Yet, given a relatively small sample size as a main limitation of this study, the proposed score should be validated in the larger cohort.

See more in PubMed

American Diabetes Association Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes—2019. Diabetes Care. 2019;42:S13–S28. doi: 10.2337/dc19-S002. PubMed DOI

Zhu Y., Zhang C. Prevalence of Gestational Diabetes and Risk of Progression to Type 2 Diabetes: A Global Perspective. Curr. Diabetes Rep. 2016;16:7. doi: 10.1007/s11892-015-0699-x. PubMed DOI PMC

Huang Y. In: IDF Diabetes Atlas. 8th ed. Suvi K., da Rocha F.J., Yadi H., Belma M., editors. International Diabetes Federation; London, UK: 2017.

Bellamy L., Casas J.-P., Hingorani A., Williams D. Type 2 diabetes mellitus after gestational diabetes: A systematic review and meta-analysis. Lancet. 2009;373:1773–1779. doi: 10.1016/S0140-6736(09)60731-5. PubMed DOI

Kim C., Newton K.M., Knopp R.H. Gestational Diabetes and the Incidence of Type 2 Diabetes: A systematic review. Diabetes Care. 2002;25:1862–1868. doi: 10.2337/diacare.25.10.1862. PubMed DOI

Metzger B.E., Gabbe S.G., Persson B., Buchanan T.A., Catalano P.A., Damm P., Dyer A.R., Leiva A., Hod M., Kitzmiler J.L., 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. doi: 10.2337/dc10-0719. PubMed DOI PMC

Newbern D., Freemark M. Placental hormones and the control of maternal metabolism and fetal growth. Curr. Opin. Endocrinol. Diabetes Obes. 2011;18:409–416. doi: 10.1097/MED.0b013e32834c800d. PubMed DOI

Nadal A., Alonso-Magdalena P., Soriano S., Ropero A.B., Quesada I. The role of oestrogens in the adaptation of islets to insulin resistance. J. Physiol. 2009;587:5031–5037. doi: 10.1113/jphysiol.2009.177188. PubMed DOI PMC

Plows J.F., Stanley J.L., Baker P.N., Reynolds C.M., Vickers M.H. The Pathophysiology of Gestational Diabetes Mellitus. Int. J. Mol. Sci. 2018;19:3342. doi: 10.3390/ijms19113342. PubMed DOI PMC

White S.L., Begum S., Vieira M.C., Seed P., Lawlor D.L., Sattar N., Nelson S.M., Welsh P., Pasupathy D., Poston L., et al. Metabolic phenotyping by treatment modality in obese women with gestational diabetes suggests diverse pathophysiology: An exploratory study. PLoS ONE. 2020;15:e0230658. doi: 10.1371/journal.pone.0230658. PubMed DOI PMC

World Health Organization . Definition, Diagnosis and Classification of Diabetes Mellitus and Its Complications. WHO; Geneva, Switzerland: 2013.

Matthews J.N., Altman D.G., Campbell M.J., Royston P. Analysis of serial measurements in medical research. BMJ. 1990;300:230–235. doi: 10.1136/bmj.300.6719.230. PubMed DOI PMC

Delong E.R., Delong D.M., Clarke-Pearson D.L. Comparing the Areas under Two or More Correlated Receiver Operating Characteristic Curves: A Nonparametric Approach. Biometrics. 1988;44:837–845. doi: 10.2307/2531595. PubMed DOI

Youden W.J. Index for rating diagnostic tests. Cancer. 1950;3:32–35. doi: 10.1002/1097-0142(1950)3:1<32::AID-CNCR2820030106>3.0.CO;2-3. PubMed DOI

Ekelund M., Shaat N., Almgren P., Groop L., Berntorp K. Prediction of postpartum diabetes in women with gestational diabetes mellitus. Diabetologia. 2010;53:452–457. doi: 10.1007/s00125-009-1621-3. PubMed DOI

Vambergue A., Dognin C., Boulogne A., Réjou M.C., Biausque S., Fontaine P. Increasing incidence of abnormal glucose tolerance in women with prior abnormal glucose tolerance during pregnancy: DIAGEST 2 study. Diabet. Med. 2008;25:58–64. doi: 10.1111/j.1464-5491.2007.02306.x. PubMed DOI

Retnakaran R., Qi Y., Sermer M., Connelly P.W., Hanley A.J., Zinman B. Glucose Intolerance in Pregnancy and Future Risk of Pre-Diabetes or Diabetes. Diabetes Care. 2008;31:2026–2031. doi: 10.2337/dc08-0972. PubMed DOI PMC

Ingram E.R., Robertson I.K., Ogden K.J., Dennis A.E., Campbell J.E., Corbould A.M. Utility of antenatal clinical factors for prediction of postpartum outcomes in women with gestational diabetes mellitus (GDM) Aust. N. Z. J. Obstet. Gynaecol. 2017;57:272–279. doi: 10.1111/ajo.12514. PubMed DOI

Su X., Zhang Z., Qu X., Tian Y., Zhang G. Hemoglobin A1c for Diagnosis of Postpartum Abnormal Glucose Tolerance among Women with Gestational Diabetes Mellitus: Diagnostic Meta-Analysis. PLoS ONE. 2014;9:e102144. doi: 10.1371/journal.pone.0102144. PubMed DOI PMC

Claesson R., Ignell C., Shaat N., Berntorp K. HbA1c as a predictor of diabetes after gestational diabetes mellitus. Prim. Care Diabetes. 2017;11:46–51. doi: 10.1016/j.pcd.2016.09.002. PubMed DOI

Wang P., Lu M.-C., Yan Y.-H. Abnormal glucose tolerance is associated with preterm labor and increased neonatal complications in Taiwanese women. Taiwan J. Obstet. Gynecol. 2013;52:479–484. doi: 10.1016/j.tjog.2013.10.005. PubMed DOI

Brankica K., Valentina V.N., Slagjana S.K., Sasha J.M. Maternal 75-g OGTT glucose levels as predictive factors for large-for-gestational age newborns in women with gestational diabetes mellitus. Arch. Endocrinol. Metab. 2016;60:36–41. doi: 10.1590/2359-3997000000126. PubMed DOI PMC

Ferrara A., Peng T., Kim C. Trends in Postpartum Diabetes Screening and Subsequent Diabetes and Impaired Fasting Glucose Among Women with Histories of Gestational Diabetes Mellitus: A report from the Translating Research into Action for Diabetes (TRIAD) Study. Diabetes Care. 2009;32:269–274. doi: 10.2337/dc08-1184. PubMed DOI PMC

Keely E. An opportunity not to be missed—How do we improve postpartum screening rates for women with gestational diabetes? Diabetes Metab. Res. Rev. 2012;28:312–316. doi: 10.1002/dmrr.2274. PubMed DOI

Köhler M., Ziegler A.G., Beyerlein A. Development of a simple tool to predict the risk of postpartum diabetes in women with gestational diabetes mellitus. Acta Diabetol. 2016;53:433–437. doi: 10.1007/s00592-015-0814-0. PubMed DOI

Bartáková V., Malúšková D., Muzik J., Bělobrádková J., Kaňková K. Possibility to predict early postpartum glucose abnormality following gestational diabetes mellitus based on the results of routine mid-gestational screening. Biochem. Med. 2015;25:460–468. doi: 10.11613/BM.2015.047. PubMed DOI PMC

Find record

Citation metrics

Loading data ...

Archiving options

Loading data ...