Background: Women with gestational diabetes (GDM) have an increased risk of metabolic syndrome (MS) after delivery. MS could precede gravidity. The aims of this study were (i) to detect the prevalence of MS in women at the time of GDM diagnosis, (ii) to detect the prevalence of MS in the subgroup of GDM patients with any form of impaired glucose tolerance after delivery (PGI), and (iii) to determine whether GDM women with MS have a higher risk of peripartal adverse outcomes. Methods: A cross-sectional observational study comprised n = 455 women with GDM. International Diabetes Federation (IDF) criteria for MS definition were modified to the pregnancy situation. Results: MS was detected in 22.6% of GDM patients in those with PGI 40%. The presence of MS in GDM patients was associated with two peripartal outcomes: higher incidence of pathologic Apgar score and macrosomia (p = 0.01 resp. p = 0.0004, chi-square). Conclusions: The presence of MS in GDM patients is a statistically significant risk factor (p = 0.04 chi-square) for PGI. A strong clinical implication of our findings might be to include MS diagnostics within GDM screening using modified MS criteria in the second trimester of pregnancy.
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- časopisecké články MeSH
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Gestační diabetes mellitus (GDM) představuje dnes poměrně častou komplikaci těhotenství, která má jak bezprostřední dopad na průběh aktuální gravidity a porod, tak pro dlouhodobé metabolické zdraví matky a potomka. Incidence GDM se udává celosvětově okolo 14 %, v České republice 9–24 % v závislosti na použitých kritériích. Preeklampsie (PE) naopak patří mezi spíše vzácnější těhotenské komplikace (incidence celosvětově okolo 2 až 8 %, v České republice 4 až 6%), nicméně její dopad na probíhající těhotenství může být velmi závažný a v minulosti – v podobě eklampsie – dokonce fatální. Cílem tohoto přehledového článku je shrnout současné poznatky o etiopatogenezi obou těhotenských komplikací, tedy (1) GDM a (2) PE. Dále (3) uvést epidemiologická data o izolovaném a současném výskytu GDM a PE a případných úskalích jejich diagnostiky (např. nejednotná kritéria, systém screeningu) a (4) diskutovat případné patofyziologické mechanismy zodpovědné za koincidenci GDM a PE.
Gestational diabetes mellitus (GDM) represents a relatively frequent complication of pregnancy, which has an impact on both the course of the current pregnancy and childbirth, as well as for the long-term metabolic health of the mother and her child. The reported incidence of GDM varies around 14% worldwide (9–24% in the Czech Republic), depending on the diagnostic criteria used. Preeclampsia (PE) is one of the rare pregnancy complications with the incidence about 2–8% worldwide (4–6% in the Czech Republic), but its impact on ongoing pregnancy can be very serious and in the past – in the form of eclampsia – even fatal. The aim of this review article is to summarize the current knowledge of the etiopathogenesis of both pregnancy complications, i.e. (1) GDM and (2) PE. Furthermore, (3) we aim to present the epidemiological data on isolated and parallel occurrence of GDM and PE and the pitfalls of their diagnostics (e.g. inconsistent criteria or screening systems) and (4) to discuss pathophysiological mechanisms responsible for concurrent manifestation of GDM and PE.
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BACKGROUND: Gestational diabetes mellitus (GDM) represents a risk factor for both mother and her offspring in a short-term (perinatal morbidity) and long-term horizon (postpartum diabetes or foetal programming). Several studies focused at peri/postnatal outcomes of GDM mother ́s offspring, however relatively few (and none in Czech population) were designed as prospective. The aim of the study was to ascertain eventual anthropometric and developmental abnormalities and/or morbidity in offspring of GDM mothers compare to controls in a 5-year follow-up using a parent-reported parameters related to psychomotor development and common paediatric morbidities including a sub-study of offspring of GDM mothers experiencing adverse perinatal outcomes. METHODS: A 5 year follow up study of offspring of GDM mothers (n = 26) vs those with a normal pregnancy (n = 63). An electronic questionnaire was used to obtain the parameters (such as growth, psychomotor development, vaccination, morbidity history etc.) available to parents from the parent-held infant health record. Data on pregnancy and delivery were available from the previous study. RESULTS: Offspring of GDM mothers had delayed psychomotor development in early childhood, but in 5 years of age they seemed to gradually achieve results of a control group. Children with macrosomia had a higher percentile of weight-for-height and were significantly more frequently ill than those with a normal birth weight. Offspring of obese mothers had worse verbal language skills in early childhood and a higher percentile of weight-for-height. CONCLUSION: Maternal gestational diabetes and obesity can be considered an important determinant of postnatal offspring development and health status, which further advocates for broader implementation of preventive strategies.
- MeSH
- dítě MeSH
- gestační diabetes * MeSH
- index tělesné hmotnosti MeSH
- kojenec MeSH
- lidé MeSH
- morbidita MeSH
- následné studie MeSH
- obezita epidemiologie MeSH
- porodní hmotnost MeSH
- předškolní dítě MeSH
- prospektivní studie MeSH
- těhotenství MeSH
- Check Tag
- dítě MeSH
- kojenec MeSH
- lidé MeSH
- předškolní dítě MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
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- časopisecké články MeSH
- práce podpořená grantem MeSH
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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.
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- časopisecké články MeSH
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