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Women with gestational diabetes – who were diagnosed with "new" criteria – were five times more likely to develop type 2 diabetes and three times more likely to develop prediabetes in the decade following pregnancy .
Children whose mothers had had gestational diabetes were also more likely to be obese, to have high body fat, a large waistline and skin folds at the age of 11 years. (However, with regard to the combined combined result of overweight and obesity, there was no significant difference between mothers aged 11 and those without gestational diabetes).
These results come from a follow-up of nearly 5,000 mothers and children from the study on hyperglycemia and the adverse consequences of pregnancy (HAPO) of William L. Lowe Jr., MD, of Northwestern University, Chicago, Illinois, and his colleagues. September 11th JAMA.
The researchers diagnosed gestational diabetes using the "new" criteria from the International Diabetes and Pregnancy Association (IADPSG) study groups (Diabetic treatments. 2010; 33: 676-682) published in 2010 and adopted by the World Health Organization and the American Diabetes Association, but not the American College of Obstetricians and Gynecologists, who still advises to use the criteria more rigorous Carpenter-Coustan.
The more flexible IADPSG criteria for the diagnosis of gestational diabetes require an abnormal glucose value during an oral glucose tolerance test, whereas the Carpenter-Coustan criteria require two abnormal values.
Less severe gestational diabetes is not without risk
"The new criteria are weaker and more sensitive and identify a larger group of women [roughly twice as many]"With gestational diabetes, senior author Boyd E. Metzger, MD, of Northwestern University, said Medscape Medical News.
This study also shows that "unfortunately, a mother's blood sugar, as identified by mild gestational diabetes, is directly associated with the risk of becoming obese at the onset of puberty", he added.
"From a public health point of view, if a disease can be treated," Metzger added, "we should identify it as soon as possible – the challenge is to make your treatment as cost-effective as possible."
The first-line treatment of gestational diabetes "is diet and lifestyle, and two clinical trials have shown that moderate gestational diabetes treatment reduces the adverse effects of pregnancy by more than 80% and without expensive drug or ultrasound. it's noted.
Thus, "rather than limiting the number of women with gestational diabetes who are diagnosed and treated, we must also focus on improving the efficiency and reducing the costs of our treatments."
Pre-diabetes can also be treated by lifestyle changes, he said.
"I really think," summarizes Metzger, "that slight increases in blood sugar during pregnancy have important implications for the mother and the child."
Lower threshold of gestational diabetes, impact on mother and child
The HAPO study (N Engl J Med. 2008; 358: 1991-2002) recruited nearly 25,000 pregnant women from 15 sites in nine countries between 2000 and 2006 and found that women with high glucose levels – but lower than the levels required to make a diagnosis of gestational diabetes time – had a higher risk of an adverse pregnancy outcome, explain the researchers for information.
The women were on average 30 years old and were of diverse ethnicity: white (47%), Asian (25%), black (16%), Hispanic (16%) and other (2%).
For the current follow-up, the researchers sought to see if gestational diabetes, diagnosed using the lower threshold criteria issued in 2010, would predict whether mothers would be at a greater risk of developing prediabetes or type 2 diabetes and whether their children would have greater adiposity. during a follow-up of 10 to 14 years.
Of the 15,000 eligible mother-to-child pairs from the initial HAPO study, 9,322 pairs were screened at 10 sites, and 4,834 children and 4,477 mothers participated in the follow-up.
The main outcome for the mother was a composite of type 2 diabetes or prediabetes. The main outcome in children was overweight or obesity, and the secondary outcomes were obesity, body fat percentage, waist circumference, and sum of skin folds (> 85th percentile for all three latest results).
Based on the IADPSG criteria, 14.3% of women were diagnosed with gestational diabetes. These women tended to be older, had a higher BMI and were more likely to have a family history of diabetes.
A greater percentage of women with gestational diabetes compared to the absence of gestational diabetes developed type 2 diabetes (10.7% vs. 1.6%) or prediabetes (41.5% vs 18%). 4%) during follow-up (P <0.001 for both), and these significantly higher risks persisted even after adjusting for several variables.
However, at the age of 11, a similar number of children were overweight or obese, whether or not their mothers had gestational diabetes (39.5% vs. 28.6%, respectively, not significant after adjustment for confounding factors).
Children whose mothers had gestational diabetes were, however, more likely to be obese (19.1%) than other children (9.9%), and other measures of adiposity were also worse.
Study not designed to eliminate new criteria for gestational diabetes
The researchers explain that in the United States, gestational diabetes is usually diagnosed progressively using a 50-g glucose test and then a 100-g oral glucose tolerance test for 3 hours.
Second, using the Carpenter-Coustan criteria, a woman is diagnosed with gestational diabetes if she has two of the following abnormal blood glucose readings over 3 hours:
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Fasting plasma glucose> 95 mg / dL
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Plasma glucose over 1 hour> 180 mg / dL
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Plasma glucose over 2 hours> 155 mg / dL
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Plasma glucose over 3 hours> 140 mg / dL
In contrast, using the IADPSG criterion, a woman is diagnosed with gestational diabetes if she has an abnormal glucose value using a 2-hour 75-g oral glucose tolerance test based on the same thresholds.
"This study was not designed to compare women with those without gestational diabetes defined by the Carpenter-Coustan criteria," the researchers write.
However, twice as many women met the criteria for gestational diabetes as defined by the IADPSG against the Carpenter-Coustan criteria (240 vs 106 women) in an exploratory analysis.
"This study demonstrated that a larger population of women with lower degrees of hyperglycemia (ie, gestational diabetes defined by IADPSG) ran a risk of progression to prediabetes and type 2 diabetes ", the authors conclude.
The research was funded by a grant from the National Center for the Advancement of Translation Sciences, National Institutes of Health. Metzger has not reported any relevant financial relationship. Disclosures for other authors are listed in the article.
JAMA. Posted online September 11, 2018. Summary
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