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More recent international criteria for gestational diabetes have identified twice as many mothers with the condition as the current US criteria, and these women were at high risk of developing diabetes or pre-diabetes after pregnancy, the researchers reported.
According to the criteria developed by the International Association of Diabetes and Pregnancy Study Groups (IADPSG), which use lower plasma glucose thresholds, slightly more than 14% of pregnant women in a vast cohort study were defined as having gestational diabetes. The criteria used in the United States, the Carpenter-Coustan criteria, put this figure at about 7%, said Boyd Metzger, MD, of the Feinberg School of Medicine at Northwestern University in Chicago.
- More recent criteria for gestational diabetes identified twice as many mothers with MDD as the current criteria in the US, and these women were at high risk of developing diabetes or prediabetes after pregnancy. and a cohort of ethnically diverse women.
- Note that the median follow-up of the study was 11 years, suggesting that mothers with a history of GD should be screened for prediabetes and diabetes at regular intervals at the time of treatment. # 39; future.
Over 11 years of median follow-up, 52% of mothers with gestational diabetes defined by IADPSG developed type 2 diabetes or prediabetes, compared to 20% of mothers without gestational diabetes (odds ratio 3.44, 95% CI 2.85 -4.14); risk difference 25.7%; 95% CI 21.7% -29.7%), researchers reported online JAMA.
"This study demonstrated that a larger population of women with lower degrees of hyperglycemia (gestational diabetes defined by IADPSG) presented a risk of progression to prediabetes and type 2 diabetes" , wrote the authors of the study. "Gestational diabetes according to the Carpenter-Coustan criteria as defined in this study was associated with higher risks, however, the risks for the large group of women meeting the criteria defined by IADPSG for gestational diabetes were substantial and can not be met. to be ignored from the public health perspective. "
The Carpenter-Coustan criteria involve a glucose challenge test of 50 g, followed by an oral glucose tolerance test of 100 g for 3 hours. A diagnosis of gestational diabetes requires two abnormal blood glucose values in these tests, defined as fasting blood glucose greater than 95 mg / dL, plasma glucose greater than 180 mg / dL over 1 hour, blood glucose greater than 2 hours 155 mg / dL or a 3-hour plasma glucose level greater than 140 mg / dL.
The IADPSG criteria only require an abnormal value during an oral glucose tolerance test of 75 g of 2 hours. Abnormal values are defined as a fasting plasma glucose level of 92 mg / dL or greater (≥ 5.1 mmol / L), a plasma glucose level of 1 hour greater than or equal to 180 mg / dL (≥ 10.0 mmol / L) or 2-hour plasma glucose level of 153 mg / dL or greater (≥ 8.5 mmol / L), indicated the study authors.
Asked about her point of view, Caroline Messer, MD, of Lenox Hill Hospital in New York and spokesperson for the American Association of Clinical Endocrinologists, said using the new IADPSG criteria might make sense. "It certainly seems that the old criteria using the 50g and 100g glucose tests are less effective and we should perhaps use the 75g test only," said Messer, who did not participate in the test. l & # 39; study.
"In addition, we should conduct regular screening among mothers with a history of gestational diabetes for prediabetes and diabetes."
Metzger and colleagues also examined whether children of mothers with gestational diabetes defined by the IADPSG were at greater risk for obesity or overweight, as defined by body mass index, compared children of mothers without gestational diabetes. However, the team found that a nonsignificant trend to a higher risk of obesity or overweight (OR 1.21, 95% CI 1.00-1.46 RD 3.7%, 95% CI -0.16% to 7.5%). The results were similar when overweight and obesity were examined, depending on the percentage of body fat and waist circumference.
The criteria for IADPSG were based in part on data from the study on Hyperglycemia and Pregnancy Adverse Consequences (HAPO), a multinational, racially diverse cohort study. ethnic group whose results were first published in 2008. The Metzger group conducted a follow-up analysis. included 4,697 mothers and 4,832 children in the original study. All participants underwent one study visit between February 2013 and December 2016. During this visit, the investigators took clinical measures, including height and weight, and performed an oral glucose tolerance test. 75 g the mothers.
The main outcome for mothers was the development of type 2 diabetes or prediabetes. Type 2 diabetes was determined by self-reported diabetes or fasting blood glucose of 126 mg / dL or greater (≥7.0 mmol / L), a plasma glucose level of 2 hours or more of 200 mg / dL (≥ 11.1 mmol / L), or both, during the oral glucose tolerance test during the study visit. Prediabetes was defined as a fasting plasma glucose level of between 100 and 125 mg / dL (5.6-6.9 mmol / L), a 2-hour plasma glucose level between 140 and 199 mg / dL ( 7.8-11.0 mmol / L). or both. The main independent variable for mothers was gestational diabetes at enrollment in the HAPO study, defined post hoc by the IADPSG criteria.
According to the researchers, a significant limitation of the analysis was that almost 2% of participants with oral glucose tolerance values above the predefined thresholds during pregnancy were precautionary and excluded from primary analyzes as well as from Monitoring evaluation. "This subgroup would probably have included mothers with higher frequencies for type 2 diabetes and prediabetes at the time of this follow-up study, and children at high risk of overweight or obesity; declared can be underestimated ". co-authors have written.
Nevertheless, "in women with gestational diabetes identified by contemporary criteria compared to those without gestational diabetes, gestational diabetes was significantly associated with a higher risk of glucose metabolism disorder in the mother during follow-up. long term after pregnancy. "
Last updated on September 11, 2018
The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases and by the Eunice Kennedy Shriver National Institute for Child Health and Human Development.
Metzger said he has no conflict of interest; a co-author has reported financial relations with AstraZeneca, Bayer, Pfizer, Boehringer-Ingelheim and Takeda.
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