Gestational Diabetes Mellitus—Innovative Approach to Prediction, Diagnosis, Management, and Prevention of Future NCD—Mother and Offspring

McIntyre, H. David; Kapur, Anil; Divakar, Hema; Hod, Moshe

doi:10.3389/fendo.2020.614533

Cited by 33 publications

(33 citation statements)

References 99 publications

(118 reference statements)

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“…The general characteristics of the participants of the current study are consistent with the results in the literature [ 11 ]. In the entire cohort, the percentage of women who developed GDM was 16%.…”

Section: Discussionsupporting

confidence: 88%

“…Thus far, no unambiguous biochemical markers for the prediction of gestational diabetes mellitus (GDM) have been identified, and extensive screening tests (including clinical and biochemical factors) are complex and have not been validated in external cohorts [ 4 , 11 ], but the etiology of GDM is complicated and is not fully understood [ 4 ]. Therefore, clinical risk factors (also identified in this study) may play an important role in the early prediction of GDM, allowing for the early implementation of surveillance and prevention [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…Long-term complications include an increased risk of developing type 2 diabetes (T2D) and obesity later in the mother’s and baby’s life, revealing the adverse intergenerational effects of GDM [ 4 , 8 , 9 , 10 ]. This is related to the theory of Developmental Origins of Health and Disease (DOHaD) [ 11 , 12 ]. Early identification of GDM risk allows for early interventions to reduce maternal and child complications [ 4 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Gestational Diabetes Mellitus (GDM) Risk for Declared Family History of Diabetes, in Combination with BMI Categories

Lewandowska

2021

IJERPH

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Whether categories of family history of diabetes can act as independent risk factors for gestational diabetes mellitus (GDM-1, -2) has not yet been established, and neither has it been established how categories of body mass index (BMI) affect these relationships. A group of 912 women without chronic diseases, recruited in the first trimester, was investigated: 125 (13.7%) women developed GDM-1 (treated with diet); 21 (2.3%) women developed GDM-2 (treated with insulin); and a control group consisted of 766 non-diabetic women. A multiple logistic regression was used to evaluate adjusted odds ratios (AOR (95% confidence intervals)) of GDM-1 and GDM-2 for declared diabetes in the parents or grandparents (separately). These relationships were investigated in the whole cohort and subgroups of pre-pregnancy BMI. (1) Some categories of the family history were independent risk factors of GDM-1 or GDM-2. Compared to ‘absence of diabetes in the family’, women with diabetes in the father had a 3.68-fold increase in GDM-1 risk (AOR-b = 3.68 (2.23–6.07)), and women with diabetes in the mother had a 2.13-fold increase in GDM-1 risk (AOR-b = 2.13 (1.1−4.14)) and a 4.73-fold increase in GDM-2 risk (AOR-b = 4.73 (1.26−17.77)). Women with diabetes in the grandmother had a 2.34-fold increase in GDM-1 risk (AOR-b = 2.34 (1.29−4.24)). (2) The cumulative assessment of diabetes in the parents and/or grandparents was not related to the intensification of the risk of GDM, except for the increased risk of GDM-1 for diabetes in both mother and grandmothers simultaneously (AOR-b = 8.80 (1.16−66.57)), however, this group was very small. (3) The analyses in the subgroups of BMI categories showed that diabetes in the father was also an independent risk factor of GDM in the subgroup of pregnant women with normal BMI. In the subgroups of overweight and/or obesity, the risk of GDM for paternal and maternal diabetes was approximately twice as high as compared to the results of pregnant women with normal BMIs. Additionally, apart from the maternal influence of diabetes, the results suggest a significant influence of diabetes in the father on the risk of GDM, even (interestingly) in lean pregnant women.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Gestational Diabetes Mellitus (GDM) Risk for Declared Family History of Diabetes, in Combination with BMI Categories

Lewandowska

2021

IJERPH

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“…However, the risk of labor induction among the treated women was higher than the untreated women. Despite the unquestionable evidence and the wide range of recommendations regarding the benefit of treatment for women with GDM (6,26,27), there is an ongoing debate about the effect of the treatment for glucose intolerance and a lower than diagnostic thresholds of GDM. Notably, after the publication of the results of the HAPO's study demonstrating that maternal glycemia continuously was associated with the increasing risk of adverse perinatal outcomes, with no obvious threshold at which risks increase, the debate as to whether a benefit exists for the treatment of the milder form of GDM assumes even greater importance now than in the past.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Mild Gestational Diabetes Mellitus Treatment on Adverse Pregnancy Outcomes: A Systemic Review and Meta-Analysis

2021

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ObjectivesIt is uncertain whether the treatment of mild gestational diabetes mellitus (GDM) improves pregnancy outcomes. The aim of this systemic review and meta-analysis was to investigate the effect of mild GDM treatment on adverse pregnancy outcomes.MethodsA comprehensive literature search was conducted on the databases of PubMed, Scopus, and Google Scholar to retrieve studies that compared interventions for the treatment of mild GDM with usual antenatal care. The fixed/random effects models were used for the analysis of heterogeneous and non-heterogeneous results. Publication bias was assessed using the Harbord test. Also, the DerSimonian and Laird, and inverse variance methods were used to calculate the pooled odds ratio of events. The quality assessment of the included studies was performed using the Modified Newcastle–Ottawa Quality Assessment scale and the CONSORT checklist. In addition, the risk of bias was evaluated using the Cochrane Collaboration’s tool for assessing risk of bias.ResultsThe systematic review and meta-analysis involved ten studies consisting of 3317 pregnant women who received treatment for mild GDM and 4407 untreated counterparts. Accordingly, the treatment of mild GDM significantly reduced the risk of macrosomia (OR = 0.3; 95%CI = 0.3–0.4), large for gestational age (OR = 0.4; 95%CI = 0.3–0.5), shoulder dystocia (OR = 0.3; 95%CI = 0.2–0.6), caesarean-section (OR = 0.8; 95%CI = 0.7–0.9), preeclampsia (OR = 0.4; 95%CI = 0.3–0.6), elevated cord C-peptide (OR = 0.7; 95%CI = 0.6–0.9), and respiratory distress syndrome (OR = 0.7; 95%CI = 0.5–0.9) compared to untreated counterparts. Moreover, the risk of induced labor significantly increased in the treated group compared to the untreated group (OR = 1.3; 95%CI = 1.0–1.6). However, no statistically significant difference was observed between the groups in terms of small for gestational age, hypoglycemia, hyperbilirubinemia, birth trauma, admission to the neonatal intensive care unit, and preterm birth. Sensitivity analysis based on the exclusion of secondary analysis data was all highly consistent with the main data analysis.ConclusionTreatment of mild GDM reduced the risk of selected important maternal outcomes including preeclampsia, macrosomia, large for gestational age, cesarean section, and shoulder dystocia without increasing the risk of small for gestational age. Nevertheless, the treatment could not reduce the risk of neonatal metabolic abnormalities or several complications in newborn.

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“…Beyond the mere documentation of risk, it is clear that both effective lifestyle interventions [26] and the use of metformin [27] are able to reduce the risk of progression to overt diabetes following a GDM diagnosis. Thus, appropriate diagnosis of GDM identifies long-term remediable maternal health risks, which we consider deserving of attention both in terms of immediate pregnancy complications and long-term maternal health.…”

Section: Accepted Articlementioning

confidence: 99%

Update on diagnosis of hyperglycemia in pregnancy and gestational diabetes mellitus from FIGO’s Pregnancy & Non‐Communicable Diseases Committee

McIntyre

Oats

Kihara

et al. 2021

Intl J Gynecology & Obste

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The optimal process for detecting and treating gestational diabetes mellitus (GDM) remains controversial, with wide variances in practice within and between countries. A recent pragmatic randomized controlled trial (RCT) undertaken by Hillier et al. 1 in the USA has raised renewed worldwide interest in and discussion of GDM diagnosis.The study reported no benefit at a population level in frequency of large-for-gestational-age (LGA) infants, hypertensive disorders of pregnancy, primary cesarean delivery, or a predefined composite perinatal outcome using a "one-step" diagnostic process and diagnostic criteria (primary diagnostic 75 g oral glucose tolerance test [OGTT]) as suggested in 2010 by the International Association of Diabetes in Pregnancy Study Groups (IADPSG) 2 as compared to current dominant USA-based criteria, 3 which employ a "two-step" process (initial nonfasting glucose challenge test [GCT] followed by a full OGTT if threshold glucose values are exceeded on the GCT).It should be noted that the USA criteria use very similar OGTT diagnostic thresholds to the IADPSG criteria, but require two elevated values for a GDM diagnosis. This time-honored practice lies contrary to the large body of evidence, confirmed in a recent USA-based systematic review, demonstrating that women with one abnormal value on their diagnostic OGTT carry substantially higher risks of LGA babies, cesarean delivery, pregnancy-induced hypertension, Apgar score <7, neonatal intensive care unit admission, and respiratory distress syndrome. 4 Since the IADPSG criteria classified 16.5% of women as GDM compared to an 8.5% frequency using the dominant USA criteria in the Hillier et al. study, 1 an accompanying editorial by Casey 5 concluded that the IADPSG approach offered "no apparent maternal or perinatal benefit overall." While we applaud the efforts of Hillier et al. 1 in conducting such an important study, we consider that the interpretation of the trial's results merits detailed scrutiny. | CONSIDERATIONS REGARDING THE HILLIER ET AL. 1 TRIAL PROTOCOL AND RESULTSThe study by Hillier et al. 1 was designed and conducted as a "pragmatic RCT." The major advantages of this approach were that the study was integrated into standard care across the two Kaiser Permanente health systems involved and recruited a very substantial number of women (23 792 randomized). The investigators obtained

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Gestational Diabetes Mellitus—Innovative Approach to Prediction, Diagnosis, Management, and Prevention of Future NCD—Mother and Offspring

Cited by 33 publications

References 99 publications

Gestational Diabetes Mellitus (GDM) Risk for Declared Family History of Diabetes, in Combination with BMI Categories

Gestational Diabetes Mellitus (GDM) Risk for Declared Family History of Diabetes, in Combination with BMI Categories

The Effect of Mild Gestational Diabetes Mellitus Treatment on Adverse Pregnancy Outcomes: A Systemic Review and Meta-Analysis

Update on diagnosis of hyperglycemia in pregnancy and gestational diabetes mellitus from FIGO’s Pregnancy & Non‐Communicable Diseases Committee

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