Hyperglycemia recognised in early pregnancy is phenotypically type 2 diabetes mellitus not gestational diabetes mellitus: a case control study

Abstract

Background and aims: Gestational diabetes is defined as 'carbohydrate intolerance first recognised in pregnancy'. The definition encompasses women diagnosed in early pregnancy. Concerns exist that such cases phenotypically resemble those with established pre-existing diabetes and therefore have a higher risk profile. We aim to evaluate women diagnosed with impaired carbohydrate intolerance in early pregnancy and compare them with those with established Type 2 diabetes and gestational diabetes diagnosed on routine screening (24À28 weeks' gestation). Methods: We retrospectively reviewed 84 women who attended our inner-city conjoint antenatal clinic (2009À2012). Baseline demographics, insulin therapy requirement and outcomes were compared in women with gestational diabetes diagnosed prior to routine screening (group 1, n = 18) and women with established Type 2 diabetes (group 2, n = 66). A separate cohort of age-matched controls with routinely diagnosed gestational diabetes was identified (group 3, n = 18). Results: Mean age (groups 1À3, 35.6 years, 32.6 years, 35.4 years respectively) and proportion of women originating from non-Caucasian ethnicities (72%, 74%, 78%) were similar across the groups. Women were significantly more likely to be multiparous in group 1 (85%, 15%, 13.6%). Mean booking body mass index (BMI) in groups 1 and 2 were similar: group 1 had a significantly higher booking BMI than group 3 (32.3kg/m 2 ; 30.4kg/m 2 ; 28.3kg/ m 2 ). Differences in HbA1c at booking/diagnosis displayed similar patterns [group 1, 61.4mmol/mol; group 2, 58.5mmol/mol (p = ns); group 3, 38.3mmol/mol (p < 0.005)], as did requirement for insulin therapy [group 1, 94%; group 2, 83.3% (p = ns); group 3, 27.8% (p = 0.04)]. Unplanned Caesarean section rates (33.3%, 28.8%, 38.9%), mean fetal birth weight (3,402g AE 767; 3,257g AE 690; 3,218g AE 503) and birth weight centile (60 AE 37; 59 AE 36; 45 AE 25) were similar across the groups. A higher proportion of infants were born large for gestational age in group 1 and group 2 (27.8%, 25.8%, 5.6%; p = ns). Conclusions: Our analysis has demonstrated that women with carbohydrate intolerance diagnosed early in pregnancy phenotypically resemble those with Type 2 diabetes both in terms of treatment required and outcomes. The role of HbA1c at booking could be investigated as a potential screening tool. A34 (P394)Fasting plasma glucose (FPG) alone will miss persisting postnatal glucose abnormalities in gestational diabetes Aims: To assess the utility of FPG in detecting persisting postnatal hyperglycaemia in gestational diabetes.Methods: Retrospective data were collected for all antenatal and postnatal oral glucose tolerance tests (OGTT) between January 2008 and 2013 across three centres in the West Midlands that used selective screening and WHO criteria. A descriptive study was undertaken comparing the utility of OGTT and FPG postnatally. Results: In all, 14,360 women were screened antenatally; 1,289 women had gestational diabetes and 632 (49%) had OGTT (mean AE SD: 9.4 AE 4.1 weeks). Mean...

Markers of Maternal Insulin Resistance and Lipid Ratios Measured in Early Pregnancy Are Related to Adverse Fetomaternal Outcomes in Women Treated for Hyperglycemia Detected in Early Pregnancy—Data from a Retrospective Cohort Study

“…Overt hyperglycemia (eDiP) was associated with more severe insulin resistance, and a higher prevalence of atherogenic traits in women of an age and BMI similar to those noted in patients with mild hyperglycemia (eGDM). This observation suggests that women with eDiP present an early phenotype of type 2 diabetes rather than type 1, or MODY, which remains in line with data presented by other authors [ 36 , 37 , 38 ]. Interestingly, although women with eDiP differed from those with eGDM with respect to insulin resistance and glucose metabolism, both subgroups had a similar proportion of women with chronic and gestational hypertension.…”

Outcomes of Pregnancy Affected by Overt Type 2 Diabetes in a Diabetic Care Unit of Padova

“…The most of the studies published in literature in order to better define the physiophatological mean of overt type 2 diabetes compare this pathology to GDM. In a case control study Agha-Jaffar et all showed an higher frequency of hypertensive disorders and an higher frequency on insulin treatment in OT2DM compared to GDM ones and pointed the fact that OT2DM is phenotypically a type 2 diabetes mellitus (13). In a multi-ethnic cohort in Spain pregnant women with OT2DM showed worse obstetric outcomes with respect to GDM ones and this was present mainly in women from ethnic minorities ( 14).…”

A Retrospective Analysis of the Outcomes of Pregnancies in Women Affected by Overt Diabetes Compared to Women Affected by Pre-Existing Type 2 Diabetes

“…Most studies are published in the literature in order to better define the physiopathological mean of overt diabetes compared to GDM pathology [11][12][13][14]. In a case-control study, Agha-Jaffar et al reported a higher frequency of hypertensive disorders and higher frequencies with respect to insulin treatment in ODM compared to women with GDM, and pointed out the fact that ODM is phenotypically a type 2 diabetes mellitus [22]. In a multi-ethnic cohort in Spain, pregnant women with ODM exhibited worse obstetric outcomes with respect to women with GDM, and this was present mainly in women from ethnic minorities [23].…”