Proposed diagnostic thresholds for gestational diabetes mellitus according to a 75‐g oral glucose tolerance test. Maternal and perinatal outcomes in 3260 Danish women

Jensen, Dorte Møller; Damm, Peter; Sørensen, Bent; Mølsted‐Pedersen, Lars; Westergaard, J.G.; Korsholm, Lars; Ovesen, Per; Beck‐Nielsen, Henning

doi:10.1046/j.1464-5491.2003.00857.x

Cited by 65 publications

(53 citation statements)

References 23 publications

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“…Preterm delivery was an independent risk factor for the development of type 1 but not type 2 diabetes. This finding is of interest, since it has been shown for pregnant women with both type 1 diabetes and GDM that increasing glucose levels increase the risk of spontaneous preterm delivery (27,28).…”

Section: Multiple Logistic Regressionmentioning

confidence: 99%

Increasing Incidence of Diabetes After Gestational Diabetes

et al. 2004

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OBJECTIVE -To study the incidence of diabetes among women with previous diet-treated gestational diabetes mellitus (GDM) in the light of the general increasing incidence of overweight and diabetes and to identify risk factors for the development of diabetes. , and IGT postpartum were identified as independent predictors of diabetes by multiple logistic regression analyses. RESEARCH DESIGN AND METHODSCONCLUSIONS -The incidence of diabetes among Danish women with previous diettreated GDM was very high and had more than doubled over a 10-year period. This seems to be due to a substantial increase in BMI in women with GDM.

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Section: Multiple Logistic Regressionmentioning

confidence: 99%

Increasing Incidence of Diabetes After Gestational Diabetes

et al. 2004

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“…estational diabetes mellitus (GDM) is estimated to occur in 2-9% of all pregnancies (1)(2)(3)(4)(5). It is defined as carbohydrate intolerance with onset or first recognition during pregnancy and is associated with increased rates of adverse pregnancy outcomes, such as macrosomia; shoulder dystocia; birth-related trauma, such as fractures and nerve palsies; neonatal hypoglycemia; and jaundice.…”

mentioning

confidence: 99%

Comparison of Accuracy Measures of Two Screening Tests for Gestational Diabetes Mellitus

Leeuwen¹,

Zweers

Opmeer

et al. 2007

Diabetes Care

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OBJECTIVE -To compare the accuracy measures of the random glucose test and the 50-g glucose challenge test as screening tests for gestational diabetes mellitus (GDM).RESEARCH DESIGN AND METHODS -In this prospective cohort study, pregnant women without preexisting diabetes in two perinatal centers in the Netherlands underwent a random glucose test and a 50-g glucose challenge test between 24 and 28 weeks of gestation. If one of the screening tests exceeded predefined threshold values, the 75-g oral glucose tolerance test (OGTT) was performed within 1 week. Furthermore, the OGTT was performed in a random sample of women in whom both screening tests were normal. GDM was considered present when the OGTT (reference test) exceeded predefined threshold values. Receiver operating characteristic (ROC) analysis was used to evaluate the performance of the two screening tests. The results were corrected for verification bias.RESULTS -We included 1,301 women. The OGTT was performed in 322 women. After correction for verification bias, the random glucose test showed an area under the ROC curve of 0.69 (95% CI 0.61-0.78), whereas the glucose challenge test had an area under the curve of 0.88 (0.83-0.93). There was a significant difference in area under the curve of the two tests of 0.19 (0.11-0.27) in favor of the 50-g glucose challenge test.CONCLUSIONS -In screening for GDM, the 50-g glucose challenge test is more useful than the random glucose test. Diabetes Care 30:2779-2784, 2007G estational diabetes mellitus (GDM) is estimated to occur in 2-9% of all pregnancies (1-5). It is defined as carbohydrate intolerance with onset or first recognition during pregnancy and is associated with increased rates of adverse pregnancy outcomes, such as macrosomia; shoulder dystocia; birth-related trauma, such as fractures and nerve palsies; neonatal hypoglycemia; and jaundice. In addition, women with GDM are at substantially higher risk to develop diabetes in later life (1,6 -8). Results from a randomized controlled trial show that treatment of GDM by means of dietary advice, blood glucose monitoring, and insulin therapy, if required, reduces the rate of serious perinatal complications without increasing the rate of caesarean delivery (1). Based on these results, identification through screening and subsequent treatment of women with GDM appears beneficial. However, consensus on the optimal policy for screening is lacking. The American Diabetes Association recommends screening based on risk factors for GDM (age Ͼ25 years, obese, close relative with diabetes, history of GDM or a previous macrosomic infant, or specific ethnicity) followed by the 50-g 1-h oral glucose challenge test as a screening test (9 -11). Other methods of screening that are regularly used are (repeated) random glucose testing and fasting glucose measurement. It is indefinite which test is the most accurate in testing women for GDM.The diversity in screening methods may result in unidentified cases of GDM and preventable neonatal and maternal morbidity. Establishment of ...

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“…IGF is bound to and modulated by at least six high-affinity IGF binding proteins (IGFBP [1][2][3][4][5][6]. The exact biological function of IGFBP-2, 4-6 is uncertain in normal human IGFBP can be associated with cell membranes, where its function is unexplored or in the extracellular matrix [14].…”

Section: Igf Binding Proteins (Igfbps)mentioning

confidence: 99%

“…Cut-off levels at 90 and 97.5% (+ 2 SD) was proposed [1,2]. In other studies fixed limits like birth weight > 4000, 4500, and 5000 g was used [1][2][3]. The advantage of the first method is its independence of gestational age.…”

Section: Introductionmentioning

confidence: 99%

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Macrosomia and the IGF System: A Short Review

Al-Far¹,

Tjessem²,

Lauszus³

2017

Foc Sci

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Introduction: Macrosomia in diabetic pregnancy is an ubiquitous finding and implies both maternal and fetal issues. Its incidence surpasses other critical obstetrical morbidity in diabetic pregnancy with increased placental size and polyhydramnios as comorbidity. The studies on the underlying factors contributing to macrosomia have focused on growth stimuli like IGF, glycemia, and insulin and their effects on regional organ function. IGF-I and -II in maternal serum are associated with birth weight and the bioavailabiliy is modulated by IGF-binding-proteins (IGFBP) and phosporylated isoforms of IGFBP and the presence of proteases and IGF split products. Human placental growth hormone regulates the effect of IGF-I in pregnancy. Methods: The literature on the IGF system′s possible effect on fetal growth in diabetic pregnancy is reviewed before our current studies and updated with respect to later findings. Regulation on bioavailability by proteolysis and phosporylation is described. The review discusses briefly the studies on pregnant women with type 1 diabetes with respect to vasculopathy. Results: The data show good correlation of IGF-1/2 levels with birth weight. No such correlation with IGFBP-1 and -3 is found. Fetal growth deviation in diabetic pregnancy is not uniform. In first trimester, growth delay is documented in fetal growth curves compared to non-diabetic controls. Accordingly, a shift in IGF-IGFBP regulation in second trimester is found with less proteolysis of IGFBPs and relative increase in total binding capacity. In third trimester, free IGF further increases as IGFBP binding decreases by proteolysis and modulation. The first trimester values may be used as predictor of fetal weight at term. Diabetic women show a two-to threefold increase in the in vitro IGFBP-3 proteolytic activity during pregnancy as compared to post-partum values. Conclusions: Prominent proteolysis of binding proteins and the modulation by insulin account for the mechanism leading to macrosomia. The two factors combined guarantee the stimulation by more bioavailable IGF and the glycemic levels reveal whether insulin dose are optimal. Structural factors of diabetes i.e. microangiopathy further modulate the sum of effects on fetal growth. In contrast to macrosomia, fetal growth restriction is associated with prominent maternal vascular endothelial complications, such as overt nephropathy, proliferative retinopathy, preeclampsia, and hypertension. In parallel to the growth inhibition, stimulatory effects are exerted by the GH axis including the placental growth hormones and occur probably as compensatory mechanism, similar to the increased IGFBP-3 proteolysis in late pregnancy found in growth retardation. This influence may in part explain the disproportionate growth in different tissue components occurring in the various stages of diabetic pregnancy.

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Proposed diagnostic thresholds for gestational diabetes mellitus according to a 75‐g oral glucose tolerance test. Maternal and perinatal outcomes in 3260 Danish women

Cited by 65 publications

References 23 publications

Increasing Incidence of Diabetes After Gestational Diabetes

Increasing Incidence of Diabetes After Gestational Diabetes

Comparison of Accuracy Measures of Two Screening Tests for Gestational Diabetes Mellitus

Macrosomia and the IGF System: A Short Review

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