Women with rigorously managed overt diabetes during pregnancy do not experience adverse infant outcomes but do remain at serious risk of postpartum diabetes

Abstract

The normal increase in insulin resistance from the third trimester of pregnancy can be greater than can be managed by compensatory insulin secretion, resulting in gestational diabetes mellitus (GDM) [1]. The severity of GDM is variable in pregnant women and it cannot be fully explained by known risk factors which include advanced maternal age, high maternal body mass index (BMI), weight gain during pregnancy, family history of diabetes, high fat diet, and certain ethnicities [1][2][3]. There are notable racial/ethnic differences in the epidemiology of type 2 diabetes and GDM. AsianWomen with rigorously managed overt diabetes during pregnancy do not experience adverse infant outcomes but do remain at serious risk of postpartum diabetes abstract. We retrospectively detected overt diabetes during pregnancy (ODMP) using a modified IADPSG definition and assessed whether ODMP increases the risk of developing maternal and neonatal complications and postpartum diabetes in Korean pregnant women. According to the definition of IADPSG, ODMP pregnant women were defined and 71 ODMP, 1781 gestational diabetes mellitus (GDM) and and 463 non-GDM pregnant women were included in a hospital-based study. Their blood glucose levels were tightly regulated by modifying lifestyles and insulin treatment. The pregnancy outcomes and postpartum glucose tolerances were determined among the non-GDM, GDM and ODMP groups. The ODMP women had higher plasma glucose levels after overnight-fasting and at 2 h after 100 g OGTT challenge as well as higher overnight-fasted plasma insulin and HbA 1c levels than GDM women. HbA 1c levels at delivery were close to the normal range in both GDM and ODMP groups. Most pregnancy outcomes such as Apgar score and the rate of preterm delivery were not significantly different among three groups. Only the rate of large for gestational age (LGA) was greater in the ODMP group than other groups. However, about 73% of ODMP women remained diabetic at 6-8 week postpartum as compared to 4.3% of GDM. The development of postpartum diabetes was also associated with postpartum waist circumferences and duration of breast feeding. In conclusion, ODMP women in this study maintained tight control of glucose homeostasis and did not experience serious adverse outcomes except for LGA infants; however most ODMP women still had postpartum glucose dysregulation.Key words: Gestational diabetes, Overt diabetes, Pregnancy outcome, Hemoglobin A 1C , Postpartum diabetes women have increased risk of GDM (9.9 %) at a lower BMI (22.0-24.9 kg/m 2 ) as compared with non-Hispanic white and African American women (>8.0% at over 28 kg/m 2 ) [4]. This is related to a relatively low maximum insulin secretion capacity and β-cell mass in Asians [5,6], placing them at increased risk of GDM at a lower BMI cut point.The symptoms of glucose dysregulation in GDM should resolve after the delivery of the baby, but some GDM patients continue to have post-partum glucose intolerance and or diabetes after delivery [7,8]. Tight

Pregnancy outcomes among multi‐ethnic women with different degrees of hyperglycaemia during pregnancy in an urban New Zealand population and their association with postnatal HbA1c uptake

“…Conversely, a UK study reported that screening based on random plasma glucose testing before 20 weeks had a sensitivity of 86% for detecting women with overt diabetes 27 showing superior sensitivity compared to HbA1c. Similar to our study, previous studies have also reported higher occurrences of adverse outcomes in women with overt diabetes than in those with GDM diagnosed in late pregnancy 28–30 . It was also shown that only one‐fifth of the women with overt diabetes maintained an HbA1c ≥50 mmol/mol postdelivery.…”

“…It was also shown that only one‐fifth of the women with overt diabetes maintained an HbA1c ≥50 mmol/mol postdelivery. A low rate of postpartum diabetes (21%) among women with overt diabetes had been reported previously by Wong et al, 28 but Park et al 30 reported a high rate of 73% despite good glycaemic control during pregnancy. Unlike our study, both studies used an OGTT for postpartum diabetes screening.…”

Factors associated with recovery from 1 minute Apgar score <4 in live, singleton, term births: an analysis of Malaysian National Obstetrics Registry data 2010–2012

“…The literature on maternal diabetes and low Apgar score is not clear cut, but tends towards worse outcomes; [32, 33] although in one recent study that found worse Apgar scores associated with maternal diabetes, the association disappeared in an adjusted analysis [34] Whether the outcome was worse also appears to be associated with the level of glycaemic control [35]. Again, and in contrast with the results on birth outcome, the odds of recovery given a low 1 min Apgar score were better in uncomplicated vaginal deliveries born to mothers with diabetes.…”

Prognosis Associated with Sub-Types of Hyperglycaemia in Pregnancy

“…Accordingly, this suggests that when DIP is suspected, screening with FPG is insufficient and must be substituted by OGTT and/or HbA1c measurement. Two studies elsewhere showed that type 2 diabetes is confirmed by postpartum OGTT in 21.1% [27] to 47.5% [28] of women diagnosed with diabetes in pregnancy, with additional prediabetes identified in 32.5% to [28] 37.6% of cases [27]. Therefore, one can hypothesize that eDIP would correspond with pre-diabetic states prior to pregnancy, and that late-diagnosed DIP (with an initial normal FPG level) would correspond to some other mechanism, which would require further investigation.…”