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Kwon, Kim, Park, Hwang, and Sohn: Perinatal Outcomes according to Screening Timing in Gestational Diabetic Women with Family History of Diabetes
Original Article

Perinatology 2017;28(4):151-155.

Published online: 19 January 2017

DOI: https://doi.org/10.14734/PN.2017.28.04.151

Perinatal Outcomes according to Screening Timing in Gestational Diabetic Women with Family History of Diabetes

Han-Sung Kwon, MD, Seo-Yeon Kim, MD, JiEun Park, MD, Han-Sung Hwang, MD, In-Sook Sohn, MD

Department of Obstetrics and Gynecology, Konkuk University School of Medicine, Seoul, Korea

Correspondence to Han-Sung Kwon, MD Department of Obstetrics and Gynecology, Konkuk University School of Medicine, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Korea Tel: +82-2-2030-7645 Fax: +82-2-2030-7749 E-mail: 20050024@kuh.ac.kr

Received 14 September 201724 October 2017       Accepted 25 October 2017

Copyright © 2017 The Korean Society of Perinatology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

To compare perinatal outcomes of gestational diabetic women with a family history of type 2 diabetes mellitus (DM), who were diagnosed through early or late screening.

Methods

After 2010, women with a family history of DM underwent 2-step screening at the initial visit, mostly before 16 weeks of gestation. The perinatal outcomes were compared with those of historical cohort screened at 24-28 weeks of gestation between 2005 and 2009. The primary outcomes were complications associated with maternal hyperglycemia such as primary cesarean delivery, large for gestational age (LGA), neonatal hypoglycemia, and fetal anomaly.

Results

The risk of gestational diabetes mellitus (GDM) was 20.8% (67/322) in women with a history of DM in a first-degree relative. Women who were screened before 16 weeks of gestation were more likely to have a high level of hemoglobin A1C at diagnosis and receive insulin therapy for glycemic control than the Late-screen group. But odds ratios of LGA, primary cesarean delivery and fetal anomalies compared with normal control were highest in the Late-screen group than in the Early screen group and the Low risk GDM group.

Conclusion

Some perinatal outcomes may be more favorable in women with GDM and a family history of DM who were screened before 16 weeks of gestation rather than routinely.

Keywords: Diabetes, gestational, Family, History, Prognosis

REFERENCES

1). Metzger BE., Coustan DR. Summary and recommendations of the Fourth International Workshop-Conference on Gestational Diabetes Mellitus. The Organizing Committee. Diabetes Care. 1998. 21(Suppl 2):B161–7.
2). Jang HC. Gestational diabetes in Korea: incidence and risk factors of diabetes in women with previous gestational diabetes. Diabetes Metab J. 2011. 35:1–7.
crossref
3). Committee on Practice Bulletins—Obstetrics. Practice bulletin no. 137: gestational diabetes mellitus. Obstet Gynecol. 2013. 122(2 Pt 1):406–16.
4). Metzger B., Buchanan T., Coustan DR., de Leiva A., Dunger DB., Hadden DR, et al. Summary and recommendations of the fifth international workshop-conference on gestational diabetes mellitus. Diabetes Care. 2007. 30(Suppl 2):S251–60.
crossref
5). American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010. 33(Suppl 1):562-9.
6). Moosazadeh M., Asemi Z., Lankarani KB., Tabrizi R., Maharlouei N., Naghi-bzadeh-Tahami A, et al. Family history of diabetes and the risk of gestational diabetes mellitus in Iran: a systematic review and meta-analysis. Diabetes Metab Syndr. 2016 Dec 13. [Epub].https://doi.org/10.1016/j.dsx.2016.12.016.
crossref
7). Kuti MA., Abbiyesuku FM., Akinlade KS., Akinosun OM., Adedapo KS., Adeleye JO, et al. Oral glucose tolerance testing outcomes among women at high risk for gestational diabetes mellitus. J Clin Pathol. 2011. 64:718–21.
crossref
8). Hong WY., Biggio JR., Tita A., Harper LM. Impact of early screening for gestational diabetes on perinatal outcomes in high-risk women. Am J Perinatol. 2016. 33:758–64.
crossref
9). D'Anna R., Scilipoti A., Giordano D., Caruso C., Cannata ML., Interdonato ML, et al. Myo-inositol supplementation and onset of gestational diabetes mellitus in pregnant women with a family history of type 2 diabetes: a prospective, randomized, placebo-controlled study. Diabetes Care. 2013. 36:854–7.
10). Watanabe N., Morimoto S., Fujiwara T., Suzuki T., Taniguchi K., Mori F, et al. Prediction of gestational diabetes mellitus by soluble (pro)renin receptor during the first trimester. J Clin Endocrinol Metab. 2013. 98:2528–35.
crossref
11). Smirnakis KV., Plati A., Wolf M., Thadhani R., Ecker JL. Predicting gestational diabetes: choosing the optimal early serum marker. Am J Obstet Gynecol. 2007. 196:410. .e1-6.
crossref
12). Smirnakis KV., Martinez A., Blatman KH., Wolf M., Ecker JL., Thadhani R. Early pregnancy insulin resistance and subsequent gestational diabetes mellitus. Diabetes Care. 2005. 28:1207–8.
crossref
13). Rasanen J., Quinn MJ., Laurie A., Bean E., Roberts CT Jr., Nagalla SR, et al. Maternal serum glycosylated fibronectin as a point-of-care biomarker for assessment of preeclampsia. Am J Obstet Gynecol. 2015. 212:82. .e1-9.
crossref
14). Plasencia W., Garcia R., Pereira S., Akolekar R., Nicolaides KH. Criteria for screening and diagnosis of gestational diabetes mellitus in the first trimester of pregnancy. Fetal Diagn Ther. 2011. 30:108–15.
crossref
15). Bartha JL., Martinez-Del-Fresno P., Comino-Delgado R. Gestational diabetes mellitus diagnosed during early pregnancy. Am J Obstet Gynecol. 2000. 182:346–50.
crossref
16). Lee JJ. Birth weight for gestational age patterns by sex, plurality, and parity in Korean population. Korean J Pediatr. 2007. 50:732–9.
crossref
17). Tisi DK., Burns DH., Luskey GW., Koski KG. Fetal exposure to altered amniotic fluid glucose, insulin, and insulin-like growth factor-binding protein 1 occurs before screening for gestational diabetes mellitus. Diabetes Care. 2011. 34:139–44.
crossref
18). Syngelaki A., Pastides A., Kotecha R., Wright A., Akolekar R., Nicolaides KH. First-trimester screening for gestational diabetes mellitus based on maternal characteristics and history. Fetal Diagn Ther. 2015. 38:14–21.
crossref
19). Moyer VA. U.S. Preventive Services Task Force. Screening for gestational diabetes mellitus: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014. 160:414–20.

Table 1.
Maternal Characteristics
  Early screen GDM (n=14) Late screen GDM (n=53) Normal group (n=255) Low risk group (n=47) P-value
Gestataional age at diagnosis (weeks) 14.9±9.0 27.0±1.9 26.4±2.1 26.0±3.4 <0.01
Age (years) 34.8±4.1 32.9±4.5 31.5±3.7 31.1±1.9 <0.01
Pregestational BMI (kg/m2) 25.2±4.3 23.4±3.8 21.3±3.2 20.8±2.1 <0.001
Gestational BMI at delivery (kg/m2) 28.6±3.6 27.8±3.8 26.5±3.5 25.3±2.5 <0.001
Nulliparous 7 (50) 32 (60) 155 (61) 29 (62) NS
Previous spontaneous abortion 3 (21) 13 (25) 5 9 (23) 16 (34) NS
Previous cesarean delivery 4 (29) 10 (19) 42 (17) 7 (15) NS
Nulliparous 7 (50) 32 (60) 155 (61) 29 (62) NS
Chronic HTN 0 (0) 1 (2) 2 (1) 1 (2) NS
HbA1C>6.5 4 (29) 3 (6) - 2 (4) <0.05
Insulin therapy 9 (64) 23 (43) - 13 (28) <0.05

Values are presented as mean±standard deviation or number (%). Abbreviations: GDM, gestational diabetes mellitus; BMI, body mass index; NS, not significant; HTN, hypertension.

Table 2.
Primary Perinatal Outcomes
  Normal control (n=255) Early screen GDM (n=14) Late screen GDM (n=53) Low risk GDM (n=47)
Primary cesarean delivery 1 1.84 (0.56-6.20) 2.11 (1.11-4.03) 1.87 (0.95-3.67)
LGA (adjusted OR)∗ 1 0.65 (0.08-5.16) 2.75 (1.31-5.76) 1.52 (0.62-3.72)
    0.45 (0.05-3.78) 2.23 (1.02-4.84) 0.81 (0.29-2.25)
Neonatal hypoglycemia 1 2.10 (0.09-18.6) 1.07 (0.16-5.55) 4.00 (1.19-13.1)
Fetal anomaly 1 - 4.86 (1.60-14.7) 1.22 (0.18-6.33)

Abbreviations: GDM, gestational diabetes mellitus; LGA, large for gestational age; OR, odds ratio.

∗ Adjusted for maternal body mass index in pregnancy

Table 3.
Secondary Perinatal Outcomes
  Early screen GDM (n=14) Late screen GDM (n=53) Normal group (n=255) Low risk GDM (n=47) P-value
Gestational age at birth (weeks) 39.1±1.4 38.1±1.4 38.9±1.9 38.4±1.3 NS
Birth weight (kg) 3.42±0.25 3.27±0.53 3.20±0.53 3.13±0.57 NS
Labor induction 7 (50) 18 (35) 74 (29) 10 (21) <0.05
Preterm births 0 (0) 7 (13) 22 (9) 5 (11) NS
Preeclampsia 0 (0) 1 (2) 7 (3) 2 (4) NS
Polyhydramnios 0 (0) 2 (4) 6 (2) 0 (0) NS

Values are presented as mean±standard deviation or number (%). Abbreviations: GDM, gestational diabetes mellitus; NS, not significant.

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