Diabetes & Metabolism Journal

Original Articles

Clinical Care/Education
Pregnancy Outcomes of Women Additionally Diagnosed as Gestational Diabetes by the International Association of the Diabetes and Pregnancy Study Groups Criteria: Min Hyoung Kim, Soo Heon Kwak, Sung-Hoon Kim, Joon Seok Hong, Hye Rim Chung, Sung Hee Choi, Moon Young Kim, Hak C. Jang; Diabetes Metab J. 2019;43(6):766-775. Published online February 28, 2019; DOI: https://doi.org/10.4093/dmj.2018.0192

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Background

We investigated the pregnancy outcomes in women who were diagnosed with gestational diabetes mellitus (GDM) by the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria but not by the Carpenter-Coustan (CC) criteria.

Methods

A total of 8,735 Korean pregnant women were identified at two hospitals between 2014 and 2016. Among them, 2,038 women participated in the prospective cohort to investigate pregnancy outcomes. Diagnosis of GDM was made via two-step approach with 50-g glucose challenge test for screening followed by diagnostic 2-hour 75-g oral glucose tolerance test. Women were divided into three groups: non-GDM, GDM diagnosed exclusively by the IADPSG criteria, and GDM diagnosed by the CC criteria.

Results

The incidence of GDM was 2.1% according to the CC criteria, and 4.1% by the IADPSG criteria. Women diagnosed with GDM by the IADPSG criteria had a higher body mass index (22.0±3.1 kg/m² vs. 21.0±2.8 kg/m², P<0.001) and an increased risk of preeclampsia (odds ratio [OR], 6.90; 95% confidence interval [CI], 1.84 to 25.87; P=0.004) compared to non-GDM women. Compared to neonates of the non-GDM group, those of the IADPSG GDM group had an increased risk of being large for gestational age (OR, 2.39; 95% CI, 1.50 to 3.81; P<0.001), macrosomia (OR, 2.53; 95% CI, 1.26 to 5.10; P=0.009), and neonatal hypoglycemia (OR, 3.84; 95% CI, 1.01 to 14.74; P=0.049); they were also at an increased risk of requiring phototherapy (OR, 1.57; 95% CI, 1.07 to 2.31; P=0.022) compared to the non-GDM group.

Conclusion

The IADPSG criteria increased the incidence of GDM by nearly three-fold, and women diagnosed with GDM by the IADPSG criteria had an increased risk of adverse pregnancy outcomes in Korea.

Citations

Citations to this article as recorded by

Gestational diabetes mellitus and adverse maternal and perinatal outcomes in twin and singleton pregnancies: a systematic review and meta-analysis
Elena Greco, Maria Calanducci, Kypros H. Nicolaides, Eleanor V.H. Barry, Mohammed S.B. Huda, Stamatina Iliodromiti
American Journal of Obstetrics and Gynecology.2024; 230(2): 213. CrossRef
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Predicting the Risk of Insulin-Requiring Gestational Diabetes before Pregnancy: A Model Generated from a Nationwide Population-Based Cohort Study in Korea
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Maternal and fetal outcomes of pregnancies associated with single versus double abnormal values in 100 gr glucose tolerance test
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Gestational diabetes mellitus: current screening problems
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Gestational diabetes mellitus and adverse pregnancy outcomes: systematic review and meta-analysis
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The Clinical Characteristics of Gestational Diabetes Mellitus in Korea: A National Health Information Database Study
Kyung-Soo Kim, Sangmo Hong, Kyungdo Han, Cheol-Young Park
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Nonalcoholic fatty liver disease and the risk of insulin-requiring gestational diabetes
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Maternal Hyperglycemia during Pregnancy Increases Adiposity of Offspring
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Mee Kyoung Kim, Kyungdo Han, Sang Youn You, Hyuk-Sang Kwon, Kun-Ho Yoon, Seung-Hwan Lee
Scientific Reports.2020;[Epub] CrossRef
Gestational Diabetes Mellitus: Diagnosis and Glycemic Control
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The Journal of Korean Diabetes.2020; 21(2): 69. CrossRef
New Diagnostic Criteria for Gestational Diabetes Mellitus and Pregnancy Outcomes in Korea
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Diabetes & Metabolism Journal.2019; 43(6): 763. CrossRef

Clinical Diabetes & Therapeutics
Progression to Gestational Diabetes Mellitus in Pregnant Women with One Abnormal Value in Repeated Oral Glucose Tolerance Tests: Sunyoung Kang, Min Hyoung Kim, Moon Young Kim, Joon-Seok Hong, Soo Heon Kwak, Sung Hee Choi, Soo Lim, Kyong Soo Park, Hak C. Jang; Diabetes Metab J. 2019;43(5):607-614. Published online February 28, 2019; DOI: https://doi.org/10.4093/dmj.2018.0159

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Abstract PDF PubReader

Background

Women with one abnormal value (OAV) in a 100 g oral glucose tolerance test (OGTT) during pregnancy are reported to have an increased risk of adverse pregnancy outcomes. However, there is limited data about whether women with OAV will progress to gestational diabetes mellitus (GDM) when the OGTT is repeated.

Methods

To identify clinical and metabolic predictors for GDM in women with OAV, we conducted a retrospective study and identified women with OAV in the OGTT done at 24 to 30 weeks gestational age (GA) and repeated the second OGTT between 32 and 34 weeks of GA.

Results

Among 137 women with OAV in the initial OGTT, 58 (42.3%) had normal, 40 (29.2%) had OAV and 39 (28.5%) had GDM in the second OGTT. Maternal age, prepregnancy body mass index, weight gain from prepregnancy to the second OGTT, GA at the time of the OGTT, and parity were similar among normal, OAV, and GDM groups. Plasma glucose levels in screening tests were different (151.8±15.7, 155.8±14.6, 162.5±20.3 mg/dL, P<0.05), but fasting, 1-, 2-, and 3-hour glucose levels in the initial OGTT were not. Compared to women with screen negative, women with untreated OAV had a higher frequency of macrosomia.

Conclusion

We demonstrated that women with OAV in the initial OGTT significantly progressed to GDM in the second OGTT. Clinical parameters predicting progression to GDM were not found. Repeating the OGTT in women with OAV in the initial test may be helpful to detect GDM progression.

Citations

Citations to this article as recorded by

Maternal and fetal outcomes of pregnancies associated with single versus double abnormal values in 100 gr glucose tolerance test
Mohammadali Shahriari, Ali Shahriari, Maryam Khooshideh, Anahita Dehghaninezhad, Arezoo Maleki-Hajiagha, Rana Karimi
Journal of Diabetes & Metabolic Disorders.2023; 22(2): 1347. CrossRef
One abnormal value or vomiting after oral glucose tolerance test in pregnancy: incidence and impact on maternal-fetal outcomes
Humberto Navarro-Martinez, Juana-Antonia Flores-Le Roux, Gemma Llauradó, Lucia Gortazar, Antonio Payà, Laura Mañé, Juan Pedro-Botet, David Benaiges
Gynecological Endocrinology.2023;[Epub] CrossRef
Analysis of the gut microflora in women with gestational diabetes mellitus
Xuping Wang, Bingfeng Bian, Fuman Du, Chaofeng Xiang, Yu Liu, Na Li, Binhong Duan
International Journal of Diabetes in Developing Countries.2023;[Epub] CrossRef
The association between gestational impaired glucose tolerance and hyperglycemic markers: A prospective study
Ohad Gluck, Hadas Ganer Herman, Nataly Fainstein, Neri Katz, Jacob Bar, Michal Kovo
International Journal of Gynecology & Obstetrics.2022; 156(1): 82. CrossRef
Association of abnormal-glucose tolerance during pregnancy with exposure to PM2.5 components and sources
Dejian Mai, Chengfang Xu, Weiwei Lin, Dingli Yue, Shaojie Fu, Jianqing Lin, Luan Yuan, Yan Zhao, Yuhong Zhai, Huiying Mai, Xiaoling Zeng, Tingwu Jiang, Xuejiao Li, Jiajia Dai, Boning You, Qin Xiao, Qing Wei, Qiansheng Hu
Environmental Pollution.2022; 292: 118468. CrossRef
Postprandial Free Fatty Acids at Mid-Pregnancy Increase the Risk of Large-for-Gestational-Age Newborns in Women with Gestational Diabetes Mellitus
So-Yeon Kim, Young Shin Song, Soo-Kyung Kim, Yong-Wook Cho, Kyung-Soo Kim
Diabetes & Metabolism Journal.2022; 46(1): 140. CrossRef
The Clinical Characteristics of Gestational Diabetes Mellitus in Korea: A National Health Information Database Study
Kyung-Soo Kim, Sangmo Hong, Kyungdo Han, Cheol-Young Park
Endocrinology and Metabolism.2021; 36(3): 628. CrossRef
Gestational Diabetes Mellitus: Diagnosis and Glycemic Control
Tae Jung Oh, Hak Chul Jang
The Journal of Korean Diabetes.2020; 21(2): 69. CrossRef
Health literacy and diabetes control in pregnant women
Azar Pirdehghan, Mohammad Eslahchi, Farzaneh Esna-Ashari, Shiva Borzouei
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Pregnancy Outcome in Korean Women with Gestational Diabetes Mellitus Diagnosed by the Carpenter-Coustan Criteria.: Hak Chul Jang, Young Min Cho, Kyong Soo Park, Seong Yeon Kim, Hong Kyu Lee, Moon Young Kim, Jae Hyug Yang, Son Moon Shin; Korean Diabetes J. 2004;28(2):122-130. Published online April 1, 2004

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Abstract PDF: BACKGROUND
The American Diabetes Association recently proposed the Carpenter-Coustan criteria for the diagnosis of gestational diabetes mellitus(GDM) based on the results of the Toronto Tri-Hospital Study. The prevalence of GDM in Korean women increased, on average, by 60% when the Carpenter-Coustan criteria were applied. However, the pregnancy outcome of Korean women with GDM with regard to the Carpenter-Coustan criteria tremains to be reported. The pregnancy outcomes of those Korean women with GDM by the Carpenter- Coustan criteria, but not by the NDDG criteria were assessed. METHODS: In this study, a total of 2776 pregnant women underwent universal screening for GDM, between January 1993 and December 1994, as recommended by the Third International Workshop-Conference on Gestational Diabetes Mellitus with minor modifications. The primary pregnancy outcomes were preeclampsia, premature delivery, delivery by C-section, birth weight and LGA infants. RESULTS: Of the 2776 women, 656 screened-positive for GDM. Of these, 37 and 74 had GDM by the Carpenter-Coustan and NDDG criteria, respectively. With increasing glucose intolerance, there was a stepwise increase in premature deliveries, deliveries by C-section and preeclampsia from those screening negative to GDM by the NDDG criteria, with a similar trend for the frequency of LGA infants. The LGA infant screening-negative and positive were 13.5 and 16.1%, but those with a normal glucose tolerance were 27.0 and 33.8% in those screening positive to GDM by the Carpenter-Coustan and NDDG criteria, respectively(P<0.001). CONCLUSION: Our study demonstrated that increasing glucose tolerance was associated with increasing frequencies of adverse pregnancy outcomes in Korean women. The maternally complicated and LGA infants were significantly higher in women with GDM by the Carpenter-Coustan criteria. Thus the Carpenter- Coustan criteria are recommended for the diagnosis of GDM in Korean Women.

Effect of Self-monitoring of Blood Glucose on Pregnancy Outcome in Women with Mild Gestational Diabetes.: Hak Chul Jang, Jeong Eun Park, Chang Hoon Yim, Ho Yeun Chung, Ki Ok Han, Hyun Koo Yoon, In Kwon Han, Moon Young Kim, Jae Hyug Yang, Mi Jung Kim, Sun Young Ko, Yeon Kyung Lee; Korean Diabetes J. 2001;25(1):93-102. Published online February 1, 2001

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Abstract PDF: BACKGROUND
Self-monitoring of blood glucose (SMBG) and intensive therapy with insulin demonstrated to have a positive effects in the reduction of the neonatal complications in women with gestational diabetes (GDM). However the utility of SMBG in the mild GDM who does not requiring insulin has not been formally reported. Therefore, to evaluate the effectiveness of SMBG in the management of mild GDM, we compared the pregnancy outcome and the postpartum glucose tolerance of women who monitored their glycemic control by SMBG to those of women who monitored by laboratory glucose test at each office visit during pregnancy. METHODS: We studied 185 women diagnosed as a GDM by NDDG criteria and their fasting glucose concentration < 5.8 mM. All subjects had singleton pregnancy,and no medical diseases that may affect fetal growth, and were certain of gestational age by early ultrasonography. They were treated with an identical GDM management protocol except glucose monitoring. One hundred five women were monitored by laboratory glucose test at each office visit (office group) and 80 women were monitored by SMBG (SMBG group). Pregnancy outcome including rates of cesarian section, obstetric complication, LGA infant and glucose tolerance status at postpartum were compared between two groups. RESULTS: The age, height, prepregnancy weight, weight at delivery and parity were not significantly different between the two groups. Fasting, 1-h, 2-h glucose concentration during the diagnostic test of GDM in SMBG group were similar to those of office group. However, 3-h glucose concentration of office group was 0.3 mM higher than that of SMBG group. The rate of primary cesarian section, preterm labor and pregnancy-induced hypertension of SMBG group were similar to those of office group. The mean postprandial 2-h glucose concentration of office group measured at each office was 0.5 mM higher than that of SMBG group. Although 5% of office group were treated with insulin, 24% of SMBG group were requiring insulin therapy. The birth weight and LGA infant rate of office group were 3403 432 g and 28%, those were heavier and higher than those of SMBG group (3169 447 g, 13.8%). The 90% of office group and 84% of SMBG group were performed 75 g oral glucose tolerance test at postpartum 6-8 weeks. There was no significant difference in rates of diabetes and IGT between office and SMBG group (9.5%, 11.6%; 7.5%, 9.0% respectively). CONCLUSIONS: This study demonstrated that SMBG is very seful in early detection of maternal hyperglycemia and lowing the postprandial glucose, as well as reducing the rate of LGA infants in women with mild GDM.

Clinical Characteristics and Pregnancy Outcome in Korean Women with Type I & Type II Diabetes Mellitus.: Yoon Huh, Dong Won Suh, Hak Chul Jang, Chang Hoon Yim, Ki Ok Han, Hyun Ku Yoon, In Kwon Han, Hun Ki Min, Eun Sung Kim, Moon Young Kim, Hyun Mi Ryu, Sung Won Yang, Hae Kyoung Han; Korean Diabetes J. 1998;22(3):353-362. Published online January 1, 2001

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Abstract PDF: BACKGROUND
The prevalence of diabetes is gradually increasing iin Korean. Moreover, the prevalence of pregnancy complicated by established diabetes seems to be increasing. During the past decades, advances in the diabetes care as well as advances in fetal surveillance and neonatal care, have continued to improve pregnancy outcome of women with diabetes. However, the incidence of congenital anomalies and spontaneous abortion as well as the perinatal morbidity in the women with diabetes are still higher compared to those of the general population. In this study, we estimated the prevalence of prepmncy complicated by both type 1 and type 2 diabetes and described the clinical characteristics and outcome of diabetic pregnancies. METHODS: We analyzed data from four sources: 1) the mother(type and duration of diabetes, diabetic complication, preconceptional care), 2) obstetric outcome(method of delivery, obstetric complication), 3) neonatal outcome(birth weight, perinatal complication, congenital anomaly), 4) glycemic control during pregnancy, of women with pregestational diabetes delivered newborns at Samsung Cheil Hospital from 1992 to 1995. RESULTS: During the study period, 34 singleton infants were delivered by the 28 women with diabetes. The diabetic pregnancy was present in 0.14% of total deliveries in Samsung Cheil Hospital. Patients with IDDM comprised 18%(6/34) of total diabetic pregnancies, 82%(28/34) had NIDDM. The duration of diabetes was 6.3 and 2.1 years in patients with IDDM and NIDDM, respectively. Two IDDM patients presented with proliferative retinopathy, and 3 background retinopathy, one in IDDM and 2 in NIDDM. Three patients with IDDM and 2 patients with NIDDM had diabetic nephropathy. Insulin requirement during pregnancy was increased about 2 times at the time of delivery when compared to the initial in women with IDDM and NIDDM. Preeclampsia was the most common obstetric compliications, which were more frequently observed in women with diabetic complications. LGA was present in 43% of women with NIDDM. One infant of mother with NIDDM, delivered at 28 weeks gestation, was died because of respiratory distress and one infant of mother with IDDM had a congenital heart disease(TOF). Only 3 patients scught for the preconceptional care before pregnancy. CONCLUSION: Pregnancies complicated by diabetes was more frequent than was expected, even though it was much less than the rates in North America. Only 9% of women with diabetes had preconceptional care before pregnancy. The importance of planned pregnancy and prepregnancy counseling should be addressed in women with diabetes of child bearing age.

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