Early diabetes screening in women with previous gestational diabetes: a new insight

Abstract

BackgroundGestational diabetes mellitus (GDM) is a risk factor for the development of diabetes mellitus (DM). However, there is a low return rate for this screening, so it is important to search for earlier methods for evaluation after delivery, to increase the number of pregnant women screened, so you can start the treatment or prevention of these early comorbidities. To determine the accuracy of the 75 g 2-h oral glucose tolerance test (OGTT) performed between 48–72 h after delivery for the diagnosis of DM using the OGTT after 6 weeks as the gold standard criterion, and to identify the optimal cutoff points for this exam for diabetes screening after a pregnancy complicated by GDM.Methods82 women with previous GDM underwent an OGTT between 48–72 h postpartum and repeated the test 6 weeks after delivery.ResultsThe prevalence of DM and prediabetes based on the first OGTT was 3.7 and 32.9 %, respectively, and 8.5 and 20.7 %, respectively, at the second OGTT. For those with DM, the area under the curve (AUC) based on the fasting plasma glucose (FPG) was 0.77 (95 % CI 0.61–0.92), and based on 2-h OGTT was 0.82 (95 % CI 0.66–0.97). For patients with prediabetes, the AUC based on the FPG was 0.73 (95 % CI 0.59–0.86) and based on the 2-h OGTT was 0.74 (95 % CI 0.61–0.87). Using a FPG cutoff value of 78 mg/dl (4.3 mmol/L) and a 2-h OGTT cutoff value of 130 mg/dl (7.2 mmol/L) for DM, the specificity was 58.7 and 60 %, the sensitivity was 71.4 and 85.7 %, the positive predictive value was 13.9 and 16.7 and the negative predictive value was 95.7 and 97.9 %, respectively.ConclusionsOGTT performed early in postpartum is a useful tool for identifying women with previous GDM who must perform an OGTT 6 weeks after delivery.

Utility of in-hospital post-delivery fasting plasma glucose to predict postpartum glucose status in women with hyperglycaemia first detected in pregnancy: A prospective cohort study

“…The results of this study showed a significant, temporary improvement in maternal fasting glucose in all subcategories of glycaemia 24–72 hours following delivery. In contrast to similar published work, early post-delivery glucose testing was not found to be a feasible alternative to the standard of care 4-12-week postpartum visit in women with HFDP within our population group [ 14 , 17 – 21 ]. The study failed to identify high risk individuals and did not demonstrate that in-hospital fasting glucose could help to direct resources to those most in need of surveillance.…”

“…Nabuco and colleagues (2016) compared the outcome of an early postpartum (48-72 hours after delivery) OGTT with the standard assessment at 6 weeks. They aimed to determine cut-off glucose values at this time point in order to identify the presence of pre-diabetes and T2DM at 6 weeks [17] . The prevalence of diabetes and pre-diabetes in their cohort of 82 women with GDM based on an OGTT performed at 48-72 hours after birth was 3.7% and 32.9%, respectively, whereas the prevalence based on the 6 week OGTT was 8.5% and 20.7%, respectively.…”

Postpartum follow up of gestational diabetes in a Tertiary Care Center

“…Probably, our sample size could be a limitation to the investigation of these factors. A study conducted also in Rio de Janeiro found that only a previous history of GDM was significantly higher in mothers who returned 6 weeks later for performing the OGTT [ 2 ].…”

“…It is an important risk factor for permanent or future development of glucose intolerance or T2DM in the postpartum period. About 3–65% of women with previous GDM present T2DM within 5–16 years after pregnancy, depending on the methods used for screening and the studied population [ 2 , 3 ]. Postpartum glucose tolerance status after GDM varies from 1.1 to 25.3% for T2DM, and from 2.2 to 42.3% for both impaired glucose tolerance and impaired fasting glycemia [ 4 ].…”

Genetic association between angiotensin converting enzyme gene in Saudi obese women established gestational diabetes; Non-replication of case-control studies in insertion and deletion polymorphism

“…1 Earlier studies have addressed ~3-65% of GDM women developed type 2 diabetes mellitus (T2DM) during 5-16 years after the index pregnancy. 2 Human and Animal studies research revealed GDM and T2DM have characterized β-cell dysfunction, insulin resistance and defects in insulin action. 3 T2DM and GDM share the common pathophysiology and predisposing factors.…”