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Haggiag N, Rotman M, Hallak M, Toledano Y, Gabbay-Benziv R, Maor-Sagie E. Hypoglycemia in Oral Glucose Tolerance Test during Pregnancy and Risk for Type 2 Diabetes-A Five-Year Cohort Study. J Clin Med 2024; 13:3806. [PMID: 38999372 PMCID: PMC11242525 DOI: 10.3390/jcm13133806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 06/20/2024] [Accepted: 06/24/2024] [Indexed: 07/14/2024] Open
Abstract
Objective: To evaluate the risk of progression to type 2 diabetes (T2D) following reactive hypoglycemia in 100 g oral glucose tolerance test (oGTT). Methods: A retrospective analysis of parturients with up to 5-year follow-up postpartum. Data were extracted from the computerized laboratory system of Meuhedet, an Israeli HMO and cross-linked with the Israeli National Registry of Diabetes. Included were parturients with no prior diabetesand available oGTT values during pregnancy. Reactive hypoglycemia was defined as glucose levels lower than 60 mg/dL in at least one of 3 post-glucose load values in oGTT. The cohort was divided into 3 groups: normal glucose status, reactive hypoglycemia, and GDM. Maternal characteristics, laboratory data, and progression to T2D over 5 years were compared. Univariate and survival analyses assessed the adjusted hazard ratio for T2D, stratified by obesity Results: Among 14,122 parturients, 16.8% had reactive hypoglycemia, 71% had normal glucose status, and 12.2% had GDM. Adjusted for age, obesity, and hypertension, Parturients with reactive hypoglycemia had similar T2D risk compared to normal glucose status and a lower risk compared to GDM patients, regardless of obesity status. Conclusions: Reactive hypoglycemia during oGTT does not increase the risk of progressing to T2D.
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Affiliation(s)
- Noa Haggiag
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera 3820302, Israel; (N.H.); (M.R.); (M.H.); (R.G.-B.)
| | - Moran Rotman
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera 3820302, Israel; (N.H.); (M.R.); (M.H.); (R.G.-B.)
| | - Mordechai Hallak
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera 3820302, Israel; (N.H.); (M.R.); (M.H.); (R.G.-B.)
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa 3200003, Israel
- Meuhedet HMO, Tel-Aviv, Israel;
| | | | - Rinat Gabbay-Benziv
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera 3820302, Israel; (N.H.); (M.R.); (M.H.); (R.G.-B.)
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa 3200003, Israel
| | - Esther Maor-Sagie
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera 3820302, Israel; (N.H.); (M.R.); (M.H.); (R.G.-B.)
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa 3200003, Israel
- Meuhedet HMO, Tel-Aviv, Israel;
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Raets L, Van Doninck L, Van Crombrugge P, Moyson C, Verhaeghe J, Vandeginste S, Verlaenen H, Vercammen C, Maes T, Dufraimont E, Roggen N, De Block C, Jacquemyn Y, Mekahli F, De Clippel K, Van Den Bruel A, Loccufier A, Laenen A, Devlieger R, Mathieu C, Benhalima K. Normal glucose tolerant women with low glycemia during the oral glucose tolerance test have a higher risk to deliver a low birth weight infant. Front Endocrinol (Lausanne) 2023; 14:1186339. [PMID: 37334297 PMCID: PMC10272607 DOI: 10.3389/fendo.2023.1186339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/22/2023] [Indexed: 06/20/2023] Open
Abstract
Background Data are limited on pregnancy outcomes of normal glucose tolerant (NGT) women with a low glycemic value measured during the 75g oral glucose tolerance test (OGTT). Our aim was to evaluate maternal characteristics and pregnancy outcomes of NGT women with low glycemia measured at fasting, 1-hour or 2-hour OGTT. Methods The Belgian Diabetes in Pregnancy-N study was a multicentric prospective cohort study with 1841 pregnant women receiving an OGTT to screen for gestational diabetes (GDM). We compared the characteristics and pregnancy outcomes in NGT women according to different groups [(<3.9mmol/L), (3.9-4.2mmol/L), (4.25-4.4mmol/L) and (>4.4mmol/L)] of lowest glycemia measured during the OGTT. Pregnancy outcomes were adjusted for confounding factors such as body mass index (BMI) and gestational weight gain. Results Of all NGT women, 10.7% (172) had low glycemia (<3.9 mmol/L) during the OGTT. Women in the lowest glycemic group (<3.9mmol/L) during the OGTT had compared to women in highest glycemic group (>4.4mmol/L, 29.9%, n=482), a better metabolic profile with a lower BMI, less insulin resistance and better beta-cell function. However, women in the lowest glycemic group had more often inadequate gestational weight gain [51.1% (67) vs. 29.5% (123); p<0.001]. Compared to the highest glycemia group, women in the lowest group had more often a birth weight <2.5Kg [adjusted OR 3.41, 95% CI (1.17-9.92); p=0.025]. Conclusion Women with a glycemic value <3.9 mmol/L during the OGTT have a higher risk for a neonate with birth weight < 2.5Kg, which remained significant after adjustment for BMI and gestational weight gain.
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Affiliation(s)
- Lore Raets
- Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | | | - Paul Van Crombrugge
- Department of Endocrinology, Onze-Lieve-Vrouwziekenhuis (OLV) Ziekenhuis Aalst-Asse-Ninove, Aalst, Belgium
| | - Carolien Moyson
- Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Johan Verhaeghe
- Department of Obstetrics & Gynecology, Universitair Ziekenhuis (UZ) Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Sofie Vandeginste
- Department of Obstetrics & Gynecology, Onze-Lieve-Vrouwziekenhuis (OLV) Ziekenhuis Aalst-Asse-Ninove, Aalst, Belgium
| | - Hilde Verlaenen
- Department of Obstetrics & Gynecology, Onze-Lieve-Vrouwziekenhuis (OLV) Ziekenhuis Aalst-Asse-Ninove, Aalst, Belgium
| | - Chris Vercammen
- Department of Endocrinology, Imelda Ziekenhuis, Bonheiden, Belgium
| | - Toon Maes
- Department of Endocrinology, Imelda Ziekenhuis, Bonheiden, Belgium
| | - Els Dufraimont
- Department of Obstetrics & Gynecology, Imelda Ziekenhuis, Bonheiden, Belgium
| | - Nele Roggen
- Department of Obstetrics & Gynecology, Imelda Ziekenhuis, Bonheiden, Belgium
| | - Christophe De Block
- Department of Endocrinology-Diabetology-Metabolism, Antwerp University Hospital, Edegem, Belgium
| | - Yves Jacquemyn
- Department of Obstetrics & Gynecology, Antwerp University Hospital, Edegem, Belgium
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC) and Global Health Institute (GHI), Antwerp University University of Antwerp (UA), Antwerp, Belgium
| | - Farah Mekahli
- Department of Endocrinology, Kliniek St-Jan Brussel, Brussel, Belgium
| | - Katrien De Clippel
- Department of Obstetrics & Gynecology, Kliniek St-Jan Brussel, Brussel, Belgium
| | - Annick Van Den Bruel
- Department of Endocrinology, Algemeen Ziekenhuis (AZ) St. Jan Brugge, Brugge, Belgium
| | - Anne Loccufier
- Department of Obstetrics & Gynecology, Algemeen Ziekenhuis (AZ) St. Jan Brugge, Brugge, Belgium
| | - Annouschka Laenen
- Center of Biostatics and Statistical bioinformatics, KU Leuven, Leuven, Belgium
| | - Roland Devlieger
- Department of Obstetrics & Gynecology, Universitair Ziekenhuis (UZ) Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Chantal Mathieu
- Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Katrien Benhalima
- Department of Endocrinology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
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Dingena CF, Arofikina D, Campbell MD, Holmes MJ, Scott EM, Zulyniak MA. Nutritional and Exercise-Focused Lifestyle Interventions and Glycemic Control in Women with Diabetes in Pregnancy: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Nutrients 2023; 15:323. [PMID: 36678193 PMCID: PMC9864154 DOI: 10.3390/nu15020323] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
Diabetes disrupts one in six pregnancies, bestowing immediate and long-term health risks to mother and child. Diet and exercise are commonly prescribed to control dysglycemia, but their effectiveness across sub-populations and types of diabetes (type-1; type-2; or gestational diabetes mellitus, GDM) is uncertain. Therefore, a systematic review and meta-analysis on the effect of diet and/or exercise on glycemia in pregnant women with diabetes was conducted. Random effects models were used to evaluate effect sizes across studies and anticipated confounders (e.g., age, ethnicity, BMI). Of the 4845 records retrieved, 26 studies (8 nutritional supplements, 12 dietary, and 6 exercise interventions) were included. All studies were conducted in patients with GDM. Overall, supplement- and exercise-based interventions reduced fasting glucose (−0.30 mmol/L; 95% CI = −0.55, −0.06; p = 0.02; and 0.10 mmol/L; 95% CI = −0.20, −0.01; p = 0.04); and supplement- and diet-based interventions reduced HOMA-IR (−0.40; 95% CI = −0.58, −0.22; p < 0.001; and −1.15; 95% CI = −2.12, −0.17; p = 0.02). Subgroup analysis by confounders only confirmed marginal changed effect sizes. Our results suggest a favorable role of certain nutritional supplements, diet, and exercise practices on glycemia in women with GDM and underline a lack of evidence in ~20% of other diabetes-related pregnancies (i.e., women with pre-existing diabetes).
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Affiliation(s)
- Cassy F. Dingena
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds LS2 9JT, UK
| | - Daria Arofikina
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds LS2 9JT, UK
| | - Matthew D. Campbell
- School of Nursing and Health Sciences, Institute of Health Sciences and Wellbeing, University of Sunderland, Sunderland SR1 3SD, UK
| | - Melvin J. Holmes
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds LS2 9JT, UK
| | - Eleanor M. Scott
- Division of Clinical and Population Sciences, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LS2 9JT, UK
| | - Michael A. Zulyniak
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds LS2 9JT, UK
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Harrison RK, Saravanan V, Davitt C, Cruz M, Palatnik A. Antenatal maternal hypoglycemia in women with gestational diabetes mellitus and neonatal outcomes. J Perinatol 2022; 42:1091-1096. [PMID: 35194160 DOI: 10.1038/s41372-022-01350-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/26/2022] [Accepted: 02/08/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine the prevalence of antenatal maternal hypoglycemia after initiation of pharmacotherapy for gestational diabetes mellitus (GDMA2) and its association with pregnancy outcomes. STUDY DESIGN Retrospective cohort of GDMA2 women receiving either insulin or oral hypoglycemic agents. Composite neonatal outcome included macrosomia, jaundice, respiratory distress syndrome, large for gestational age, shoulder dystocia, birth trauma, 5-minute Apgar < 7, and neonatal hypoglycemia, and was compared between women with and without hypoglycemia using bivariate and multivariate analyses. RESULTS Of 489 women included in the study, 95 (19.4%) had at least one episode of hypoglycemia, most often in the setting of glyburide. Newborns exposed to maternal hypoglycemia had higher rates of the composite neonatal outcome (54.7% vs. 38.3%, p = 0.004). After controlling for confounding factors, maternal hypoglycemia remained independently associated with the composite neonatal outcome (aOR = 1.69, 95% CI 1.04-2.72). CONCLUSION Maternal hypoglycemia in GDMA2 was associated with higher rates of adverse neonatal outcomes.
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Affiliation(s)
- Rachel K Harrison
- Maternal Fetal Medicine, Advocate Medical Group, 4400W. 95th St, Suite 207, Chicago, IL, 60453, USA
| | - Vishmayaa Saravanan
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, 9200W. Wisconsin Ave, Milwaukee, WI, 53226, USA
| | - Caroline Davitt
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, 9200W. Wisconsin Ave, Milwaukee, WI, 53226, USA
| | - Meredith Cruz
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, 9200W. Wisconsin Ave, Milwaukee, WI, 53226, USA
| | - Anna Palatnik
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, 9200W. Wisconsin Ave, Milwaukee, WI, 53226, USA.
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