Efficacy of nutrition therapy for glucose intolerance in Japanese women diagnosed with gestational diabetes based on IADPSG criteria during early gestation

Patients with gestational diabetes mellitus may be treated in both early and late pregnancy, especially in patients with pre-pregnancy overweight: A cross-sectional study in Japan

The significance of diagnosing gestational diabetes mellitus (GDM) in early pregnancy is controversial. We used the International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria to investigate whether clinical background and neonatal outcomes differ depending on when GDM is diagnosed in early or late pregnancy. This was a single-center, observational study conducted between November 2012 and March 2020 at St. Marianna University Hospital (Kawasaki, Japan). We compared the background and perinatal outcomes of patients with GDM depending on the time of diagnosis (at < 24 gestational weeks or ≥ 24 weeks). Insulin sensitivity index, homeostasis model assessment of insulin resistance, and β-cell function were calculated from a 75-g oral glucose tolerance test. Stratified analysis was performed by pre-pregnancy BMI in patients with early GDM. As a result, in the 507 patients, 89.9% gave birth at our hospital. The pre-pregnancy BMI was significantly higher in patients with early GDM than in those with late GDM (the median [interquartile range], 22.7 [20.3, 26.3] and 21.5 [19.3, 23.8] kg/m2, respectively; p = 0.001). Perinatal outcomes were not different between the two groups. However, in the subgroup analysis of patients with early GDM, the prevalence of large-for-gestational-age infants was significantly higher in the group with overweight (15.4% vs 2.1%, respectively; p = 0.008). In conclusion, patients with GDM using the IADPSG criteria in early pregnancy may be treated, especially in patients with pre-pregnancy overweight.

Predictors of later insulin therapy for gestational diabetes diagnosed in early pregnancy

Interventions for gestational diabetes mellitus (GDM), diagnosed in early pregnancy, have been a topic of controversy. This study aimed to elucidate factors that predict patients with GDM diagnosed before 24 gestational weeks (early GDM: E-GDM) who require insulin therapy later during pregnancy. Furthermore, we identified patients whose impaired glucose tolerance should be strictly controlled from early gestation onward. Women diagnosed with GDM were categorized based on the gestational age at diagnosis into E-GDM (n = 388) or late GDM (L-GDM, diagnosed after 24 weeks, n = 340) groups. Clinical features were compared between the groups, and the predictors for insulin therapy was evaluated in the E-GDM group. There were no significant between-group differences in terms of perinatal outcomes (e.g., gestational weeks at delivery, fetal growth, hypertensive disorder of pregnancy), with the exception of the Apgar score at 5 min. Moreover, there was no significant difference in the frequency of insulin therapy during pregnancy between the two groups. Using multiple logistic regression analysis, pre-pregnancy body mass index (BMI) ≥25 kg/m², a family history of diabetes, and higher fasting plasma glucose (FPG), 1 h-plasma glucose (PG), and 2 h-PG values increased insulin therapy risk during pregnancy in the E-GDM group. Furthermore, since E-GDM patients with abnormal levels of FPG, as well as 1 h-PG or 2 h-PG, and those with pre-pregnancy BMI ≥25 kg/m² and a family history of diabetes had a higher risk of later insulin therapy during pregnancy, they may require more careful follow-up in the perinatal period.

A Review on Research Progress in the Application of Glycosylated Hemoglobin and Glycated Albumin in the Screening and Monitoring of Gestational Diabetes

Glycosylated hemoglobin (HbA1C) and glycated albumin (GA) can be used for blood glucose management of a person with diabetes as a result of their convenience and stability. However, there is no corresponding standard for the application of glycosylated hemoglobin and glycosylated albumin in gestational diabetes mellitus (GDM). In this review, we summarize the published research and discuss three aspects of the significance of HBA1C and GA in GDM patients: screening of gestational diabetes mellitus, blood glucose monitoring and the relationship with pregnancy outcome. At present, studies suggest that HBA1C can be used as a screening indicator for pregnant women, but it cannot completely replace OGTT. HbA1C and GA can be used for blood glucose management in patients with GDM to reduce the incidence of GDM complications. However, the application of HBA1C and GA in GDM still needs more research and clinical practice support.

Maternal serum pentraxin 3 level in early pregnancy for prediction of gestational diabetes mellitus

Background

Our study aimed to reveal the relationship of maternal pentraxin 3 (PTX3)'s serum concentrations in early pregnancy with gestational diabetes mellitus (GDM) and to explore its potential in the prediction of GDM.

Methods

Totally 824 pregnant women were enrolled and divided into a GDM group and a normal glucose tolerance (NGT) group, whose maternal fasting serum PTX3 levels, plasma glucose and insulin were collected. The beta cell function index and quantitative insulin sensitivity check index (QUICKI) was calculated and a homeostatic model assessment of insulin resistance (HOMA-IR) was used with SPSS 22 software used for statistical analysis.

Results

Of all subjects, 13.59% developed GDM. Compared to the NGT group, the PTX3 level was increased in the GDM group (1.48 vs. 1.52 ng/mL, P<0.05), and independently associated with the prediction of GDM (4.209, 95% CI, 1.756-10.091) (P=0.001). The area under receiver operating characteristic curve (AUROC) of the combined screening of PTX3 for GDM was incremented to 0.657 by the addition of maternal characteristics, and it reached a maximum of 0.743 in further combination with biochemical markers.

Conclusions

Serum PTX3 levels in early pregnancy may provide a useful approach for early prediction of GDM.

Impaired early-phase suppression of glucagon secretion after glucose load is associated with insulin requirement during pregnancy in gestational diabetes

AIMS/INTRODUCTION

The role of glucagon abnormality has recently been reported in type 2 diabetes; however, its role in gestational diabetes mellitus (GDM) is still unknown. The glucose intolerance in GDM is heterogeneous, and not all patients require insulin treatment during pregnancy. Here, we investigated whether glucagon abnormality is associated with the requirement for insulin treatment during pregnancy.

MATERIALS AND METHODS

A total of 49 pregnant women diagnosed with GDM were enrolled. They underwent a 75-g oral glucose tolerance test during mid-gestation, and we measured their plasma glucagon levels (by a new sandwich enzyme-linked immunosorbent assay) at fasting (0 min), and at 30, 60 and 120 min after glucose load in addition to the levels of plasma glucose and serum insulin. All participants underwent another oral glucose tolerance test at postpartum.

RESULTS

Of the 49 patients, 15 required insulin treatment (Insulin group) and 34 were treated with diet therapy alone until delivery (Diet group). The early-phase glucagon secretion after glucose load, as determined by the changes in glucagon from the baseline to 30 min, was paradoxically augmented during mid-gestation in the Insulin group, but not in the Diet group. The impaired glucagon suppression during mid-gestation in the Insulin group was not associated with insulin secretory/sensitivity indexes studied, and was ameliorated postpartum, although the plasma glucose levels remained higher in the Insulin group versus the Diet group.

CONCLUSIONS

Impaired early-phase suppression of glucagon could be associated with the requirement for insulin treatment during pregnancy in patients with GDM.

Background Factors Determining the Introduction and Dosage of Insulin in Women With Gestational Diabetes Mellitus

Background

Gestational diabetes mellitus (GDM) is a risk for perinatal complication, and appropriate diagnosis of and intervention in this condition are important. This study aimed to identify patient factors associated with introduction and dosage of insulin, which is the main drug for treatment of GDM.

Methods

In total, 114 patients who had been diagnosed with GDM at our hospital were included in this study. We retrospectively collected clinical parameters of GDM patients, including how many times positive glucose tolerance test results were obtained, whether insulin was introduced, dosage of insulin, body weight, and infant weight. Background factors differing between the insulin introduction and non-introduction groups of GDM patients and parameters associated with the insulin dosage were analyzed.

Results

Insulin was introduced in 51 GDM patients (45%). In the insulin introduction group, the six-divided diet was less common and the 75-g glucose tolerance test result was positive a significantly greater number of times compared with the non-introduction group. The factor associated with the insulin introduction status was the number of positive 75-g glucose tolerance test results (odds ratio (OR) 2.04, 95% confidence interval (CI): 1.09 - 3.81, P value = 0.025). In addition, the insulin dosage was found to positively correlate with body weight in the non-pregnant state (P value = 0.005).

Conclusions

The six-divided diet was effective for blood glucose control in GDM women. A positive correlation found between the insulin dosage and body weight in the non-pregnant state suggests the importance of proper pre-pregnancy body weight control.

Should the IADPSG criteria be applied when diagnosing early-onset gestational diabetes?

AIMS

To investigate whether the broad interpretation of the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria with application to the early pregnancy, which is adopted as the standard in Japan, is appropriate.

METHODS

We conducted this investigation by comparing diabetes-related adverse pregnancy outcomes among women treated for gestational diabetes mellitus (GDM) following an early-pregnancy diagnosis (early-onset GDM, n = 528) and those treated for GDM following a mid-pregnancy diagnosis, which is the international standard (Mid-term-onset GDM, n = 147).

RESULTS

Gestational weight gain was significantly lower in the early-onset GDM group (7.5 kg) than in the mid-term-onset GDM group (8.4 kg). The frequency of hypertensive disorders of pregnancy tended to be lower in the early-onset GDM group (5.6% vs. 8.8%, p = 0.085), but infant birth weight did not differ significantly between the groups. No between-group difference was observed in macrosomia, large-for-gestational-age (LGA), small-for-gestational age (SGA), low Apgar score, shoulder dystocia, cesarean delivery, NICU admission, hyperbilirubinemia, neonatal hypoglycemia, or respiratory distress syndrome. The frequency of LGA showed a significant association with pre-pregnancy body mass index, but did not differ according to the timing of therapy initiation.

CONCLUSIONS

We could not find the effectiveness of therapeutic interventions initiated after GDM diagnosis in the early pregnancy based on the IADPSG criteria, compared with therapeutic interventions after a mid-pregnancy GDM diagnosis. It was suggested that the IADPSG criteria for diagnosing GDM at 24-28 weeks' gestation should not be applied to Japanese women in the early pregnancy by a broader interpretation.

Screening and Treatment for Early-Onset Gestational Diabetes Mellitus: a Systematic Review and Meta-analysis

We conducted a systematic review to evaluate the current evidence for screening and treatment for early-onset gestational diabetes mellitus (GDM) RECENT FINDINGS: Many of the women with early GDM in the first trimester do not have evidence of hyperglycemia at 24-28 weeks' gestation. A high proportion (15-70%) of women with GDM can be detected early in pregnancy depending on the setting, criteria used and screening strategy. However, there remains no good evidence for any of the diagnostic criteria for early-onset GDM. In a meta-analysis of 13 cohort studies, perinatal mortality (relative risk (RR) 3.58 [1.91, 6.71]), neonatal hypoglycemia (RR 1.61 [1.02, 2.55]), and insulin use (RR 1.71 [1.45, 2.03]) were greater among early-onset GDM women compared to late-onset GDM women, despite treatment. Considering the high likelihood of benefit from treatment, there is an urgent need for randomized controlled trials that investigate any benefits and possible harms of treatment of early-onset GDM.