Am J Perinatol 2010; 27(9): 697-704
DOI: 10.1055/s-0030-1253101
© Thieme Medical Publishers

Prevalence of Gestational Fasting and Postload Single Dysglycemia in Mexican-American Women and Their Relative Significance in Identifying Carbohydrate Intolerance

Ramaswami Kalamegham1 , Bahij S. Nuwayhid2 , Zuber D. Mulla2
  • 1Department of Pathology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
  • 2Department of Obstetrics and Gynecology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
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Publikationsverlauf

Publikationsdatum:
12. April 2010 (online)

ABSTRACT

This study investigated the prevalence of gestational dysglycemia in a largely Hispanic population in a U.S.-Mexico border city and the influence of single plasma glucose (PG) result on the identification of gestational carbohydrate intolerance. Gestational dysglycemia was studied in a largely Mexican-American population using retrospective data. Gestational diabetes (GDM), gestational impaired fasting glucose (GIFG), and gestational impaired glucose tolerance (GIGT) were identified with Carpenter-Coustan thresholds. Glucose challenge test result was abnormal in 32.7% of 18307 women screened; 47% of them had one or more dysglycemic results in the confirmatory oral glucose tolerance test (OGTT). The prevalence of GDM, GIFG, and GIGT in these women was 8.7, 2.2, and 4.5%, respectively. Fasting, 1-hour, 2-hour, and 3-hour PGs were elevated in 20.5, 28.5, 25.0, and 15.0% of OGTT, respectively (GIFG: 6.0%; 1-hour GIGT: 6.5%; 2-hour GIGT: 4.4%; and 3-hour GIGT: 3.1%). Twelve percent of OGTTs showed dysglycemia at 1 hour with normal 2-hour PG. Isolated dysglycemia, similar to GDM, is prevalent in Mexican-American women. The minimal impact of 3-hour PG supports a 2-hour OGTT. But our results question the use of an “OGTT protocol without a first-hour specimen.”

REFERENCES

  • 1 O'Sullivan J B, Mahan C M. Criteria for the oral glucose tolerance test in pregnancy.  Diabetes. 1964;  13 278-285
  • 2 Coustan D R, Imarah J. Prophylactic insulin treatment of gestational diabetes reduces the incidence of macrosomia, operative delivery, and birth trauma.  Am J Obstet Gynecol. 1984;  150 836-842
  • 3 Sermer M, Naylor C D, Gare D J et al.. Impact of increasing carbohydrate intolerance on maternal-fetal outcomes in 3637 women without gestational diabetes. The Toronto Tri-Hospital Gestational Diabetes Project.  Am J Obstet Gynecol. 1995;  173 146-156
  • 4 Persson B, Hanson U. Neonatal morbidities in gestational diabetes mellitus.  Diabetes Care. 1998;  21(Suppl 2) B79-B84
  • 5 American Diabetes Association . Diagnosis and classification of diabetes mellitus.  Diabetes Care. 2009;  32(Suppl 1) S62-S67
  • 6 National Diabetes Data Group . Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance.  Diabetes. 1979;  28 1039-1057
  • 7 Carpenter M W, Coustan D R. Criteria for screening tests for gestational diabetes.  Am J Obstet Gynecol. 1982;  144 768-773
  • 8 Kuzuya T, Nakagawa S, Satoh J Committee of the Japan Diabetes Society on the diagnostic criteria of diabetes mellitus et al. Report of the Committee on the classification and diagnostic criteria of diabetes mellitus.  Diabetes Res Clin Pract. 2002;  55 65-85
  • 9 Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications. Report of a WHO Consultation, Part 1. Diagnosis and Classification of Diabetes Mellitus Geneva; World Health Organization 1999
  • 10 Weiss P A, Haeusler M, Kainer F, Pürstner P, Haas J. Toward universal criteria for gestational diabetes: relationships between seventy-five and one hundred gram glucose loads and between capillary and venous glucose concentrations.  Am J Obstet Gynecol. 1998;  178 830-835
  • 11 Yogev Y, Metzger B E, Hod M. Establishing diagnosis of gestational diabetes mellitus: impact of the hyperglycemia and adverse pregnancy outcome study.  Semin Fetal Neonatal Med. 2009;  14 94-100
  • 12 Langer O, Brustman L, Anyaegbunam A, Mazze R. The significance of one abnormal glucose tolerance test value on adverse outcome in pregnancy.  Am J Obstet Gynecol. 1987;  157 758-763
  • 13 Jensen D M, Damm P, Sørensen B et al.. Clinical impact of mild carbohydrate intolerance in pregnancy: a study of 2904 nondiabetic Danish women with risk factors for gestational diabetes mellitus.  Am J Obstet Gynecol. 2001;  185 413-419
  • 14 Gruendhammer M, Brezinka C, Lechleitner M. The number of abnormal plasma glucose values in the oral glucose tolerance test and the feto-maternal outcome of pregnancy.  Eur J Obstet Gynecol Reprod Biol. 2003;  108 131-136
  • 15 Langer O, Anyaegbunam A, Brustman L, Divon M. Management of women with one abnormal oral glucose tolerance test value reduces adverse outcome in pregnancy.  Am J Obstet Gynecol. 1989;  161 593-599
  • 16 Texas Department of State Health Services .Projected Texas Population by Area, 2009. Available at: http://www.dshs.state.tx.us/chs/popdat/ST2009.shtm Accessed February 2, 2010
  • 17 Meza E, Barraza L, Martínez G et al.. Gestational diabetes in a Mexican-U.S. border population: prevalence and epidemiology.  Rev Invest Clin. 1995;  47 433-438
  • 18 Yogev Y, Langer O, Xenakis E M, Rosenn B. Glucose screening in Mexican-American women.  Obstet Gynecol. 2004;  103 1241-1245
  • 19 Abdul-Ghani M A, Tripathy D, DeFronzo R A. Contributions of beta-cell dysfunction and insulin resistance to the pathogenesis of impaired glucose tolerance and impaired fasting glucose.  Diabetes Care. 2006;  29 1130-1139
  • 20 Meyer C, Pimenta W, Woerle H J et al.. Different mechanisms for impaired fasting glucose and impaired postprandial glucose tolerance in humans.  Diabetes Care. 2006;  29 1909-1914
  • 21 Langer O. Maternal glycemic criteria for insulin therapy in gestational diabetes mellitus.  Diabetes Care. 1998;  21(Suppl 2) B91-B98
  • 22 The DECODE-study group . Is fasting glucose sufficient to define diabetes? Epidemiological data from 20 European studies. The DECODE-study group. European Diabetes Epidemiology Group. Diabetes Epidemiology: Collaborative analysis of Diagnostic Criteria in Europe.  Diabetologia. 1999;  42 647-654
  • 23 Jovanovic-Peterson L, Peterson C M, Reed G F et al.. Maternal postprandial glucose levels and infant birth weight: the Diabetes in Early Pregnancy Study. The National Institute of Child Health and Human Development—Diabetes in Early Pregnancy Study.  Am J Obstet Gynecol. 1991;  164(1 Pt 1) 103-111
  • 24 Combs C A, Gunderson E, Kitzmiller J L, Gavin L A, Main E K. Relationship of fetal macrosomia to maternal postprandial glucose control during pregnancy.  Diabetes Care. 1992;  15 1251-1257
  • 25 Weiss P A, Haeusler M, Tamussino K, Haas J. Can glucose tolerance test predict fetal hyperinsulinism?.  BJOG. 2000;  107 1480-1485
  • 26 Mello G, Parretti E, Cioni R et al.. The 75-gram glucose load in pregnancy: relation between glucose levels and anthropometric characteristics of infants born to women with normal glucose metabolism.  Diabetes Care. 2003;  26 1206-1210
  • 27 Schaefer-Graf U M, Rossi R, Bührer C et al.. Rate and risk factors of hypoglycemia in large-for-gestational-age newborn infants of nondiabetic mothers.  Am J Obstet Gynecol. 2002;  187 913-917
  • 28 Schäfer-Graf U M, Dupak J, Vogel M et al.. Hyperinsulinism, neonatal obesity and placental immaturity in infants born to women with one abnormal glucose tolerance test value.  J Perinat Med. 1998;  26 27-36
  • 29 Retnakaran R, Zinman B, Connelly P W, Sermer M, Hanley A J. Impaired glucose tolerance of pregnancy is a heterogeneous metabolic disorder as defined by the glycemic response to the oral glucose tolerance test.  Diabetes Care. 2006;  29 57-62
  • 30 Retnakaran R, Qi Y, Sermer M, Connelly P W, Zinman B, Hanley A J. Isolated hyperglycemia at 1 hour on oral glucose tolerance test in pregnancy resembles gestational diabetes mellitus in predicting postpartum metabolic dysfunction.  Diabetes Care. 2008;  31 1275-1281
  • 31 Aberg A E, Jönsson E K, Eskilsson I, Landin-Olsson M, Frid A H. Predictive factors of developing diabetes mellitus in women with gestational diabetes.  Acta Obstet Gynecol Scand. 2002;  81 11-16
  • 32 Kühl C. Etiology and pathogenesis of gestational diabetes.  Diabetes Care. 1998;  21(Suppl 2) B19-B26
  • 33 Carver T D, Anderson S M, Aldoretta P W, Hay Jr W W. Effect of low-level basal plus marked “pulsatile” hyperglycemia on insulin secretion in fetal sheep.  Am J Physiol. 1996;  271(5 Pt 1) E865-E871
  • 34 Cobley J F, Lancaster H O. Carbohydrate tolerance in pregnancy.  Med J Aust. 1955;  42 171-175
  • 35 Atilano L C, Lee-Parritz A, Lieberman E, Cohen A P, Barbieri R L. Alternative methods of diagnosing gestational diabetes mellitus.  Am J Obstet Gynecol. 1999;  181(5 Pt 1) 1158-1161
  • 36 Metzger B E, Lowe L P, Dyer A R HAPO Study Cooperative Research Group et al. Hyperglycemia and adverse pregnancy outcomes.  N Engl J Med. 2008;  358 1991-2002

Ramaswami KalameghamPh.D. F.A.C.B. 

Associate Professor, Department of Pathology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center

4800 Alberta Avenue, El Paso, TX 79905

eMail: ramaswami.kalameham@ttuhsc.edu