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Are There Benefits for Gestational Diabetes Mellitus in Treating Lower Levels of Hyperglycemia Than Standard Recommendations?

  • Thi Hoang Lan Nguyen
    Affiliations
    Endocrinology Division, Department of Medicine, Centre de Recherche du Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
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  • Ji Wei Yang
    Affiliations
    Endocrinology Division, Department of Medicine, Centre de Recherche du Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
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  • Michèle Mahone
    Affiliations
    Internal Medicine Division, Department of Medicine, Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
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  • Ariane Godbout
    Correspondence
    Address for correspondence: Ariane Godbout, MD, FRCPC, Hôpital St-Luc du Centre hospitalier de l'Université de Montréal, 1058 rue Saint-Denis, Montréal, Québec H2X 3J4, Canada.
    Affiliations
    Endocrinology Division, Department of Medicine, Centre de Recherche du Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada

    Department of Obstetrics and Gynecology, Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
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      Abstract

      Objectives

      The new International Association of Diabetes and Pregnancy Study Groups (IADPSG) recommendations for diagnosis of gestational diabetes mellitus (GDM) are generating discussion regarding their universal adoption. Our centre is currently using stricter GDM diagnostic criteria than those proposed by the IADPSG. Evaluation of complication rates and their predictors in our cohort may provide insight for the care of this high-risk population. Therefore, we determined complication rates and identified antepartum maternal predictors of adverse outcomes in our cohort with mild GDM.

      Methods

      A retrospective cohort study was performed between 2005 and 2011. It included women with and without GDM, which was diagnosed if fasting plasma glucose levels were 5.0 or above or 2-hour post 75 gram oral glucose tolerance test (OGTT) were 7.8 mmol/L or higher.

      Results

      A total of 3712 women, with and without diabetes, were included. Rates of macrosomia and pre-eclampsia were significantly higher in the group with GDM but were lower than the rates usually reported. Macrosomia, the need for insulin therapy or caesarean section and postpartum glucose intolerance predictors included prepregnancy body mass index, excessive gestational weight gain and OGTT screening results, although no specific threshold was found.

      Conclusions

      This study provides insight into GDM-related complications rates and the benefits of intervention in a large cohort of women with levels of hyperglycemia lower than those currently recommended for diagnosis of GDM. These findings suggest a continuous association between adverse outcomes and maternal hyperglycemia and highlight the important role of maternal risk factors other than glycemic results in the development of pregnancy-related complications. Milder forms of hyperglycemia that would not be identified by IADPSG guidelines may benefit from treatment.

      Résumé

      Objectifs

      Les nouvelles recommandations émises par l'Association internationale des groupes d'études sur le diabète et grossesse (IADPSG) pour le diagnostic du diabète gestationnel (DG) suscitent plusieurs débats au niveau international en ce qui attrait à son adoption universelle. Notre centre utilise actuellement des critères diagnostiques plus stricts pour le DG que ceux proposés par l'IADPSG. L'évaluation des taux de complications et de leurs prédicteurs dans notre cohorte pourrait aider à raffiner la prise en charge de cette population à haut risque. Par conséquent, cette étude avait pour objectif de déterminer les taux de complications et les prédicteurs maternels de complications au sein de cette cohorte de femmes enceintes atteintes d'une forme dite moins sévère de DG.

      Méthode

      Une étude de cohorte rétrospective fut réalisée entre 2005 et 2011 et incluait des femmes enceintes avec et sans DG. Un diagnostic de DG était établi si la glycémie veineuse à jeun étaient supérieure ou égale à 5,0 mmol/l, ou si la glycémie veineuse 2 heures après l'ingestion de 75 grammes de glucose étaient de 7,8 mmol/l ou plus.

      Résultats

      Un total de 3712 femmes enceintes avec ou sans DG furent incluses. Les taux de macrosomie et de prééclampsie étaient significativement plus élevés dans le groupe avec DG, mais étaient plus faibles queles taux habituellement rapportés. Les principaux prédicteurs identifés pour la macrosomie, la nécessité d'une insulinothérapie, d'une césarienne et/ou l'intolérance au glucose résiduelle postpartum sont: l'indice de masse corporel maternel pré-grossesse, la prise de poids gestationnelle excessive et les résultats glycémiques au test d'hyperglycémie orale provoquée, bien que nous n'ayons observé aucun seuil glycémique précis.

      Conclusions

      Cette étude permet d'établir les taux de complications liées au DG ainsi que ses principaux prédicteurs dans une grande cohorte de femmes ayant des niveaux d'hyperglycémie moins élevés que ceux actuellement recommandés pour le diagnostic du DG. Cette étude offre également un aperçu sur les avantages et les conséquences d'une intervention dans un groupe de femmes avec une forme moins sévère de DG. Cette étude démontre notamment une association continue entre les taux de complications obstétricales et périnatales et l'hyperglycémie maternelle, tout en soulignant le rôle déterminant de certains facteurs de risque maternels autres que les résultats glycémiques dans le développement des complications durant une grossesse marquée par le DG. Il semble donc que des formes d'hyperglycémie plus légère, soit sous le seuil de détection des nouveaux critères diagnostiques du DG des lignes directrices de l'IADPSG, pourraient bénéficier d'un traitement.

      Keywords

      Mots clés

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