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Gestational diabetes and ethnicity: Are results of pregnancy outcome generalizable?
SMFM Abstracts S51 149
GESTATIONAL DIABETES AND ETHNICITY: ARE RESULTS OF PREGNANCY OUTCOME GENERALIZABLE? YARIV YOGEV1, ORLI MOST1, ODED LANGER2, 1St. Luke’s Roosevelt Hospital Center, Obstetrics and Gynecology, NY, New York, 2St Luke’s Roosevelt Hospital Center, Obstetrics and Gynecology, NY, New York OBJECTIVE: Non-diabetic pregnancy outcome (mainly SGA and prematurity) is affected by ethnicity. In GDM women, limited data exists on the association between pregnancy outcome and ethnicity. We investigated if perinatal outcome results are generalizable. STUDY DESIGN: A cohort study of 1932 GDM patients, 970 Mexican American (MA), 570 non-Hispanic white (NHW) and 392 African American (AA) were treated in the same center by the same diabetic protocol and compared for pregnancy outcome. RESULTS: (1) Patients were comparable in demographic data, maternal age, nulliparity, gestational age at diagnosis and delivery, chronic hypertension, number of perinatal visits and weight gain in pregnancy. (2) A higher obesity rate (BMI >30 kg/m2) was found for AA, P = .001 (44% vs. 35% in NHW and 32% in MA, respectively). (3) Glycemic characteristics (fasting glucose, postprandial, and mean) were similar, P = .27. (4) Patients achieving good control (MBG !105 mg/dL) was 64% (MA), 62% (NHW), 68% (AA), respectively, P = .09. (5) Additionally, when pregnancy outcome was analyzed separately by level of achieved glycemic control,similar pregnancy outcome was found within the poor and well controlled groups unrelated to ethnicity. (6) A higher rate of preeclampsia was found in AA women, 14.1% vs. 9.5% in MA and 10.0% for NHW, P = .04. (7) Finally,multivariate logistic regression analysis for LGA and metabolic complications as dependent variables failed to demonstrate significant effect of ethnicity. CONCLUSION: Ethnicity does not influence pregnancy outcome in GDM when comparable levels of glycemic control are achieved.
Preterm labor (%) LGA (%) SGA (%) Ponderal index O2.85 (%) Metabolic complications (%)
150
Mexican-American
Non-Hispanic white
African-American
7.1 16.7 6.1 13.8
6.2 15.8 7.4 12.4
6.4 13.6 7.9 11.3
8.1
6.3
5.2
GESTATIONAL DIABETES MELLITUS: IS THEIR A RISK FOR PERINATAL MORTALITY? YARIV YOGEV1, ORLI MOST1, ODED LANGER1, 1St. Luke’s-Roosevelt Hospital Center, University Hospital of Columbia University, NY, New York OBJECTIVE: We investigated factors that may contribute to the rate of perinatal mortality (PNM) in gestational diabetes (GDM). STUDY DESIGN: 4757 GDM patients were treated with the same diabetic and surveillance protocols. The control group consisted of 10,804 non-diabetic women. Stillbirth (SB) was defined as fetal death at > 500gr or after 23 weeks’ gestation with no lethal anomalies. Neonatal death (ND) was divided into early (!7 days) and late (8-28 days). RESULTS: The stillbirth rate was 23/4757 (5/1000) and the neonatal death rate was 28/4757 (5.8/1000), comparable to the non-diabetic population (46/10,804 (4/1000) and 58/10,804 (5.3/1000), respectively (P = 0.33). 79% of GDM women achieved established levels of glucose control (MBG ! 105mg/dl). GDM women with current pregnancy loss had higher rates of previous PNM, previous macrosomia, and non-compliance. 65% of patients with SB and 72% of patients with ND were poorly controlled (MBG >105, P = .01). The association between SB and fetal size revealed 9/23 (40%) had deviant fetal growth; 4/23 were LGA (> 90th %), 5/23 were SGA (!10th %) and 14/23 were AGA. For ND, 12/28 (42%) had abnormal fetal growth; 8/28 were LGA, 4/28 were SGA and 16/28 were AGA. A higher rate of maternal obesity (BMI >30 kg/m2) was found for both SB and ND groups, P = 0.01. The association between gestational age and stillbirth diagnosis revealed that 4/23 occurred at 24-30 weeks, 4/23 between 30-34 weeks, 7/23 at 35-37 weeks and 8/23 at gestational age >37 weeks. Delivery with subsequent neonatal death occurred: 4/28 at 24-30 weeks, 3/28 between 30-34 weeks, 5/28 at 35-37 weeks and 16/28 at gestational age >37 weeks. In 23/28 ND occurred early (!7 days). CONCLUSION: Achievement of established levels of glycemic control in GDM may contribute to the reduction of perinatal mortality comparable to the general population.
151
152
COMBINATION OF ELEVATED FASTING GLUCOSE AND POSITIVE GLUCOSE CHALLENGE TEST (GCT) FOR GESTATIONAL DIABETES (GDM) DIAGNOSIS YARIV YOGEV1, ORLI MOST1, ODED LANGER1, 1St. Luke’s-Roosevelt Hospital Center, University Hospital of Columbia University, Obstetrics and Gynecology, NY, New York OBJECTIVE: No data currently exists on the combination of fasting plasma glucose and screening results for the diagnosis of GDM. We sought to evaluate if a combination of elevated fasting blood glucose with positive GCT is associated with increased likelihood for GDM diagnosis. STUDY DESIGN: A prospective cohort of 6857 gravid women tested with 50 g GCT at 24-28 weeks of gestation. A screening value >130 mg/dL was followed by 3-hour 100 g OGTT. GDM was diagnosed using Carpenter/Coustan criteria. For purpose of analysis, probability for GDM diagnosis was assessed using elevated GCT (>130 mg/dL) and two thresholds of fasting blood glucose (FBG) (95,105 mg/dL). Sensitivity, specificity, positive and negative predictive value for GDM diagnosis was calculated for each FBG threshold. RESULTS: (1) Overall, GDM was diagnosed in 469/6857 (6.8%). (2) Positive GCT (>130 mg/dL) was found in 2537/8757 (37%), 620/6857 (9%) had FBG>95 and 226/6857 (3.3%) had FBG >105 mg/dL. (3) The likelihood for GDM is increased when positive GCT (>130 mg/dL) is combined with FBG >105 mg/dL (Table). (4) Combination of elevated GCT and FBG >105 mg/dL will identify 98% of the GDM patients and will fail to diagnose only 0.6% of the GDM patients with no need for definitive OGTT for diagnosis. CONCLUSION: Data suggests that combination of a positive GCT (>130 mg/ dL) with FBG >105 mg/dL is efficient for GDM diagnosis and may be considered as diagnostic procedure for GDM. FBG
Sensitivity
Specificity
PPV
NPV
O95mg/dL O105 mg/dL
93% 98%
64% 77%
17% 32%
98% 99.4%
IS THERE A DIFFERENCE IN THE GLYCEMIC PROFILE OF NON-DIABETIC WOMEN WITH POSITIVE/NEGATIVE GLUCOSE CHALLENGE TEST SCREENING (GCT) RESULTS? YARIV YOGEV1, ODED LANGER1, AVI BEN HAROUSH2, RONY CHEN2, ORLI MOST1, MOSHE HOD2, 1St. Luke’s-Roosevelt Hospital Center, University Hospital of Columbia University, Obstetrics and Gynecology, NY, New York, 2Rabin Medical Center, Perinatal Division, Department of Obstetrics and Gynecology, Petach-Tikva, Israel, Israel OBJECTIVE: It has been suggested that the elevated glucose challenge test (GCT) by itself reflects glucose intolerance during pregnancy. We sought to evaluate the glycemic profile characteristics in relation to GCT results in nondiabetic pregnant women. STUDY DESIGN: 52 non-diabetic gravid subjects were evaluated, of them 26 had positive 1-h 50 gr GCT results (>130 mg/dL). All subjects in both groups had normal OGTT by the Carpenter/Coustan criteria. Daily glycemic profile was evaluated using the Continuous Glucose Monitoring System (CGMS). CGMS measures glucose levels every 5 minutes for 72 consecutive hours for a total of 288 measurements daily. During the study period, all women were requested to refrain from any lifestyle modification or dietary restrictions. For quality control, CGM data were compared to self-monitoring blood glucose performed in this timeframe by the women 6-8 times/daily. RESULTS: (1) Overall, 39,123 glucose determinations were obtained with an average of 752 G 29/patient. (2) The correlation coefficient (r) between the glucose measurements by the sensor and meter was 0.93 G 0.04, and the reliability coefficient was 0.88. (3) No difference was found in maternal age (28.2 G 4.1 vs. 29.0 G 3.1) and gestational age at evaluation (29.2 G 2.1 vs. 29.5 G 2.8 weeks, P = 0.3). (4) Subjects with a positive GCT had higher rates of obesity (BMI >30 kg/m2) compared to women with negative GCT results (47% vs. 19%, P = .001) (5) Similar glycemic profiles (P = .23) were found for both screening glucose threshold groups (mean blood glucose, fasting value, 1-h and 2-h postprandial glucose value (Table). CONCLUSION: In non diabetic subjects, elevated GCT by itself is not a marker for glucose intolerance.
Mean blood glucose Fasting value 1-h postprandial glucose value 2-h postprandial glucose value
GCT !130
GCT O130
83 75 107 103
86 77 113 106
G G G G
14 11 16 15
G G G G
17 14 19 17
GESTATIONAL DIABETES AND ETHNICITY: ARE RESULTS OF PREGNANCY OUTCOME GENERALIZABLE? YARIV YOGEV1, ORLI MOST1, ODED LANGER2, 1St. Luke’s Roosevelt Hospital Center, Obstetrics and Gynecology, NY, New York, 2St Luke’s Roosevelt Hospital Center, Obstetrics and Gynecology, NY, New York OBJECTIVE: Non-diabetic pregnancy outcome (mainly SGA and prematurity) is affected by ethnicity. In GDM women, limited data exists on the association between pregnancy outcome and ethnicity. We investigated if perinatal outcome results are generalizable. STUDY DESIGN: A cohort study of 1932 GDM patients, 970 Mexican American (MA), 570 non-Hispanic white (NHW) and 392 African American (AA) were treated in the same center by the same diabetic protocol and compared for pregnancy outcome. RESULTS: (1) Patients were comparable in demographic data, maternal age, nulliparity, gestational age at diagnosis and delivery, chronic hypertension, number of perinatal visits and weight gain in pregnancy. (2) A higher obesity rate (BMI >30 kg/m2) was found for AA, P = .001 (44% vs. 35% in NHW and 32% in MA, respectively). (3) Glycemic characteristics (fasting glucose, postprandial, and mean) were similar, P = .27. (4) Patients achieving good control (MBG !105 mg/dL) was 64% (MA), 62% (NHW), 68% (AA), respectively, P = .09. (5) Additionally, when pregnancy outcome was analyzed separately by level of achieved glycemic control,similar pregnancy outcome was found within the poor and well controlled groups unrelated to ethnicity. (6) A higher rate of preeclampsia was found in AA women, 14.1% vs. 9.5% in MA and 10.0% for NHW, P = .04. (7) Finally,multivariate logistic regression analysis for LGA and metabolic complications as dependent variables failed to demonstrate significant effect of ethnicity. CONCLUSION: Ethnicity does not influence pregnancy outcome in GDM when comparable levels of glycemic control are achieved.
Preterm labor (%) LGA (%) SGA (%) Ponderal index O2.85 (%) Metabolic complications (%)
150
Mexican-American
Non-Hispanic white
African-American
7.1 16.7 6.1 13.8
6.2 15.8 7.4 12.4
6.4 13.6 7.9 11.3
8.1
6.3
5.2
GESTATIONAL DIABETES MELLITUS: IS THEIR A RISK FOR PERINATAL MORTALITY? YARIV YOGEV1, ORLI MOST1, ODED LANGER1, 1St. Luke’s-Roosevelt Hospital Center, University Hospital of Columbia University, NY, New York OBJECTIVE: We investigated factors that may contribute to the rate of perinatal mortality (PNM) in gestational diabetes (GDM). STUDY DESIGN: 4757 GDM patients were treated with the same diabetic and surveillance protocols. The control group consisted of 10,804 non-diabetic women. Stillbirth (SB) was defined as fetal death at > 500gr or after 23 weeks’ gestation with no lethal anomalies. Neonatal death (ND) was divided into early (!7 days) and late (8-28 days). RESULTS: The stillbirth rate was 23/4757 (5/1000) and the neonatal death rate was 28/4757 (5.8/1000), comparable to the non-diabetic population (46/10,804 (4/1000) and 58/10,804 (5.3/1000), respectively (P = 0.33). 79% of GDM women achieved established levels of glucose control (MBG ! 105mg/dl). GDM women with current pregnancy loss had higher rates of previous PNM, previous macrosomia, and non-compliance. 65% of patients with SB and 72% of patients with ND were poorly controlled (MBG >105, P = .01). The association between SB and fetal size revealed 9/23 (40%) had deviant fetal growth; 4/23 were LGA (> 90th %), 5/23 were SGA (!10th %) and 14/23 were AGA. For ND, 12/28 (42%) had abnormal fetal growth; 8/28 were LGA, 4/28 were SGA and 16/28 were AGA. A higher rate of maternal obesity (BMI >30 kg/m2) was found for both SB and ND groups, P = 0.01. The association between gestational age and stillbirth diagnosis revealed that 4/23 occurred at 24-30 weeks, 4/23 between 30-34 weeks, 7/23 at 35-37 weeks and 8/23 at gestational age >37 weeks. Delivery with subsequent neonatal death occurred: 4/28 at 24-30 weeks, 3/28 between 30-34 weeks, 5/28 at 35-37 weeks and 16/28 at gestational age >37 weeks. In 23/28 ND occurred early (!7 days). CONCLUSION: Achievement of established levels of glycemic control in GDM may contribute to the reduction of perinatal mortality comparable to the general population.
151
152
COMBINATION OF ELEVATED FASTING GLUCOSE AND POSITIVE GLUCOSE CHALLENGE TEST (GCT) FOR GESTATIONAL DIABETES (GDM) DIAGNOSIS YARIV YOGEV1, ORLI MOST1, ODED LANGER1, 1St. Luke’s-Roosevelt Hospital Center, University Hospital of Columbia University, Obstetrics and Gynecology, NY, New York OBJECTIVE: No data currently exists on the combination of fasting plasma glucose and screening results for the diagnosis of GDM. We sought to evaluate if a combination of elevated fasting blood glucose with positive GCT is associated with increased likelihood for GDM diagnosis. STUDY DESIGN: A prospective cohort of 6857 gravid women tested with 50 g GCT at 24-28 weeks of gestation. A screening value >130 mg/dL was followed by 3-hour 100 g OGTT. GDM was diagnosed using Carpenter/Coustan criteria. For purpose of analysis, probability for GDM diagnosis was assessed using elevated GCT (>130 mg/dL) and two thresholds of fasting blood glucose (FBG) (95,105 mg/dL). Sensitivity, specificity, positive and negative predictive value for GDM diagnosis was calculated for each FBG threshold. RESULTS: (1) Overall, GDM was diagnosed in 469/6857 (6.8%). (2) Positive GCT (>130 mg/dL) was found in 2537/8757 (37%), 620/6857 (9%) had FBG>95 and 226/6857 (3.3%) had FBG >105 mg/dL. (3) The likelihood for GDM is increased when positive GCT (>130 mg/dL) is combined with FBG >105 mg/dL (Table). (4) Combination of elevated GCT and FBG >105 mg/dL will identify 98% of the GDM patients and will fail to diagnose only 0.6% of the GDM patients with no need for definitive OGTT for diagnosis. CONCLUSION: Data suggests that combination of a positive GCT (>130 mg/ dL) with FBG >105 mg/dL is efficient for GDM diagnosis and may be considered as diagnostic procedure for GDM. FBG
Sensitivity
Specificity
PPV
NPV
O95mg/dL O105 mg/dL
93% 98%
64% 77%
17% 32%
98% 99.4%
IS THERE A DIFFERENCE IN THE GLYCEMIC PROFILE OF NON-DIABETIC WOMEN WITH POSITIVE/NEGATIVE GLUCOSE CHALLENGE TEST SCREENING (GCT) RESULTS? YARIV YOGEV1, ODED LANGER1, AVI BEN HAROUSH2, RONY CHEN2, ORLI MOST1, MOSHE HOD2, 1St. Luke’s-Roosevelt Hospital Center, University Hospital of Columbia University, Obstetrics and Gynecology, NY, New York, 2Rabin Medical Center, Perinatal Division, Department of Obstetrics and Gynecology, Petach-Tikva, Israel, Israel OBJECTIVE: It has been suggested that the elevated glucose challenge test (GCT) by itself reflects glucose intolerance during pregnancy. We sought to evaluate the glycemic profile characteristics in relation to GCT results in nondiabetic pregnant women. STUDY DESIGN: 52 non-diabetic gravid subjects were evaluated, of them 26 had positive 1-h 50 gr GCT results (>130 mg/dL). All subjects in both groups had normal OGTT by the Carpenter/Coustan criteria. Daily glycemic profile was evaluated using the Continuous Glucose Monitoring System (CGMS). CGMS measures glucose levels every 5 minutes for 72 consecutive hours for a total of 288 measurements daily. During the study period, all women were requested to refrain from any lifestyle modification or dietary restrictions. For quality control, CGM data were compared to self-monitoring blood glucose performed in this timeframe by the women 6-8 times/daily. RESULTS: (1) Overall, 39,123 glucose determinations were obtained with an average of 752 G 29/patient. (2) The correlation coefficient (r) between the glucose measurements by the sensor and meter was 0.93 G 0.04, and the reliability coefficient was 0.88. (3) No difference was found in maternal age (28.2 G 4.1 vs. 29.0 G 3.1) and gestational age at evaluation (29.2 G 2.1 vs. 29.5 G 2.8 weeks, P = 0.3). (4) Subjects with a positive GCT had higher rates of obesity (BMI >30 kg/m2) compared to women with negative GCT results (47% vs. 19%, P = .001) (5) Similar glycemic profiles (P = .23) were found for both screening glucose threshold groups (mean blood glucose, fasting value, 1-h and 2-h postprandial glucose value (Table). CONCLUSION: In non diabetic subjects, elevated GCT by itself is not a marker for glucose intolerance.
Mean blood glucose Fasting value 1-h postprandial glucose value 2-h postprandial glucose value
GCT !130
GCT O130
83 75 107 103
86 77 113 106
G G G G
14 11 16 15
G G G G
17 14 19 17