One elevated oral glucose tolerance test value in pregnancy increases the risk for future diabetes mellitus type 2
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MATERNAL-FETAL MEDICINE
One elevated oral glucose tolerance test value in pregnancy increases the risk for future diabetes mellitus type 2 Enav Yefet1,2,3 · Naama Schwartz4 · Basma Sliman1 · Zohar Nachum1,5 Received: 18 August 2020 / Accepted: 26 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Women with only one elevated 100 g OGTT value are not considered as having gestational diabetes mellitus (GDM) and therefore there are no recommendations to address this population as a risk group for type 2 diabetes mellitus (T2DM). We aimed to elucidate whether one elevated OGTT value increases the risk for T2DM. Methods A retrospective population-based cohort study of women with a first diagnosis of GDM who delivered between 1991 and 2011 was conducted. Women were divided according to GDM diagnosis criteria into three groups: (1) at least two elevated values of Carpenter and Coustan criteria (C&C; N = 209), (2) At least two elevated values of the National Diabetes Data Group (NDDG) criteria (NDDG2; N = 290) and (3) only one elevated value of the NDDG criteria (NDDG1; N = 226). A fourth group comprising women without GDM was included (control; N = 352). The primary outcome was the development of T2DM. Results The mean follow-up was 12.4 ± 5.3 years and the mean age at follow-up was 43.0 ± 5.7 years. The rate of T2DM in the control, C&C, NDDG1 and NDDG2 groups were 5%, 18%, 19% and 31%, respectively. All GDM diagnoses were independent risk factors for T2DM in multivariable Cox regression when compared to controls, adjusted hazard ratio and 95% CI: C&C 7.8 [95% CI 3.7–16.4], NDDG1 5.5 [2.6–11.6], and NDDG2 10.5 [5.2–21.4]. Additional independent risk factors were parity, fasting and 1-h post-glucose load of the OGTT and insulin use. Conclusions Women with one elevated OGTT value using the NDDG criteria are at increased risk for T2DM. Further studies are needed to decide whether those women should be considered a focus group for long-term surveillance and T2DM prevention interventions. Keywords Gestational diabetes mellitus · Pregnancy · Oral glucose tolerance test · Type 2 diabetes mellitus
Introduction Gestational diabetes mellitus (GDM) complicates 6–9% of pregnancies [1–3]. Several diagnostic criteria have been suggested and are in common use worldwide. Those include * Enav Yefet [email protected] 1
Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
2
Department of Obstetrics and Gynecology, Baruch Padeh Medical Center Poriya, Tiberias, Israel
3
Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
4
Research Authority, Emek Medical Center, Afula, Israel
5
Rappaport Faculty of Medicine, Technion, Haifa, Israel
the 75 g oral glucose tolerance test (OGTT), recommended by the American Diabetes Association (ADA) and the twostep strategy of performing 50 g glucose challenge test (GCT) followed by 100 g OGTT, which is recommended by the American College of Obstetricians and Gynecologists (ACOG) and is acceptable by the AD
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