EPIDEMIOLOGY IN GESTATIONAL DIABETES MELLITUS

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EPIDEMIOLOGY IN GESTATIONAL DIABETES MELLITUS
Methodology
Dr. Nam-Han Cho Associate Professor of Preventive
Medicine Director of Center for Clinical
Epidemiology Ajou University School of
Medicine Suwon, Korea
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GESTATIONAL DIABETES MELLITUS
Gestational Diabetes Mellitus(GDM), defined as
carbohydrate intolerance with onset or first
recognition during pregnancy

• Occurs in approximately 2 to 5 of all
  pregnancies, with marked worldwide variations
  reported
• Is associated with an increased risk of fetal
  macro- somia, as well as perinatal morbidity
  and mortality
• Is linked with future developments of diabetes
  mellitus in women post-pregnancy.

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METHODOLOGICAL INCONSISTENCIES IN EPIDEMIOLOGICAL
STUDIES OF GDM
DIAGNOSTIC OGTT
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DIFFERENCE IN SCREENING THRESHOLD VALUES AND
ETHNIC DIFFERENCES IN THE RATE OF GDM
Author Site Threshold for OGTT Race
Prevalence Green S. F
gt150mg/dl White
1.6 Black 1.7
Hispanic 4.2 Berkowitz New York ?
135mg/dl White 2.3
Black 3.7 Hispanic
4.1 Dooley Chicago ? 130mg/dl
White 2.7 Black
3.3 Hispanic 4.4
50g-1hr, 100g-3 hr OGTT
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RESEARCH AREA
Maternal

• High Risk for PIH
• High Risk for DM

Offspring

• High Risk for birth complications
• High Risk for Obesity
• High Risk for IGT/DM
• Potential Risk for the future Hypertension

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Risk Factors for DM after GDM

• Impaired ß-cell function
• Higher PIBW
• Family history (30 M, 11 F)

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Overview Minor adverse health effects for
offspring
Normal GDM DM P
Birth Wt (g) 330364 364951 384972
lt0.01 Macrosomia() 8 36 47 lt0.01 C-S
5 10 14 lt0.01 Hypoglycemia
2 28 52 lt0.01 Hypocalcemia 0 4
7 lt0.01 Hyperbilirubinemia 15 23 21 lt0.01 Polycy
themia 0 7 11 lt0.01 Cord C-Pep 1.180.1
2.070.12 2.980.22 lt0.01 Cord Glu 1003.6
1032.9 1145.5 lt0.01
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MACROSOMIA
GDM Non-diabetic p-value
Birth Wt (g) 3512711 3333479
lt0.05 LGA 40.4 13.7
lt0.001 Macrosomia() 32.0 11.0
lt0.01
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OverviewMajor adverse health effects for
offspring
Normal DM
CNS 6.4 18.4 Congenital heart
disease 7.5 21.0 Respiratory
disease 2.9 7.9 Intestinal
atresia 0.6 2.6 Anal atresia 1.0 2.6
Renal Urinary defect 3.1 11.8 Upper limb
deficiences 2.3 3.9 Lower limb
deficiences 1.2 6.6 Upper Lower
spine 0.1 6.6 Caudal dysgenesis 0.1 5.3
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NEONATAL COMPLICATIONS
DM GDM Normal p-value
T. hypoglycemia() 52 28 3 lt0.01 P.
hypoglycemia() 6 2
0 lt0.01 Hypocalcemia() 5 5
0 lt0.01 Hyperbilirubinemia()
21 23 15 lt0.01 Trans tachypnea() 5 2
0 lt0.01 Polycythemia() 11 7
0 lt0.01 RDS() 5 2
0 lt0.01IUGR() 2 1 0 lt0.05
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ONGOING GDM EPIDEMIOLOGIC STUDIES Prevalence
Study

• Study Sites
• Chicago
• Cheil Samsung
• Ajou University Hospital

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METHODOLOGY
SCREENING
50g / 1 hr at 24-28 weeks gestation ?130
mg/dl requires 100g, 3 hr OGTT
DIAGNOSTIC OGTT
Fasting (105 mg/dl)
1 hour (190 mg/dl)
2 hour (165 mg/dl)
3 hour (145 mg/dl)
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ONGOING GDM EPIDEMIOLOGIC STUDIES Prevalence
Study
Prevalence of GDM
SITE RACE PREVALENCE
Chicago White 2.7 Black 3.3 Hispanic
4.4 Korean American 4.5 -13.6 Seoul Korean
2.2 Suwon Korean 5.0
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LONGITUDINAL STUDY OF GDM
Site and Measurements

• Anthropometric
• Demographic
• 75gm-2 hr OGTT
• Stress
• Diet
• BIP
• Lipid Profile

• Ajou University Hospital
• Samsung Cheil General
• Cha Hospital
• Il-Sin Christian Hospital

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LONGITUDINAL STUDY OF GDM
Standardization

• Skin fold caliper
• Questionnaire
• BIP (GIF-891DX)
• Insulin assay

• Inter-Variation (0.97-0.98)
• Intra-Variation (cv0.23-0.38)
• Sampling Tube - Device

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LONGITUDINAL STUDY OF GDM

• GDM screening ??
• Maternal follow-up ??
• Offspring follow-up

Projects
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SUCCESS TO THE PROJECT
Dept. of Prev. Med.
Center for Clinical Epidemiology
Dept. of Ob-Gyn
Dept. of Endocr.