EPIDEMIOLOGY IN GESTATIONAL DIABETES

MELLITUS

MethodologyDr. Nam-Han ChoAssociate Professor of Preventive MedicineDirector of Center for Clinical EpidemiologyAjou University School of MedicineSuwon, Korea

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.

METHODOLOGICAL INCONSISTENCIES IN EPIDEMIOLOGICAL STUDIES OF GDM

• Glucose loads range from 50g to 100g

• Threshold values range from 125 mg/dl to 150 mg/dl

SCREENING

• Glucose loads range from 50g to 100g

• Two and Three hour tests are used

• Differences in diagnostic procedures and values

DIAGNOSTIC OGTT

DIFFERENCE IN SCREENING THRESHOLD VALUES AND ETHNIC DIFFERENCES IN THE RATE OF GDM

Author Site Threshold for OGTT Race Prevalence*

Green S. F >150mg/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

RESEARCH AREARESEARCH AREA

High Risk for PIH High Risk for DM

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

Offspring

Maternal

0

10

20

30

40

50

60

70

80

90

100

0 6 12 18 24 30 36 42 48 54 60

A1 A2 B1

Risk Factors for DM after GDM

Impaired ß-cell function

Higher PIBW

Family history (30% M, 11% F)

Overview: Minor adverse health effects for offspring

Birth Wt (g) 3303±64 3649±51 3849±72 <0.01

Macrosomia(%) 8 36 47 <0.01

C-S 5 10 14 <0.01

Hypoglycemia 2 28 52 <0.01

Hypocalcemia 0 4 7 <0.01

Hyperbilirubinemia 15 23 21 <0.01

Polycythemia 0 7 11 <0.01

Cord C-Pep 1.18±0.1 2.07±0.12 2.98±0.22 <0.01

Cord Glu 100±3.6 103±2.9 114±5.5 <0.01

Normal GDM DM P

MACROSOMIA

Birth Wt (g) 3512±711 3333±479 <0.05

LGA 40.4% 13.7% <0.001

Macrosomia(%) 32.0% 11.0% <0.01

GDM Non-diabetic p-value

Overview:Major adverse health effects for offspring

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%

Normal DM

NEONATAL COMPLICATIONS

T. hypoglycemia(%) 52 28 3 <0.01

P. hypoglycemia(%) 6 2 0 <0.01

Hypocalcemia(%) 5 5 0 <0.01

Hyperbilirubinemia(%) 21 23 15 <0.01

Trans tachypnea(%) 5 2 0 <0.01

Polycythemia(%) 11 7 0 <0.01

RDS(%) 5 2 0 <0.01

IUGR(%) 2 1 0 <0.05

DM GDM Normal p-value

ONGOING GDM EPIDEMIOLOGIC STUDIES :Prevalence Study

Study Sites Chicago Cheil Samsung Ajou University Hospital

METHODOLOGY

50g / 1 hr at 24-28 weeks gestation

130 mg/dl requires 100g, 3 hr OGTT

Fasting (105 mg/dl)

1 hour (190 mg/dl)

3 hour (145 mg/dl)

SCREENING

DIAGNOSTIC OGTT

2 hour (165 mg/dl)

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%

LONGITUDINAL STUDY OF GDM

Ajou University HospitalAjou University Hospital Samsung Cheil GeneralSamsung Cheil General Cha Hospital Cha Hospital Il-Sin Christian HospitalIl-Sin Christian Hospital

AnthropometricAnthropometric DemographicDemographic 75gm-2 hr OGTT75gm-2 hr OGTT StressStress DietDiet BIPBIP Lipid ProfileLipid Profile

Site and Measurements

LONGITUDINAL STUDY OF GDM

Skin fold caliper Skin fold caliper QuestionnaireQuestionnaire BIP (GIF-891DX)BIP (GIF-891DX) Insulin assayInsulin assay

Inter-Variation (0.97-0.98)Inter-Variation (0.97-0.98) Intra-Variation (cv=0.23-0.38%)Intra-Variation (cv=0.23-0.38%) Sampling Tube - DeviceSampling Tube - Device

Standardization

LONGITUDINAL STUDY OF GDM

GDM screening GDM screening

Maternal follow-up Maternal follow-up

Offspring follow-upOffspring follow-up

Projects

SUCCESS TO THE PROJECT

Dept. of Prev. Med.

Dept. of Endocr. Dept. of Ob-Gyn

Center for Clinical Epidemiology