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. GESTATIONAL DIABETES MELLITUS.

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Epidemiology in gestational diabetes mellitus
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


Gestational diabetes mellitus
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

SCREENING

  • Glucose loads range from 50g to 100g

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

  • Glucose loads range from 50g to 100g

  • Two and Three hour tests are used

  • Differences in diagnostic procedures and values

METHODOLOGICAL INCONSISTENCIES IN EPIDEMIOLOGICAL STUDIES OF GDM

DIAGNOSTIC OGTT


Difference in screening threshold values and ethnic differences in the rate of gdm
DIFFERENCE IN SCREENING THRESHOLD VALUES AND ETHNIC DIFFERENCES IN THE RATE OF GDM

Author Site Threshold for OGTT Race Prevalence*

Green S. F >150mg/dlWhite 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 area
RESEARCH AREA DIFFERENCES IN THE RATE OF GDM

Maternal

  • High Risk forPIH

  • High Risk forDM

Offspring

  • High Risk for birthcomplications

  • High Risk forObesity

  • High Risk forIGT/DM

  • Potential Risk for the futureHypertension


Risk factors for dm after gdm
Risk Factors for DM after GDM DIFFERENCES IN THE RATE OF GDM

  • Impaired ß-cell function

  • Higher PIBW

  • Family history (30% M, 11% F)


Overview minor adverse health effects for offspring
Overview: DIFFERENCES IN THE RATE OF GDMMinor adverse health effects for offspring

NormalGDMDMP

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


Macrosomia
MACROSOMIA DIFFERENCES IN THE RATE OF GDM

GDMNon-diabetic p-value

Birth Wt (g) 3512±711 3333±479 <0.05

LGA 40.4% 13.7% <0.001

Macrosomia(%) 32.0% 11.0% <0.01


Overview major adverse health effects for offspring
Overview: DIFFERENCES IN THE RATE OF GDMMajor adverse health effects for offspring

NormalDM

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%


Neonatal complications
NEONATAL COMPLICATIONS DIFFERENCES IN THE RATE OF GDM

DMGDMNormal p-value

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 <0.01IUGR(%) 2 1 0 <0.05


Ongoing gdm epidemiologic studies prevalence study
ONGOING GDM EPIDEMIOLOGIC STUDIES : DIFFERENCES IN THE RATE OF GDMPrevalence Study

Study Sites

  • Chicago

  • Cheil Samsung

  • Ajou University Hospital


Methodology
METHODOLOGY DIFFERENCES IN THE RATE OF GDM

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)


Ongoing gdm epidemiologic studies prevalence study1
ONGOING GDM EPIDEMIOLOGIC STUDIES : DIFFERENCES IN THE RATE OF GDMPrevalence 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 Hospital DIFFERENCES IN THE RATE OF GDM

Samsung Cheil General

Cha Hospital

Il-Sin Christian Hospital

Anthropometric

Demographic

75gm-2 hr OGTT

Stress

Diet

BIP

Lipid Profile

LONGITUDINAL STUDY OF GDM

Site and Measurements


Longitudinal study of gdm1

Skin fold caliper DIFFERENCES IN THE RATE OF GDM

Questionnaire

BIP (GIF-891DX)

Insulin assay

Inter-Variation (0.97-0.98)

Intra-Variation (cv=0.23-0.38%)

Sampling Tube - Device

LONGITUDINAL STUDY OF GDM

Standardization


Longitudinal study of gdm2

GDM screening DIFFERENCES IN THE RATE OF GDM

Maternal follow-up 

Offspring follow-up

LONGITUDINAL STUDY OF GDM

Projects


Success to the project
SUCCESS TO THE PROJECT DIFFERENCES IN THE RATE OF GDM

Dept. of Prev. Med.

Center for Clinical

Epidemiology

Dept. of Ob-Gyn

Dept. of Endocr.


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