EPIDEMIOLOGY IN GESTATIONAL DIABETES MELLITUS (PowerPoint)

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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
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
DIAGNOSTIC OGTT
 • Glucose loads range from 50g to 100g
 • Two and Three hour tests are used
 • Differences in diagnostic procedures and values
   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 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
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
                  Normal      GDM         DM         P
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

               GDM      Non-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
                           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%
         NEONATAL COMPLICATIONS

                     DM    GDM Normal   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     <0.01
IUGR(%)                2    1     0     <0.05
ONGOING GDM EPIDEMIOLOGIC STUDIES
          :Prevalence Study


      Study Sites
       Chicago
       Cheil Samsung
       Ajou University Hospital
        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)
  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
            Site and Measurements

 Ajou University Hospital     Anthropometric

 Samsung Cheil General        Demographic

 Cha Hospital                 75gm-2 hr   OGTT
 Il-Sin Christian Hospital    Stress
                               Diet
                               BIP
                               Lipid Profile
LONGITUDINAL STUDY OF GDM
       Standardization

       Skin fold caliper
       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
            Projects


        GDM screening    


        Maternal follow-up 


        Offspring follow-up
           SUCCESS TO THE PROJECT


                   Dept. of Prev. Med.



                   Center for Clinical
                     Epidemiology

Dept. of Endocr.                         Dept. of Ob-Gyn