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 macrosomia, 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 Black Hispanic White Black Hispanic White Black Hispanic

1.6 1.7 4.2 2.3 3.7 4.1 2.7 3.3 4.4

Berkowitz New York 135mg/dl

Dooley

Chicago

130mg/dl

* 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

0 0 10 20 30 40 50 60 70 80 90 100 A1

12

18

24

30

36

42

48

54

60

A2

B1

Risk Factors for DM after GDM

Impaired -cell function

Higher PIBW Family history (30% M, 11% F)

Overview:
Minor adverse health effects for offspring
Normal
Birth Wt (g)
Macrosomia(%) C-S

GDM
364951
36 10

DM
384972
47 14

P
<0.01
<0.01 <0.01

330364
8 5

Hypoglycemia
Hypocalcemia

2
0

28
4 23

52
7 21

<0.01
<0.01 <0.01

Hyperbilirubinemia 15

Polycythemia
Cord C-Pep Cord Glu

0
1.180.1 1003.6

7
2.070.12 1032.9

11

<0.01

2.980.22 <0.01 1145.5 <0.01

MACROSOMIA
GDM
Birth Wt (g)

Non-diabetic
3333479

p-value
<0.05

3512711

LGA

40.4%

13.7%

<0.001

Macrosomia(%) 32.0%

11.0%

<0.01

Overview:
Major adverse health effects for offspring
Normal
CNS Congenital heart disease Respiratory disease Intestinal atresia Anal atresia 6.4% 7.5% 2.9% 0.6% 1.0%

DM
18.4% 21.0% 7.9% 2.6% 2.6%

Renal & Urinary defect

Upper limb deficiences Lower limb deficiences

3.1%
2.3% 1.2%

11.8%
3.9% 6.6%

Upper + Lower spine

Caudal dysgenesis

0.1%
0.1%

6.6%
5.3%

NEONATAL COMPLICATIONS
DM
T. hypoglycemia(%) P. hypoglycemia(%) 52 6

GDM Normal
28 2 3 0

p-value
<0.01 <0.01

Hypocalcemia(%)

5
23 2

0
15 0

<0.01
<0.01 <0.01

Hyperbilirubinemia(%) 21 Trans tachypnea(%) 5

Polycythemia(%)
RDS(%) IUGR(%)

11
5 2

7
2 1

0
0 0

<0.01
<0.01 <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

Seoul Suwon

White Black Hispanic Korean American Korean Korean

2.7% 3.3% 4.4% 4.5 -13.6% 2.2% 5.0%

LONGITUDINAL STUDY OF GDM Site and Measurements Ajou University Hospital Samsung Cheil General Cha Hospital Il-Sin Christian Hospital
Anthropometric
Demographic 75gm-2 Stress Diet

hr OGTT

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