Early prediction of gestational diabetes mellitus in patients with a low risk of its development
AbstractThe aim of the study was to identify predictors of the risk of developing gestational diabetes mellitus (GDM) and to develop a model for mathematical prediction of probability of developing the disease in the first trimester of pregnancy, to evaluate its cost-effectiveness in patients with an initially low risk of developing GDM.
Material and methods. Within a prospective cohort study in the period 2018–2019, 1230 pregnant women registered up to 12 weeks were observed during pregnancy, childbirth and the postpartum period on the basis of the Nikulino Women’s Clinic. According to the inclusion criteria (consent to participation, age 20–34 years, single pregnancy, absence of a burdened gynecological history, bad habits and diseases of the endocrine system), 438 women were selected who, when being registered, in addition to the standard examination, according to the order of the Ministry of Health of the Russian Federation Nо. 572, the level of glycated hemoglobin (HbA1) was determined. At the end of gestation, the study group included 40 women with GDM [average age 29.1±2.4 years, average body mass index (BMI) – 26.8±2.4 kg/m2], the control group included 85 women with physiological pregnancy (26.4±2.3 years and 23.1±2.0 kg/m2, respectively).
Results. The frequency of GDM registration in the studied cohort was 9% (40 out of 438). A prognostic model P = 1/(1 + e-z) × 100% was developed, in which z = -54.8 + 0.19 × X1 + 0.89 × X2 + 4.3 × X3 + 5.92 × X4 – 0.2 × X5 – 0.17 × X6, where P is the probability of developing GDM (%), X1 – age of the woman (full years), X2 – BMI (kg/m2), X3 – serum glucose level (mmol/l), X4 – HbA1с level (%), X5 – CB level (ng/ml), X6 – blood hemoglobin level (g/l). Pregnant women had a risk of developing GDM at P≥50%. The most common conditions that complicated the course of pregnancy were anemia (4 times more common in women with GDM), preeclampsia (3.3 times more common in women with GDM), gestational hypertension (2.6 times more common in women with GDM). The prognostic model showed the possibility of reducing the expenditure of budgetary funds for pregnancy management with early prognosis and the profile of GDM (prenatal and postpartum hospitalization, peculiarities of labor management) by 47.0%.
Conclusion. Predictors of the risk of developing GDM are the age of a pregnant woman >28.5 years, BMI ≥24.4 kg/m2, glycated hemoglobin levels ≥4.85%, hemoglobin levels ≤109.5 g/l, serum iron levels ≤10.7 ng/ml. The development of GDM in pregnant women, as well as complications associated with it, increases budget expenditures by 32.0%. Increasing the efficiency of early identification of contingents of the probable development of the disease at its initially low risk makes it possible to prevent not only GDM, but also obstetric complications associated with it.
Keywords:gestational diabetes mellitus (GDM); venous plasma glucose; early prediction of GDM; economic efficiency
Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
For citation: Radzinskiy V.E., Epishkina-Minina A.A., Khamoshina M.B, Lebedeva M.G. Early prediction of gestational diabetes mellitus in patients with a low risk of its development. Akusherstvo i ginekologiya: novosti, mneniya, obuchenie [Obstetrics and Gynecology: News, Opinions, Training]. 2023; 11 (3): 38–43. DOI: https://doi.org/10.33029/2303-9698-2023-11-3-38-43 (in Russian)
References
1. Saravanan P.; Diabetes in Pregnancy Working Group; Maternal Medicine Clinical Study Group; Royal College of Obstetricians and Gynaecologists, UK. Gestational diabetes: opportunities for improving maternal and child health. Lancet Diabetes Endocrinol. 2020; 8: 793–800. DOI: https://doi.org/10.1016/S2213-8587(20)30161-3
2. O’Sullivan J.B., Mahan C.M. Criteria for the oral glucose tolerance test in pregnancy. Diabetes. 1964; 13: 278–85.
3. Xie W., Wang Y., Xiao S., Qiu L., Yu Y., Zhang Z. Association of gestational diabetes mellitus with overall and type specific cardiovascular and cerebrovascular diseases: systematic review and meta-analysis. BMJ. 2022; 378: e070244. DOI: https://doi.org/10.1136/bmj-2022-070244 Epub 2022 Sep 21.
4. Kaiser K., Nielsen M.F., Kallfa E., Dubietyte G., Lauszus F.F. Metabolic syndrome in women with previous gestational diabetes. Sci Rep. 2021; 11: 11558. DOI: https://doi.org/10.1038/s41598-021-90832-0
5. Retnakaran R., Shah B.R. Role of type 2 diabetes in determining retinal, renal, and cardiovascular outcomes in women with previous gestational diabetes mellitus. Diabetes Care. 2017; 40: 101–8. DOI: https://doi.org/10.2337/dc16-1400
6. Tocantins C., Diniz M.S., Grilo L.F., Pereira S.P. The birth of cardiac disease: mechanisms linking gestational diabetes mellitus and early onset of cardiovascular disease in offspring. WIREs Mech Dis. 2022; 14 (4): e1555. DOI: https://doi.org/10.1002/wsbm.1555
7. Chong H., Li J., Chen C., Wang W., Liao D., Zhang K. The diagnostic model for early detection of gestational diabetes mellitus and gestational diabetic nephropathy. J Clin Lab Anal. 2022; 36 (9): e24627. DOI: https://doi.org/10.1002/jcla.24627
8. Furse S., Koulman A., Ozanne S.E., Poston L., White S.L., Meek C.L. Altered lipid metabolism in obese women with gestational diabetes and associations with offspring adiposity. J Clin Endocrinol Metab. 2022; 107 (7): e2825–32. DOI: https://doi.org/10.1210/clinem/dgac206
9. Ye W., Luo C., Huang J., Li C., Liu Z., Liu F. Gestational diabetes mellitus and adverse pregnancy outcomes: systematic review and meta-analysis. BMJ. 2022; 377: e067946. DOI: https://doi.org/10.1136/bmj-2021-067946 Epub 2022 May 25.
10. Zhang S., Li N., Li W., et al. Increased gestational weight gain is associated with a higher risk of offspring adiposity before five years of age: a population-based cohort study. Diabetes Metab Syndr Obes. 2022; 15: 2353–63. DOI: https://doi.org/10.2147/DMSO.S374427 Epub 2022 Aug 8.
11. Modzelewski R., Stefanowicz-Rutkowska M.M., Matuszewski W., Bandurska-Stankiewicz E.M. Gestational diabetes mellitus – recent literature review. J Clin Med. 2022; 11 (19): 5736. DOI: https://doi.org/10.3390/jcm11195736 Epub 2022 Sep 28.
12. Wang H., Li N., Chivese T., Werfalli M., Sun H., Yuen L., et al. IDF Diabetes Atlas: Estimation of Global and Regional Gestational Diabetes Mellitus Prevalence for 2021 by International Association of Diabetes in Pregnancy Study Group’s Criteria. Diabetes Res Clin Pract. 2022; 183: 109050. DOI: https://doi.org/10.1016/j.diabres.2021.109050
13. McIntyre H.D., Catalano P., Zhang C., Desoye G., Mathiesen E.R., Damm P. Gestational diabetes mellitus. Nat Rev Dis Primers. 2019; 5: 47. DOI: https://doi.org/10.1038/s41572-019-0098-8
14. Kondracki A.J., Valente M.J., Ibrahimou B., Bursac Z. Risk of large for gestational age births at early, full and late term in relation to pre-pregnancy body mass index: mediation by gestational diabetes status. Paediatr Perinat Epidemiol. 2022; 36: 566–76. DOI: https://doi.org/10.1111/ppe.12809
15. Epishkina-Minina A., Khamoshina M. Gestational diabetes mellitus in young women: the contraversions of pathogenesis (abstract). Int J Gynecol Obstet. 2021; 155 (S2): 191.