Gestational Diabetes, screening, diagnosis and prognosis

Research output: ThesisDoctoral Thesis (compilation)

Abstract

Gestational diabetes (GD) is still a nonentity disease. There is no worldwide consensus how to define it or whether it is harmful to the woman or fetus. Therefore, from an ethical point of view, it is uncertain whether one should try to identify it. Since 1991, all pregnant women in Lund are offered a 75g oral glucose tolerance test (OGTT) at 27 – 28 weeks of pregnancy. In Sweden, the definition of GD is a 2-hour glucose value in capillary whole blood, at a 75g OGTT, of at least 9.0 mmol/l. In the materials from Lund, the upper 2 standard deviation limit in the distribution of 2-hour glucose values at OGTT is 8.3 mmol/l. Increased rates of Caesarean section and infant macrosomia were found even in the “sub GD” region (7.8 mmol/l – 8.9 mmol/l), suggesting that the limit of 7.8 mmol/l for impaired glucose tolerance, set by World Health Organisation, is more relevant from a clinical point of view. The Swedish Medical Birth Registry was used to identify 3,958 women with pregnancies complicated by GD in 1987–92. Their previous pregnancy outcomes were compared with those of 7,916 controls without a diagnosis of GD. A significantly increased risk of previous intrauterine death (OR 1.56) was found. Many of the GD women probably had an undetected GD in the previous pregnancy. The 8,684 children born in 1987–97 to women with GD in Sweden were significantly more often hospitalised during their first decade of life than the 1,213,957 controls but less often than the 3,874 children to women with pregestational diabetes. Congenital defects, neurological problems, accidents, and infections were the reasons for the increased hospital care rate in both groups. The increased rate of accidents may be due to neurological damage and it can be speculated that increased glucose values during pregnancy may contribute to infant brain damage. All women with GD in Lund, 1.2 % of all pregnant women, were offered another OGTT one year post partum. Then, 9.2% had diabetes mellitus (2 hour glucose value > 11.0 mmol/l) and another 21.8% had impaired glucose tolerance (7.8–11.0 mmol/l). No specific symptoms or factors were found, except the 2hour glucose value at the diagnostic OGTT, which could predict future development of diabetes. Thorough information and guidance to individuals at the risk of developing diabetes may lower their risk to develop diabetes mellitus and its complications. Today the diagnosis of diabetes mellitus type 2 is often not made until complications have occurred. Then the diabetes may have been undetected for several years.

Details

Authors
  • Anders E Åberg
Organisations
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Obstetrics, Gynecology and Reproductive Medicine

Keywords

  • Obstetrik, reproduction, sexualitet, Gestational diabetes, sexuality, screening, diagnosis, gynekologi, prognosis, Obstetrics, andrology, gynaecology, reproduktion, andrologi
Original languageEnglish
QualificationDoctor
Awarding Institution
Supervisors/Assistant supervisor
  • [unknown], [unknown], Supervisor, External person
Award date2001 Mar 22
Publisher
  • Department of Obstetrics and Gynecology, Lund University
Publication statusPublished - 2001
Publication categoryResearch

Bibliographic note

Defence details Date: 2001-03-22 Time: 10:15 Place: The main aula at the University Hospital External reviewer(s) Name: Damm, Peter Title: MD, PhD Affiliation: Rigshospital, Copenhagen --- I: Glucose levels and insulin secretion during a 75 gglucose challenge test in normal pregnancy. Carl-David Agardh, Anders Åberg and Nils Nordén. J Int Med 1996:240:303-309.II: Impaired glucose tolerance during pregnancy isassociated with increased fetal mortality in preceding sibs. Anders Åberg, Håkan Rydhström, Bengt Källén and Karin Källén. Acta Obstet GynecolScand 1997:76:212-217.III: Impaired glucose tolerance associated with adversepregnancy outcome. A population-based study in southern Sweden. Anders Åberg, Håkan Rydhström and Anders Frid. Am J Obstet Gynecol.2001;184:77-83IV: Predictive factors to develop diabetes mellitus inwomen with gestational diabetes. Anders Åberg, Eva Jönsson, Inger Eskilsson, Mona Landin-Olsson and Anders Frid. Submitted.V: Association between maternal preexisting orgestational diabetes and health problems of their children. Anders Åberg and Lena Westbom. Acta Paediatr. In press VI: Congenital malformations among infants whose mothers had gestational diabetes or preexisting diabetes. Anders Åberg, Lena Westbom and Bengt Källén. Early Human Development. In press.