Gestational diabetes mellitus: screening and diagnostic criteria in early pregnancy


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Gestational diabetes mellitus (GSD) is the most common complication of pregnancy. As one of the causes of perinatal and neonatal diseases, GSD presents a high risk of chronic metabolic and cardiovascular diseases to both the mother and her baby. Currently, the diagnosis of GSD is based on venous plasma glucose levels at the end of the second trimester of pregnancy and at the beginning of the third trimester. But it should be noted that medical interventions to correct hyperglycemia in these periods are not effective enough and are frequently late to prevent adverse pregnancy outcomes in the mother and fetus. Early detection of GSD and, consequently, timely correction of carbohydrate metabolism disorders contribute to the optimization of perinatal outcomes. That is why the problem of diagnosing carbohydrate metabolism disorders in early pregnancy is particularly relevant. This paper reviews the data currently available in the literature on GSD screening and early diagnosis. Conclusion. Further investigations are needed for the prediction and early diagnosis of GSD to determine the most appropriate strategy for the clinical management of women with carbohydrate metabolism disorders.

Full Text

Restricted Access

About the authors

M. E Abramova

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: m_abramova@oparina4.ru
graduate student in the Department of Pregnancy Pathology 117997, Russia, Moscow, Akademika Oparina str., 4

Z. S Khodzhaeva

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: zkhodjaeva@mail.ru
M.D., Professor, Deputy Director of Obstetrics Institute 117997, Russia, Moscow, Akademika Oparina str., 4

K. A Gorina

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: k_gorina@oparina4.ru
PhD, Junior researcher at the Department of Pregnancy Pathology 117997, Russia, Moscow, Akademika Oparina str., 4

K. T Muminova

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: k_muminova@oparina4.ru
PhD, Junior researcher of the Department of Pregnancy Pathology 117997, Russia, Moscow, Akademika Oparina str., 4

K. V Goryunov

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: k_gorunov@oparina4.ru
PhD, researcher at the Department of Cell Technologies 117997, Russia, Moscow, Akademika Oparina str., 4

A. K Ragozin

N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia

Email: a_ragozin@mail.ru
MD, PhD, assistant professor 117997, Russia, Moscow, Ostrovityanova str., 1

D. N Silachev

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: d_silachev@oparina4.ru
PhD, Head of the Department of Cell Technologies 117997, Russia, Moscow, Akademika Oparina str., 4

References

  1. Сухих Г.Т., Краснопольский В.И., Рунихина Н.К. Переход на новый уровень ведения гипертензивных и метаболических осложнений при беременности: современные критерии диагностики гестационного сахарного диабета. Акушерство и гинекология. 2013; 3: 5-9
  2. American Diabetes Association. Professional Practice Committee: Standards of Medical Care in Diabetes-2020. Diabetes Care. 2020; 43 (Suppl. 1): S3-S3. https://doi.org/10.2337/dc20-Sppc.
  3. Pastorino S., Bishop T., Crozier S.R., Granstrom C., Kordas K., Kupers L.K. et al. Associations between maternal physical activity in early and late pregnancy and offspring birth size: remote federated individual level meta-analysis from eight cohort studies. BJOG. 2019; 126(4): 459-70. https://dx.doi.org/10.1111/1471-0528.15476.
  4. International Diabetes Federation. IDF Diabetes atlas. 8th ed. Brussels, Belgium: International Diabetes Federation; 2017.
  5. Дедов И.И., Шестакова М.В., Майоров А.Ю. Алгоритмы специализированной медицинской помощи больным сахарным диабетом. М.: Медицина; 2019.
  6. Committee on Practice Bulletins - Obstetrics ACOG practice bulletin no 190: gestational diabetes mellitus. Obstet. Gynecol. 2018; 131(2): e49-e64. https:// dx.doi.org/10.1097/AOG.0000000000002501.
  7. Berger H., Gagnon R., Sermer M., Basso M., Bos H., Brown R.N. et al. Diabetes in pregnancy. J. Obstet. Gynaecol. Can. 2016; 38(7): 667-79. https:// dx.doi.org/10.1016/j.jogc.2016.04.002.
  8. Gestational Diabetes. Current Care Guidelines. Working group set up by the Finnish Medical Society Duodecim, the Finnish Diabetes Associations Medical Advisory Board, a the Finnish Society of Obstetrics and Gynaecology. Helsinki: The Finnish Medical Society Duodecim; 2013.
  9. American Diabetes Association. Classification and diagnosis of diabetes: standards of medical care in diabetes - 2020. Diabetes Care. 2020; 43(Suppl. 1): S14-31. https://dx.doi.org/10.2337/dc20-S002.
  10. Kharroubi A.T., Darwish H.M. Diabetes mellitus: The epidemic of the century. World J. Diabetes. 2015; 6(6): 850-67. https://dx.doi.org/10.4239/wjd. v6.i6.850.
  11. Петрухин В.А., Бурумкулова Ф.Ф., Титова Т.В., Головненко М.А., Котов Ю.Б. Распространенность гестационного сахарного диабета в Московской области: результаты скрининга. Российский вестник акушера гинеколога. 2012; 12(4): 81-4.
  12. Webber J., Charlton M., Johns N. Diabetes in pregnancy: management of diabetes and its complications from preconception to the postnatal period (NG3). Br. J. Diabetes. 2015; 15(3): 107-11.
  13. Moyer V.A.; U.S. Preventive Services Task Force. Screening for gestational diabetes mellitus: U.S. Preventive Services Task Force recommendation statement. Ann. Intern. Med. 2014; 160(6): 414-20. https://dx.doi. org/10.7326/M13-2905.
  14. Lavery J.A., Friedman A.M., Keyes K.M., Wright J.D., Ananth C.V. Gestational diabetes in the United States: temporal changes in prevalence rates between 1979 and 2010. BJOG. 2017; 124(5): 804-13. https://dx.doi.org/10.1111/ 1471-0528.14236.
  15. Xiao Y., Chen R., Chen M., Luo A., Chen D., Liang Q. et al. Age at menarche and risks of gestational diabetes mellitus: a meta-analysis of prospective studies. Oncotarget. 2017; 9(24): 17133-40. https://dx.doi.org/10.18632/ oncotarget.23658.
  16. Dos Santos R.A., Madi J.M., da Silva E.R., Vergani D.O.P., de Araujo B.F., Garcia R.M.R. Gestational diabetes in the population served by Brazilian Public Health Care. Prevalence and risk factors. Rev. Bras. Ginecol. Obstet. 2020; 42(1): 12-8. https://dx.doi.org/10.1055/s-0039-1700797.
  17. Mc Guane J.T., Grlj L., Peek M.J. Obesity, gestational diabetes and macrosomia are associated with increasing rates of early-term induction of labour at The Canberra Hospital. Aust. N. Z. J. Obstet. Gynaecol. 2019; 59(2): 215-20. https:// dx.doi.org/10.1111/ajo.12820.
  18. Peaceman A.M., Clifton R.G., Phelan S. Lifestyle interventions limit gestational weight gain in women with overweight or obesity: LIFE-moms prospective metaanalysis. Obesity (Silver Spring). 2018; 26(9): 1396-404.
  19. Zhang H, Wang Q, He S., Wu K., Ren M., Dong H. et al. Ambient air pollution and gestational diabetes mellitus: A review of evidence from biological mechanisms to population epidemiology. Sci. Total Environ. 2020; 719: 137349. https://dx.doi.org/10.1016/j.scitotenv.2020.137349.
  20. Izci Balserak B, Pien G.W, Prasad B., Mastrogiannis D., Park C., Quinn L.T. et al. Obstructive sleep apnea is associated with newly-diagnosed gestational diabetes mellitus. Ann. Am. Thorac. Soc. 2020; 17(6): 754-61. https:// dx.doi.org/10.1513/AnnalsATS.201906-473OC.
  21. Retnakaran R., Kramer C., Chang Y., Kew S., Hanley A., Connelly P. et al. Fetal sex and maternal risk of gestational diabetes mellitus: The impact of having a boy. Diabetes Care. 2015; 38(5): 844-51. https://dx.doi.org/10.2337/dc14-2551.
  22. Kouhkan A., Khamseh M.E., Moini A., Pirjani R., Valojerdi A.E., Arabipoor A. et al. Predictive factors of gestational diabetes in pregnancies following assisted reproductive technology: a nested case-control study. Arch. Gynecol. Obstet. 2018; 298(1): 199-206. https://dx.doi.org/10.1007/s00404-018-4772-y.
  23. Scholtens D.M., Kuang A., Lowe L.P., Hamilton J., Lawrence J.M., Lebenthal Y. et al. Hyperglycemia and Adverse Pregnancy Outcome Follow-up Study (HAPO FUS): maternal glycemia and childhood glucose metabolism. Diabetes Care. 2019; 42(3): 381-92. https://dx.doi.org/10.2337/dc18-2021.
  24. Li X., Zhang W., Lin J., Liu H., Yang Z., Teng Y. et al. Risk factors for adverse maternal and perinatal outcomes in women with preeclampsia: analysis of 1396 cases. J. Clin. Hypertens. (Greenwich). 2018; 20(6): 1049-57. https:// dx.doi.org/10.1111/jch.13302.
  25. Miller N.E., Curry E., Laabs S.B., Manhas M., Angstman K. Impact of gestational diabetes diagnosis on concurrent depression in pregnancy. J. Psychosom. Obstet. Gynaecol. 2020; Jan 7; 1-4. https://dx.doi.org/10.1080/ 0167482X.2019.1709816.
  26. Hartling L., Dryden D.M., Guthrie A., Muise M., Vandermeer B., Donovan L. Benefits and harms of treating gestational diabetes mellitus: a systematic review and meta-analysis for the U.S. Preventive Services Task Force and the National Institutes of Health Office of Medical Applications of research. Ann. Intern. Med. 2013; 159(2): 123-9. https://dx.doi.org/10.7326/ 0003-4819-159-2-201307160-00661.
  27. Brown J., Grzeskowiak L., Williamson K., Downie M.R., Crowther C.A. Insulin for the treatment of women with gestational diabetes. Cochrane Database Syst. Rev. 2017; (11): CD012037. https://dx.doi.org/10.1002/14651858.CD012037.pub2.
  28. American Diabetes Association. Standards of medical care in diabetes-2014. Diabetes Care. 2014; 37(Suppl. 1): S14-80.
  29. Egan A.M., Hod M., Mahmood T., Dunne F.P. Perspectives on diagnostic strategies for hyperglycaemia in pregnancy - dealing with the barriers and challenges: Europe. Diabetes Res. Clin. Pract. 2018; 145: 67-72. https://dx.doi. org/10.1016/j.diabres.2018.06.001.
  30. McIntyre H.D., Sacks D.A., Barbour L.A., Feig D.S., Catalano P.M., Damm P. et al. Issues with the diagnosis and classification of hyperglycemia in early pregnancy. Diabetes Care. 2016; 39(1): 53-4. https://dx.doi.org/10.2337/dc15-1887.
  31. World Health Organization. Diagnostic c.riteria and classification of hyperglycaemia first detected in pregnancy: A World Health Organization Guideline. 2013.
  32. Hod M., Kapur A., Sacks D.A., Hadar E., Agarwal M., Di Renzo G.C. et al. The International Federation of Gynecology and Obstetrics (FIGO) Initiative on gestational diabetes mellitus: A pragmatic guide for diagnosis, management, and care. Int. J. Gynaecol. Obstet. 2015; 131(Suppl. 3): S173-211. https:// dx.doi.org/10.1016/S0020-7292(15)30033-3.
  33. National Collaborating Centre for Women’s and Children’s Health (UK) Diabetes in pregnancy: management of diabetes and its complications from preconception to the postnatal period. London: National Institute for Health and Care Excellence (UK); 2015.
  34. Linee Guida Gravidanza Fisiologica. Sistema nazionale per le linee guida dell’Istituto Superiore di Sanita. 2012.
  35. Associazione Medici Diabetologi - Societa Italiana di Diabetologia. Standard italiani per la cura del diabete mellito. 27 April 2018.
  36. Bianchi C., De Gennaro G., Romano M., Battini L., Aragona M., Corfini M. et al. Italian national guidelines for the screening of gestational diabetes: time for a critical appraisal? Nutr. Metab. Cardiovasc. Dis. 2017; 27(8): 717-22. https:// dx.doi.org/10.1016/j.numecd.2017.06.010.
  37. Yang H.X. Diagnostic criteria for gestational diabetes mellitus (WS 331-2011). Chin. Me. J. (Engl). 2012; 125(7): 1212-3.
  38. Seshiah V., Balaji V., Shah S.N., Joshi S., Das A.K., Sahay B.K. et al. Diagnosis of gestational diabetes mellitus in the community. J. Assoc. Physicians India. 2012; 60: 15-7.
  39. Zhu W.W., Yang H.X., Wei Y.M., Yan J., Wang Z.L., Li X.L. et al. Evaluation of the value of fasting plasma glucose in the first prenatal visit to diagnose gestational diabetes mellitus in China. Diabetes Care. 2013; 36(3): 586-90. https:// dx.doi.org/10.2337/dc12-1157.
  40. Wang C., Zhu W., Wei Y., Su R., Feng H., Lin L., Yang H. The predictive effects of early pregnancy lipid profiles and fasting glucose on the risk of gestational diabetes mellitus stratified by body mass index. J. Diabetes Res. 2016; 2016: 3013567. https://dx.doi.org/10.1155/2016/3013567.
  41. Mane L., Flores-Le Roux J.A., Pedro-Botet J., Gortazar L., Chillaron J.J., Llaurado G. et al. Is fasting plasma glucose in early pregnancy a better predictor of adverse obstetric outcomes than glycated haemoglobin? Eur. J. Obstet. Gynecol. Reprod. Biol. 2019; 234: 79-84. https://dx.doi.org/10.1016/j.ejogrb.2018.12.036.
  42. Meek C.L., Murphy H.R., Simmons D. Random plasmaglucose in early pregnancy is a better predictor of gestational diabetes diagnosis than maternal obesity. Diabetologia. 2016; 59(3): 445-52. https://dx.doi.org/10.1007/ s00125-015-3811-5.
  43. Harreiter J., Simmons D., Desoye G., Corcoy R., Adelantado J.M., Devlieger R. et al. IADPSG and WHO 2013 gestational diabetes mellitus criteria identify obese women with marked insulin resistance in early pregnancy. Diabetes Care. 2016; 39(7): e90-2. https://dx.doi.org/10.2337/dc16-0200.
  44. Jokelainen M., Stach-Lempinen B., Rono K., Nenonen A., Kautiainen H., Teramo K., Klemetti M.M. Oral glucose tolerance test results in early pregnancy: A Finnish population-based cohort study. Diabetes Res. Clin. Pract. 2020; 162: 108077. https://dx.doi.org/10.1016/j.diabres.2020.108077.
  45. Дедов И.И., Сухих Г.Т., Краснопольский В.И., ред. Гестационный сахарный диабет: диагностика, лечение и послеродовое наблюдение. Клинические рекомендации (протокол). М.; 2014.
  46. Fong A., Serra A.E., Gabby L., Wing D.A., Berkowitz K.M. Use of hemoglobin A1c as an early predictor of gestational diabetes mellitus. Am. J. Obstet. Gynecol. 2014; 211(6): 641. E1-7. https://dx.doi.org/10.1016/ j.ajog.2014.06.016.
  47. Hughes R.C.E., Moore M.P., Gullam J.E., Mohamed K., Rowan J. An early pregnancy HbA1c >5.9% (41 mmol/mol) is optimal for detecting diabetes and identifies women at increased risk of adverse pregnancy outcomes. Diabetes Care. 2014; 37: (11): 2953-9. https://dx.doi.org/10.2337/dc14-1312.
  48. Amylidi S., Mosimann B., Stettler C., Fiedler G.M., Surbek D., Raio L. First-trimester glycosylated hemoglobin in women at high risk for gestational diabetes. Acta Obstet. Gynecol. Scand. 2016; 95(1): 93-7. https://dx.doi.org/10.1111/ aogs.12784.
  49. Dereke J., Nilsson C., Strevens H., Landin-Olsson M., Hillman M. Pregnancy-associated plasma protein-A2 levels are increased in early-pregnancy gestational diabetes: a novel biomarker for early risk estimation. Diabet. Med. 2020; 37(1): 131-7. https://dx.doi.org/10.1111/dme.14088.
  50. Alamolhoda S.H., Yazdkhasti М., Namdari M., Zakariayi S.J., Mirabi P. Association between C-reactive protein and gestational diabetes: a prospective study. J. Obstet. Gynaecol. 2020; 40(3): 349-53. https://dx.doi.org/10.1080/01 443615.2019.1631767.
  51. Yadav A, Kataria M.A., Saini V., Yadav A. Role of leptin and adiponectin in insulin resistance. Clin. Chim. Acta. 2013; 417: 80-4. https://dx.doi. org/10.1016/j.cca.2012.12.007.
  52. Iliodromiti S., Sassarini J., Kelsey T.W., Lindsay R.S., Sattar N., Nelson S.M. Accuracy of circulating adiponectin for predicting gestational diabetes: a systematic review and meta-analysis. Diabetologia. 2016; 59(4): 692-9. https:// dx.doi.org/10.1007/s00125-015-3855-6.
  53. Guo W., Wang H., Liu Q., Yuan Y., Jing Y., Yang X. Analysis of the correlation of gestational diabetes mellitus and peripheral ferritin with iron levels in early pregnancy. Minerva Endocrinol. 2019; 44(1): 91-6. https://dx.doi.org/10.23736/ S0391-1977.18.02734-7.
  54. Ma D., Luque-Fernandez M.A., Bogdanet D., Desoye G., Dunne F., Halperin J.A. Plasma glycated CD59 predicts early gestational diabetes and large for gestational age newborns. J. Clin. Endocrinol. Metab. 2020; 105(4): e1033-40. https:// dx.doi.org/10.1210/clinem/dgaa087.
  55. Sarker S., Scholz-Romero K., Perez A., Illanes S.E., Mitchell M.D., Rice G.E., Salomon C. Placenta-derived exosomes continuously increase in maternal circulation over the first trimester of pregnancy. J. Transl. Med. 2014; 12: 204. https://dx.doi.org/10.1186/1479-5876-12-204.
  56. Salomon C., Scholz-Romero K., Sarker S., Sweeney E., Kobayashi M., Correa P. et al. Gestational diabetes mellitus is associated with changes in the concentration and bioactivity of placenta-derived exosomes in maternal circulation across gestation. Diabetes. 2016; 65(3): 598-609. https://dx.doi.org/10.2337/ db15-0966.
  57. Monteiro L.J., Varas-Godoy I.D., Monckeberg M., Realini O., Herna M., Rice G., Romero R. Oral extracellular vesicles in early pregnancy can identify patients at risk of developing gestational diabetes mellitus. PLoS One. 2019; 14(6): e0218616. https://dx.doi.org/10.1371/journal.pone.0218616.
  58. Guarino E., Delli Poggi C., Grieco G.E., Cenci V., Ceccarelli E., Crisci I. et al. Circulating microRNAs as biomarkers of gestational diabetes mellitus: Updates and perspectives. Int. J. Endocrinol. 2018; 2018: 6380463. https:// dx.doi.org/10.1155/2018/6380463.
  59. Zhu Y., Tian F., Li H., Zhou Y., Lu J., Ge Q. Profiling maternal plasma microRNA expression in early pregnancy to predict gestational diabetes mellitus. Int. J. Gynaecol. Obstet. 2015; 130(1): 49-53. https://dx.doi.org/10.1016/ j.ijgo.2015.01.010.
  60. Yoffe L., Polsky A., Gilam A., Raff C., Mecacci F., Ognibene A. et al. Early diagnosis of gestational diabetes mellitus using circulating micro RNAs. Eur. J. Endocrinol. 2019; 181(5): 565-77. https://dx.doi.org/10.1530/EJE-19-0206.
  61. Horie I., Kawasaki E., Sakanaka A., Takashima M., Maeyama M., Ando T. et al. Efficacy of nutrition therapy for glucose intolerance in Japanese women diagnosed with gestational diabetes based on IADPSG criteria during early gestation. Diabetes Res. Clin. Pract. 2015; 107(3): 400-6. https:// dx.doi.org/10.1016/j.diabres.2014.12.011.
  62. Sovio U., Murphy H.R., Smith G.C. Accelerated fetal growth prior to diagnosis of gestational diabetes mellitus: A prospective cohort study of nulliparous women. Diabetes Care. 2016; 39(6): 982-7. https://dx.doi.org/10.2337/dc16-0160.
  63. Abe be K.Z., Scifres C., Simhan H.N., Day N., Catalano P., Bodnar L.M. et al. Comparison of two screening strategies for gestational diabetes (GDM2) trial: design and rationale. Contemp. Clin. Trials. 2017; 62: 43-9. https:// dx.doi.org/10.1016/j.cct.2017.08.012.
  64. Tieu J., McPhee A.J., Crowther C.A., Middleton P., Shepherd E. Screening for gestational diabetes mellitus based on different risk profiles and settings for improving maternal and infant health. Cochrane Database Syst. Rev. 2017; (8): CD007222. https://dx.doi.org/10.1002/14651858.CD007222.pub4.
  65. Sovio U., Murphy H.R., Smith G.C. Accelerated fetal growth prior to diagnosis of gestational diabetes mellitus: a prospective cohort study of nulliparous women. Diabetes Care. 2016; 39(6): 982-7. https://dx.doi.org/10.2337/dc16-0160.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies