Poster Australasian Diabetes in Pregnancy Annual Scientific Meeting 2013

Early Prevalence and Predictors of Gestational Diabetes in a High Risk Cohort (#117)

Arianne Sweeting 1 , Roslyn Muirhead 2 3 , Shannon Overs 2 3 , Glynis Ross 1 , Jennie Brand-Miller 2 3 , Tania Markovic 1 2
  1. Department of Endocrinology & Metabolism, Royal Prince Alfred Hospital, Sydney
  2. Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, University of Sydney, Sydney
  3. Department of Molecular Biochemistry, University of Sydney, Sydney

Background: Gestational diabetes (GDM) is an increasingly common pregnancy complication. It is unclear whether earlier testing of women at higher risk for GDM is warranted on detection yield or pregnancy outcomes and whether biomarkers may predict GDM.
Objective: Determine the prevalence of early versus late GDM diagnosis for women at higher risk of GDM and analyse maternal demographics and biomarkers that may predict risk of early GDM.
Methods: We conducted a two-arm, parallel randomised controlled study at a tertiary hospital to assess the impact of antenatal dietary intervention on neonatal anthropometry. 139 women with ≥ 1 GDM risk factor(s) were recruited at ~12 weeks’ nuchal visit and randomised to a dietary intervention. Early GDM screening was conducted between 14-20 weeks’ gestation with a 75 gram oral glucose tolerance test (OGTT) using ADIPS criteria. If early OGTT was negative, OGTT was repeated between 26-28 weeks’ gestation. Food record diaries and baseline biochemistry were assessed prior to dietary intervention.
Results: 21/139 (15.1%) women had GDM diagnosed before 20 weeks’ gestation. Overall 40/139 (29%) women developed GDM. Differences in maternal demographics and biomarkers between early and late GDM diagnosis are summarised in Table 1. At baseline, women with early GDM diagnosis had significantly higher fasting free fatty acids (543 ± 34 vs 364 ± 24µmol/L, p<0.001) (mean±SEM) and were more likely to have had previous GDM (48 ± 0.1 vs 11 ± 0.1%, p=0.009). A non-significant trend was observed for lower LDL cholesterol (2.4 ± 0.1 vs 2.9 ± 0.2mmol/L, p=0.040), lower saturated fat recounted in pre-study diet (24 ± 2 vs 31 ± 3grams, p=0.026) and increased parity (1.1 ± 0.2 vs 0.5 ± 0.2, p=0.014) in this group. Other maternal characteristics, biomarkers and pregnancy outcomes were similar whether GDM was diagnosed early or late.
Conclusion: In our higher risk cohort, half of the women with GDM already had abnormal glucose tolerance before 20 weeks gestation. These women had higher fasting free fatty acids, reflecting underlying insulin resistance. Whether early diagnosis and treatment of GDM in higher risk cohorts improves pregnancy outcomes requires further study.

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