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Journal of Endocrinological Investigation

, Volume 41, Issue 5, pp 567–573 | Cite as

Abnormal 1-hour post-load glycemia during pregnancy impairs post-partum metabolic status: a single-center experience

  • A. Tumminia
  • A. Milluzzo
  • F. Cinti
  • M. Parisi
  • F. Tata
  • F. Frasca
  • L. Frittitta
  • R. Vigneri
  • L. Sciacca
Original Article
First Online:
Received:
Accepted:

Abstract

Purpose

Recent evidence indicates that people with normal glucose tolerance (NGT) but 1-h post-load plasma glucose (1-h OGTT) ≥ 155 mg/dl have an increased risk for developing Type 2 diabetes mellitus (T2DM), determining a new risk category with deeper metabolic impairment. The aim of this study was to identify, among women with gestational diabetes (GDM), which alterations at OGTT during pregnancy are more frequently associated with 1-h OGTT ≥ 155 mg/dl at post-partum examination.

Methods

Among 297 women affected by GDM, we retrospectively evaluated 244 resulted NGT after delivery. Based on post-partum glucose levels at 1-h OGTT, these people were divided into 188 cases (77.0%) with 1-h OGTT < 155 mg/dl (L-NGT) and 56 (23.0%) with 1-h OGTT ≥ 155 mg/dl (H-NGT).

Results

Abnormal glucose levels at 1-h OGTT during pregnancy (≥ 180 mg/dl) were more frequent in H-NGT than in L-NGT (39.3 vs. 24.6%, odds ratio 3.7 [95% CI 1.4–9.6]; p = 0.016). Moreover, H-NGT showed more frequently the simultaneous alteration of all three OGTT plasma glucose values during pregnancy (10.7 vs. 2.1%, odds ratio 4.5 [95% CI 1.5–20.3]; p = 0.038) and less frequently the alteration of fasting plasma glucose alone (14.3 vs. 30.8%, odds ratio 0.4 [95% CI 0.1–0.7]; p = 0.028).

Conclusions

Abnormal 1-h OGTT during pregnancy predicts an increased risk for post-partum 1-h OGTT ≥ 155 mg/dl in women with previous GDM. Even if NGT after delivery, these women may require a closer long-term post-partum follow-up, being at higher risk to develop future glucose intolerance.

Keywords

Gestational diabetes Pregnancy Oral glucose tolerance test Type 2 diabetes mellitus 
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Notes

Acknowledgements

The authors thank Prof. Giuliana Arcidiacono, Ph.D. in English and Anglo-American Studies, University of Catania, for the language revision of the manuscript.

Compliance with ethical standards

Conflict of interest

RV. participated in the Novo Nordisk Advisory Board in 2015 and 2016. L.S. participated in the Lilly Advisory Board in 2017. The other authors have nothing to disclose.

Ethical approval

The ethical committee approval is not required in our institution for retrospective studies. The study was conducted in accordance with the ethical principles of the Declaration of Helsinki and its later amendments.

Informed consent

For this type of study formal consent is not required.

Supplementary material

40618_2017_774_MOESM1_ESM.docx (59 kb)
Supplementary material 1 (DOCX 59 kb)

References

  1. 1.
    American Diabetes Association (2016) Standards of medical care in diabetes—2016. Diabetes Care 39(suppl 1):S1–S112Google Scholar
  2. 2.
    Associazione Medici Diabetologi (AMD)—Società Italiana di Diabetologia (SID) (2016) Standard italiani per la cura del diabete mellito 2016. Available at http://www.standarditaliani.it. Accessed 18 Apr 2017
  3. 3.
    Ferrara A (2007) Increasing prevalence of gestational diabetes mellitus: a public health perspective. Diabetes Care 30:S141–S146CrossRefPubMedGoogle Scholar
  4. 4.
    American Diabetes Association (2004) Gestational diabetes mellitus. Diabetes Care 27:S88–S90CrossRefGoogle Scholar
  5. 5.
    Nesbitt TS, Gilbert WM, Herrchen B (1998) Shoulder dystocia and associated risk factors with macrosomic infants born in California. Am J Obstet Gynecol 179:476–480CrossRefPubMedGoogle Scholar
  6. 6.
    Kim C, Newton KM, Knopp RH (2002) Gestational diabetes and the incidence of type 2 diabetes: a systematic review. Diabetes Care 25:1862–1868CrossRefPubMedGoogle Scholar
  7. 7.
    Chiefari E, Arcidiacono B, Foti D, Brunetti A (2017) Gestational diabetes mellitus: an updated overview. J Endocrinol Invest. doi: 10.1007/s40618-016-0607-5 PubMedGoogle Scholar
  8. 8.
    HAPO Study Cooperative Research Group, Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, Coustan DR et al (2008) Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 358:1991–2002CrossRefGoogle Scholar
  9. 9.
    Committee on Obstetric Practice (2009) ACOG Committee Opinion No. 435: postpartum screening for abnormal glucose tolerance in women who had gestational diabetes mellitus. Obstet Gynecol 113:1419–1421CrossRefGoogle Scholar
  10. 10.
    Hunt KJ, Conway DL (2008) Who returns for postpartum glucose screening following gestational diabetes mellitus? Am J Obstet Gynecol 198(404):e1–e6Google Scholar
  11. 11.
    Lawrence JM, Black MH, Hsu JW, Chen W, Sacks DA (2010) Prevalence and timing of postpartum glucose testing and sustained glucose dysregulation after gestational diabetes mellitus. Diabetes Care 33:569–576CrossRefPubMedGoogle Scholar
  12. 12.
    Russell MA, Phipps MG, Olson CL, Welch HG, Carpenter MW (2006) Rates of postpartum glucose testing after gestational diabetes mellitus. Obstet Gynecol 108:1456–1462CrossRefPubMedGoogle Scholar
  13. 13.
    Almario CV, Ecker T, Moroz LA, Bucovetsky L, Berghella V, Baxter JK (2008) Obstetricians seldom provide postpartum diabetes screening for women with gestational diabetes. Am J Obstet Gynecol 198(528):e1–e5Google Scholar
  14. 14.
    Abdul-Ghani MA, Abdul-Ghani T, Ali N, Defronzo RA (2008) One-hour plasma glucose concentration and the metabolic syndrome identify subjects at high risk for future type 2 diabetes. Diabetes Care 31:1650–1655CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Abdul-Ghani MA, Lyssenko V, Tuomi T, Defronzo RA, Groop L (2009) Fasting versus postload plasma glucose concentration and the risk for future type 2 diabetes: results from the Botnia Study. Diabetes Care 32:281–286CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Priya M, Anjana RM, Chiwanga FS, Gokulakrishnan K, Deepa M, Mohan V (2013) 1-hour venous plasma glucose and incident prediabetes and diabetes in Asian Indians. Diabetes Technol Ther 15:497–502CrossRefPubMedGoogle Scholar
  17. 17.
    Succurro E, Marini MA, Arturi F, Grembiale A, Lugarà M, Andreozzi F et al (2009) Elevated 1-hour post-load plasma glucose levels identifies subjects with normal glucose tolerance but early carotid atherosclerosis. Atherosclerosis 207:245–249CrossRefPubMedGoogle Scholar
  18. 18.
    Sciacqua A, Miceli S, Carullo G, Greco L, Succurro E, Arturi F et al (2011) One-hour postload plasma glucose levels and left ventricular mass in hypertensive patients. Diabetes Care 34:1406–1411CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Marini MA, Succurro E, Frontoni S, Mastroianni S, Arturi F, Sciacqua A et al (2012) Insulin sensitivity, beta-cell function, and incretin effect in individuals with elevated 1-hour post-load plasma glucose levels. Diabetes Care 35:868–872CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Sesti G, Fiorentino TV, Succurro E, Perticone M, Arturi F, Sciacqua A et al (2014) Elevated 1-h post-load plasma glucose levels in subjects with normal glucose tolerance are associated with unfavorable inflammatory profile. Acta Diabetol 51:927–932CrossRefPubMedGoogle Scholar
  21. 21.
    Fiorentino TV, Marini MA, Andreozzi F, Arturi F, Succurro E, Perticone M et al (2015) One-Hour Postload Hyperglycemia is a stronger predictor of type 2 diabetes than impaired fasting glucose. J Clin Endocrinol Metab 100:3744–3751CrossRefPubMedGoogle Scholar
  22. 22.
    Bianchi C, Miccoli R, Trombetta M, Giorgino F, Frontoni S, Faloia E, GENFIEV Investigators et al (2013) Elevated 1-hour postload plasma glucose levels identify subjects with normal glucose tolerance but impaired β-cell function, insulin resistance, and worse cardiovascular risk profile: the GENFIEV study. J Clin Endocrinol Metab 98(5):2100–2105. doi: 10.1210/jc.2012-3971 CrossRefPubMedGoogle Scholar
  23. 23.
    Carpenter MW, Coustan DR (1982) Criteria for screening tests for gestational diabetes. Am J Ostet Gynecol 144(7):768–773CrossRefGoogle Scholar
  24. 24.
    International Association of Diabetes and Pregnancy Study Groups Consensus Panel (2010) International Association Of Diabetes And Pregnancy Study Groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 33(3):676–682CrossRefPubMedCentralGoogle Scholar
  25. 25.
    Cozzolino M, Serena C, Maggio L, Rambaldi MP, Simeone S, Mello G, Pasquini L, Di Tommaso M, Mecacci F (2017) Analysis of the main risk factors for gestational diabetes diagnosed with International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria in multiple pregnancies. J Endocrinol Invest. doi: 10.1007/s40618-017-0646-6 PubMedGoogle Scholar
  26. 26.
    Unwin N, Shaw J, Zimmet P, Alberti KG (2002) Impaired glucose tolerance and impaired fasting glycemia: the current status on definition and intervention. Diabet Med 19:708–723CrossRefPubMedGoogle Scholar
  27. 27.
    Kuang L, Huang Z, Hong Z, Chen A, Li Y (2015) Predictability of 1-h postload plasma glucose concentration: a 10-year retrospective cohort study. J Diabetes Investig 6:647–654. doi: 10.1111/jdi.12353 CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Bellamy L, Casas JP, Hingorani AD, Williams D (2009) Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet 373:1773–1779CrossRefPubMedGoogle Scholar
  29. 29.
    Nathan DM, Davidson MB, DeFronzo RA, Heine RJ, Henry RR, Pratley R (2007) Impaired fasting glucose and impaired glucose tolerance: implications for care. Diabetes Care 30:753–759CrossRefPubMedGoogle Scholar
  30. 30.
    Abdul-Ghani MA, Tripathy D, DeFronzo RA (2006) Contributions of beta-cell dysfunction and insulin resistance to the pathogenesis of impaired glucose tolerance and impaired fasting Glucose. Diabetes Care 29:1130–1139CrossRefPubMedGoogle Scholar
  31. 31.
    Laakso M, Zilinskaite J, Hansen T, Boesgaard TW, Väntinnen M, Stancáková A (2008) Insulin sensitivity, insulin release and glucagon-like peptide-1 levels in persons with impaired fasting glucose and/o impaired glucose tolerance in the EUGENE2 study. Diabetologia 51:502–511CrossRefPubMedGoogle Scholar

Copyright information

© Italian Society of Endocrinology (SIE) 2017

Authors and Affiliations

  • A. Tumminia
    • 1
  • A. Milluzzo
    • 1
  • F. Cinti
    • 1
  • M. Parisi
    • 1
  • F. Tata
    • 1
  • F. Frasca
    • 1
  • L. Frittitta
    • 1
  • R. Vigneri
    • 1
    • 2
  • L. Sciacca
    • 1
  1. 1.Endocrinology Section, Department of Clinical and Experimental Medicine, Garibaldi-Nesima HospitalUniversity of CataniaCataniaItaly
  2. 2.Institute of Bioimages and Biostructures, CNRCataniaItaly

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