The Effect of Common and Possible Risk Factors’ Co-occurrence to the Development of Gestational Diabetes Mellitus

Abstract

Objectives: Advanced maternal age, obesity, presence of family history of diabetes and macrosomic infant delivery are known risk factors for gestational diabetes (GDM). The increase in pregnancy weight and number of pregnancies are also possible risk factors. The purpose of this study was to assess the association of known and possible risk factors with GDM development.
Materials and Methods: A case-control study was planned with a structured questionnaire on gestational diabetes mellitus screening. For this purpose, pregnant patients who applied to the Hatay State Hospital gynecology and obstetric outpatient clinic between January and October 2017 were included in the study. 181 case records who were applied a two-step oral glucose tolerance test (OGTT) were scanned. 102 participants were included in this study. In our study, the data were analyzed statistically using 95% confidence, using the SPSS 22 (Statistical Package for the Social Sciences) package program. The significance level of all the tests used was determined to be 0,05. Pearson-ContinuityCorrection-FisherExactChi-Square tests, binary logistic regression (enter method) analyzes were used in the study.
Results: 74 of our 102 participants (72.50%) were non-GDM and 28 (27.50%) were GDM. The average age is 29,04 ± 6.11. Univariate relations with GDM are investigated, age (p=0,001), prevalence of GDM at previous pregnancies (p=0,002), presence of diabetes mellitus family history (p=0,001), increase of body weight in pregnancy (p=0,011), presence of glycosuria before pregnancy (p= 0,020), multiple pregnancies (p=0,012), presence of macrosomic baby delivery (p=0,027). However, when the significance of risk factors is evaluated together with logistic regression analysis, advancing maternal age, multiple pregnancies and presence of diabetes mellitus family history increases the risk of GDM. Body mass index (BMI) and the weight of the first two trimester weight> 8 kg are not significant.
Conclusion: Presence of diabetes mellitus family history, increased maternal age together with BMI, multiple pregnancies increases GDM risk. These risk factors need to be considered in prenatal screening.

Keywords

• Gestational diabetes mellitus,multiple pregnancies,maternal age,obesity

Bilinen ve Olası Risk Faktörlerinin Birlikteliğinin Gestasyonel Diyabetes Mellitus Gelişimine Etkisi

Öz

Objectives: Advanced maternal age, obesity, presence of family history of diabetes and macrosomic infant delivery are common risk factors for gestational diabetes (GDM). The increase in pregnancy weight and number of pregnancies are also possible risk factors. The purpose of this study was to assess the association of common and possible risk factors with GDM development.
Materials and Methods: A case-control study was planned with a structured questionnaire on GDM screening. For this purpose, pregnant patients who applied to the Hatay State Hospital gynecology and obstetric outpatient clinic between January and October 2017 were included in the study. 181 case records who were applied a two-step oral glucose tolerance test (OGTT) were scanned. 102 participants were included in this study. In our study, the data were analyzed statistically using 95% confidence, using the SPSS 22 (Statistical Package for the Social Sciences) package program. The significance level of all the tests used was determined to be 0.05. Pearson-Continuity Correction-Fisher Exact Chi-Square tests, binary logistic regression (enter method) analyzes were used in the study.

Results: 74 of our 102 participants (72.50%) were non-GDM and 28 (27.50%) were GDM. The average age is 29.04 ± 6.11. Univariate relations with GDM are investigated, age (p=0.001), prevalence of GDM at previous pregnancies (p=0.002), presence of diabetes mellitus family history (p=0.001), increase of body weight in pregnancy (p=0.011), presence of glycosuria before pregnancy (p= 0.020), multiple pregnancies (p=0.012), presence of macrosomic baby delivery (p=0.027). However, when the significance of risk factors is evaluated together with logistic regression analysis, advancing maternal age, multiple pregnancies and presence of diabetes mellitus family history increases the risk of GDM. Body mass index (BMI) and the weight of the first two trimester weight> 8 kg are not significant.
Conclusion: Presence of diabetes mellitus family history, increased maternal age together with BMI, multiple pregnancies increases GDM risk. These risk factors need to be considered in prenatal screening.

Anahtar Kelimeler

• Gestasyonel diyabetes mellitus,artan gebelik sayısı,maternal yaş,obesite,,

References

1. 1. ADA Clinical Practice Recommendations. Standarts of medical care in diabetes. Diabetes Care, 2017;40(Suppl 1):1-142.
2. 2. Cheung NW, BYTH K. Population health significiance of gestational diabetes. Diabetes Care 2003;26(7):2005-9.
3. 3. Ferrara A. Increasing prevalance of gestational diabetes mellitus: a public helath perspective. Diabetes Care 2007;30(Suppl 2):141-6.
4. 4. Hillier TA, Pedula KL, Schmidt MM, Mullen JA, Charles MA, Pettitt DJ. Childhood obesity and metabolic imprinting: the ongoing effects of maternal hyperglycemia. Diabetes Care 2007;30:2287–92.
5. 5. Reece EA, Leguizamon G, Wiznitner A. Gestational diabetes: the need for a common ground. Lancet 2009;373(9677):1789-97. 6. Kuhl C. Etiology and pathogenesis of gestational diabetes. Diabetes Care 1998;21(Suppl 2):B19-B26.
6. 7. Renata Selbach Pons, Fernanda Camboim Rockett, Bibiana de Almeida Rubin, Maria Lúcia Rocha Oppermann, Vera Lúcia Bosa. Risk factors for gestational diabetes mellitus in a sample of pregnant women diagnosed with the disease. Diabetol Metab Syndr 2015;7(Suppl 1):A80.
7. 8. Erem C, Arslan C, Hacihasanoglu A, et al. Prevalence of obesity and associated risk factors in a Turkish population (Trabzon city, Turkey) Obes Res 2004;12:1117–27.
8. 9. Gundogan K, Bayram F, Gedik V, et al. Metabolic syndrome prevalence according to ATP III and IDF criteria and related factors in Turkish adults. Arch Med Sci. 2013;9:243–53.

9. 10. Satman I, Omer B, Tutuncu Y, et al. TURDEP-II Study Group. Twelve-year trends in the prevalence and risk factors of diabetes and prediabetes in Turkish adults. Eur J Epidemiol 2013;28:169–80.
10. 11. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2017;40(Suppl. 1):18–20.
11. 12. Carpenter MW, Coustan DR. Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol 1982;144:768–73.
12. 13. IDF Diabetes Atlas. Eight edition, 2017 http://diabetesatlas.org/resources/2017-atlas.html, Erişim tarihi: 1 Nisan 2018.
13. 14. Di Cianni G, Volpe L, Lencioni C, et al. Prevalence and risk factors for gestational diabetes assessed by universal screening. Diabetes Res Clin Pract 2003;62:131–7.
14. 15. Jang HC. Gestational diabetes in Korea: incidence and risk factors of diabetes in women with previous gestational diabetes. Diabetes Metab J 2011;35:1–7.
15. 16. Yang H, Wei Y, Gao X, et al. China National GDM Survey Working Group. Risk factors for gestational diabetes mellitus in Chinese women: a prospective study of 16,286 pregnant women in China. Diabet Med. 2009;26:1099–104.
16. 17. Shargorodsky M, Kovo M, Schraiber L, Bar J. Does a First-Degree Family History of Diabetes Impact Placental Maternal and Fetal Vascular Circulation and Inflammatory Response? J Clin Endocrinol Metab 2017;102(9):3375-80.
17. 18. Pridjian G, Benjamin TD. Update on gestational diabetes. Obstet Gynecol Clin North Am 2010;37:255–67.
18. 19. Keshavarz M, Cheung NW, Babaee GR, Moghadam HK, Ajami ME, Shariati M. Gestational diabetes in Iran: incidence, risk factors and pregnancy outcomes. Diabetes Res Clin Pract 2005;69:279–86.
19. 20. Spaight C, Gross J, Horsch A, Puder JJ, Gestational Diabetes Mellitus. Endocr Dev 2016;31:163-8.
20. 21. Xu Q, Gao ZY, Li LM et al. The association of maternal body composition and dietary intake with the risk of gestational diabetes mellitus during the second trimester in a cohort of Chinese pregnant women. Biomed Environ Sci 2016;29:1-11.
21. 22. Russo LM, Nobles C, Ertel KA, Chasan-Taber L, Whitcomb BW. Physical activity interventions in pregnancy and risk of gestational diabetes mellitus: a systematic review and meta-analysis. Obstet Gynecol 2015;125:576-82.
22. 23. Tobias DK, Zhang C, van Dam RM, Bowers K, Hu FB. Physical activity before and during pregnancy and risk of gestational diabetes mellitus: a meta-analysis. Diabetes Care 2011;34:223-9.
23. 24. Sanabria-Martínez G, García-Hermoso A, Poyatos-León R, Álvarez-Bueno C, Sánchez-López M, Martínez-Vizcaíno V. Effectiveness of physical activity interventions on preventing gestational diabetes mellitus and excessive maternal weight gain: a meta-analysis. BJOG 2015;122:1167-74.
24. 25. Dong B, Yu H, Wei Q et al. The effect of pre-pregnancy body mass index and excessive gestational weight gain on the risk of gestational diabetes in advanced maternal age. Oncotarget 2017;8(35):58364-71.
25. 26. Dai ZY, Liu D, Li R, Wang Y, Zhang J, Liu J, Zhou R, Zeng G. Association between gestational weight gain per trimester/total gestational weight gain and gestational diabetes mellitus]. Zhonghua Liu Xing Bing Xue Za Zhi 2016;37(10):1336-40.
26. 27. Simmons D, Shaw J, McKenzie A, Eaton S, Cameron AJ, Zimmet P. Is grand multiparity associated with an increased risk of dysglycaemia? Diabetologia 2006;49(7):1522-7.
27. 28. Naver KV, Lundbye-Christensen S, Gorst-Rasmussen A et al. Parity and risk of diabetes in a Danish nationwide birth cohort. Diabet Med 2011;28:43–7.
28. 29. Iversen DS, Støy J, Kampmann U et al. Parity and type 2 diabetes mellitus: a study of insulin resistance and β-cell function in women with multiple pregnancies. BMJ Open Diabetes Res Care 2016;25;4(1):e000237. doi: 10.1136/bmjdrc-2016-000237.