A key challenge in gestational diabetes screening: resistance to oral glucose tolerance test screening and implications for neonatal health

Year 2021, Volume: 4 Issue: 3, 262 - 266, 21.05.2021

Serkan Tursun , İlkin Yeral , Volkan Yıldız Elif Ünal Nilufer Guzoglu , Didem Aliefendioğlu

https://doi.org/10.32322/jhsm.894842

Abstract

Objective: Gestational diabetes mellitus (GDM) is the most common endocrine disorder in pregnancy and the number of pregnant women resistant to oral glucose tolerance test (OGTT) has increased significantly in recent years. In this study, we investigated the extent of resistance to OGTT screening in pregnant women followed-up in our hospital and the effect of this situation on the newborn.
Material and Method: Pregnant women and their babies who were followed up regularly for 25 months (December 1, 2015- December 31, 2017) in the obstetrics and gynecology clinic of our hospital were included in our study. The relationship between OGTT and clinicopathological findings was analyzed.
Results: The cesarean (C/S) delivery rate was significantly lower in the babies of mothers who did not have the OGTT test (p <0.05). Also, the rate of hospitalization of the babies of mothers who had OGTT test and who did not have gestational diabetes was significantly lower than the rate of hospitalization in all groups (p <0.05). In the risk analysis, it was seen that OGTT was an independent risk factor for C/S delivery (OR=1.28, p=0.015).
Conclusion: Our study shows that resistance to OGTT is quite strong and this situation leads to an increase in C/S and hospitalization of newborns. Our results suggest that these scans that cannot be performed may bring along unidentified problems.

Keywords

Oral glucose tolerance test, OGTT, pregnancy, diabetes

Project Number

yok

References

• Sert UY, Ozgu-Erdinc AS. Gestational diabetes mellitus screening and diagnosis. Adv Exp Med Biol 2021; 1307: 231-55.
• Lende M, Rijhsinghani A. Gestational diabetes: overview with emphasis on medical management. Int J Environ Res Public Health 2020; 17: 9573.
• Casey BM, Rice MM, Landon MB, et al. Effect of treatment of mild gestational diabetes on long-term maternal outcomes. Am J Perinatol 2020; 37: 475-82.
• Eunice Kennedy Shriver, National Institute of Child Health and Human Development. Maternal-Fetal Medicine Units (MFMU) Network. Available on https://mfmunetwork.bsc.gwu.edu/PublicBSC/MFMU/MFMUPublic/, Access date: 2020.
• Thayer SM, Lo JO, Caughey AB. Gestational diabetes: importance of follow-up screening for the benefit of long-term health. Obstet Gynecol Clin North Am 2020; 47: 383-96.
• Li YX, Long DL, Liu J, et al. Gestational diabetes mellitus in women increased the risk of neonatal infection via inflammation and autophagy in the placenta. Medicine (Baltimore) 2020; 99: e22152.
• Akgol S, Obut M, Baglı İ, et al. An evaluation of the effect of a one or two-step gestational diabetes mellitus screening program on obstetric and neonatal outcomes in pregnancies. Gynecol Obstet Reprod Med 2019; 25: 62–6.
• Metzger BE, Gabbe SG, Persson B, et al. International Association of Diabetes and Pregnancy Study Groups Consensus Panel, International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010; 33: 676-82.
• Chan A, King JF, Flenady V, et al. Classification of perinatal deaths: development of the Australian and New Zealand classifications. J Paediatr Child Health 2004; 40: 340-7.
• Metzger BE, Lowe LP et al. HAPO Study Cooperative Research Group, Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008; 358: 1991–2001.
• Crowther CA, Hiller JE, Moss JR, et al. Effect of treatment of gestational diabetes on pregnancy outcomes. N Engl J Med 2005; 352: 2477-86.
• Landon MB, Thom E, Spong CY, et al. The National Institute of Child Health and Human Development Maternal-Fetal Medicine Unit Network randomized clinical trial in progress: standard therapy versus no therapy for mild gestational diabetes. Diabetes Care 2007; 30: 194-9.
• Karagöl BS, Karadag N, Zenciroglu A, et al. Yenidoğan yoğun bakımında yedi yıllık diyabetik anne bebeği deneyimi. Çocuk Derg 2012; 12: 169-76.
• Başbuğ A, Kaya AE, Sönmez Cİ, et al. Gestasyonel diyabet taramasında karşılaşılan önemli bir problem: Gebeler neden oral glukoz tolerans testi yaptırmak istemiyor? Konuralp Tıp Derg 2018; 10: 144-8.
• Chi C, Loy SL, Chan SY, et al. Impact of adopting the 2013 World Health Organization criteria for diagnosis of gestational diabetes in a multi-ethnic Asian cohort: a prospective study. BMC Pregnancy Childbirth 2018; 18: 69.
• Committee on Practice Bulletins-Obstetrics. ACOG practice bulletin no 190 summary: gestational diabetes mellitus. Obstet Gynecol 2018; 131: 406–8.
• Agarwal MM. Consensus in gestational diabetes mellitus: looking for the Holy Grail. J Clin Med 2018; 7: 123.
• Türkyılmaz E, Keleştemur, Eray IK, Ocal FG, Avşar AY. Knowledge level, attitude and behaviours about glucose challenge test among Turkish pregnant women. Ankara Med J 2016; 16: 191–9.
• American Diabetes A. 14.Management of diabetes in pregnancy: standards of medical care in diabetes-2020. Diabetes Care 2020; 43: 183–92.
• Benhalima K, Van Crombrugge P, Moyson C, et al. The sensitivity and specificity of the glucose challenge test in a universal two-step screening strategy for gestational diabetes mellitus using the 2013 World Health Organization Criteria. Diabetes Care 2018; 41: e111–e1e2.
• Brown FM, Wyckoff J. Application of one-step IADPSG versus two-step diagnostic criteria for gestational diabetes in the real world: impact on health services, clinical care, and outcomes. Curr Diab Rep 2017; 17: 85.
• Blumer I, Hadar E, Hadden DR, et al. Diabetes and pregnancy: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2013; 98: 4227–49.
• Spellacy WN, Miller S, Winegar A, et al. Macrosomia: maternal characteristics and infant complications. Obstet Gynecol 1985; 66: 158-61.
• Jang HC, Cho NH, Min YK, et al. Increased macrosomia and perinatal morbidity independent of maternal obesity and advanced age in Korean women with GDM. Diabetes Care 1997; 20: 1582-8.
• Goldman M, Kitzmiller JL, Abrams B, et al. Obstetric complications with GDM. Diabetes 1991; 40: 79-82.
• Wang J, Chen K, Jin X, et al. Prognostic factors for cesarean section outcome of pregnant women with gestational diabetes mellitus: a systematic review and meta-analysis. Diabetes Metab Syndr Obes 2019; 12: 913-29.
• Gorgal R, Goncalves E, Barros M, et al. Gestational diabetes mellitus: a risk factor for non-elective cesarean section. J Obstet Gynaecol Res 2012; 38: 154-9.
• Moses RG, Knights SJ, Lucas EM, et al. Gestational diabetes: is a higher cesarean section rate inevitable? Diabetes Care 2000; 23: 15-8.
• Naylor CD, Sermer M, Chen E, et al. Cesarean delivery in relation to birthweight and gestational glucose tolerance: pathophysiology or practice style? JAMA 1996; 275: 1165-70.
• Palatnik A, Swanson K, Churchill T, et al. Association between type of screening for gestational diabetes mellitus and cesarean delivery. Obstet Gynecol 2017; 130: 539-44.