Evaluation of oral glucose tolerance test, β‑cell function and adverse obstetric outcomes

Zhang,Hongxiu; Zhao,Dongmei; Shen,Jie; Zhou,Xiaoping; Chen,Wenwei; Jiang,Shiwen

doi:10.3892/br.2013.136

Evaluation of oral glucose tolerance test, β‑cell function and adverse obstetric outcomes

Authors:
- Hongxiu Zhang
- Dongmei Zhao
- Jie Shen
- Xiaoping Zhou
- Wenwei Chen
- Shiwen Jiang
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Affiliations: Department of Obstetrics and Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210036, P.R. China, HLA Laboratory, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China, Department of Biomedical Sciences, Mercer University School of Medicine, Savannah, GA 31404, USA
Published online on: July 16, 2013 https://doi.org/10.3892/br.2013.136
Pages: 807-811

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Abstract

This study was conducted in order to investigate the prevalence of impaired glucose tolerance (IGT) and gestational diabetes mellitus (GDM), their effect on pregnancy and their association with adverse obstetric outcomes. A cross‑sectional study was performed on 345 pregnant women, who were screened between the 24th and 28th gestational week with a 75‑g oral glucose tolerance test following abnormal results at 1 h after a 50‑g oral glucose challenge test. The obstetric outcomes were recorded along with plasma glucose and insulin levels, homeostasis model assessment of insulin resistance (HOMA‑IR) and homeostasis model assessment of β‑cell function index (HOMA‑βCFI) and 50 subjects were excluded due to incomplete data recovery. Of the 295 pregnant women, 18.6% (55/295) were diagnosed with GDM and 32% (95/295) with IGT. The GDM group exhibited significantly higher fasting and 1‑h blood glucose concentrations compared to the normal glucose tolerance (NGT) and IGT groups (P<0.01). The 2- and 3‑h insulin values of the NGT group were significantly lower compared to those of the GDM group (P<0.05, P<0.01). in the IGT group, the 2‑h insulin values were higher compared to the NGT group and the 3‑h values were significantly higher (P<0.01), similar to the GDM group. There was a tendency for progressively decreased β‑cell function and increased HOMA‑IR from the NGT to the IGT to the GDM group. The adverse outcomes of pregnancy‑induced hypertension, fetal distress, neonatal hyperbilirubinemia, preterm delivery, macrosomia and cesarean delivery indicated an association with HOMA‑βCFI and HOMA‑IR. In conclusion, these findings suggest a clinical significance of β‑cell dysfunction in women with gestational IGT.

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1	Casey BM, Lucas MJ, McIntire DD and Leveno KJ: Pregnancy outcomes in women with gestational diabetes compared with the general obstetric population. Obstet Gynecol. 90:869–873. 1997. View Article : Google Scholar : PubMed/NCBI
2	Gokcel A, Bagis T, Killicadag EB, Tarim E and Guvener N: Comparison of the criteria for gestational diabetes mellitus by NDDG and Carpenter and Coustan, and the outcomes of pregnancy. J Endocrinol Invest. 25:357–361. 2002. View Article : Google Scholar : PubMed/NCBI
3	Yogev Y and Visser GH: Obesity, gestational diabetes and pregnancy outcome. Semin Fetal Neonatal Med. 14:77–84. 2009. View Article : Google Scholar : PubMed/NCBI
4	Kjos SL and Buchanan TA: Gestational diabetes mellitus. N Engl J Med. 341:1749–1756. 1999. View Article : Google Scholar : PubMed/NCBI
5	Thompson DM, Dansereau J, Creed M and Ridell L: Tight glucose control results in normal perinatal outcome in 150 patients with gestational diabetes. Obstet Gynecol. 83:362–366. 1994.PubMed/NCBI
6	Homko C, Sivan E, Chen X, Reece EA and Boden G: Insulin secretion during and after pregnancy in patients with gestational diabetes mellitus. J Clin Endocrinol Metab. 86:568–573. 2001.PubMed/NCBI
7	Kautzky-Willer A, Prager R, Waldhausl W, Pacini G, Thomaseth K, Wagner OF, Ulm M, Streli C and Ludvik B: Pronounced insulin resistance and inadequate beta-cell secretion characterize lean gestational diabetes during and after pregnancy. Diabetes Care. 20:1717–1723. 1997. View Article : Google Scholar : PubMed/NCBI
8	Higgins M and Mc Auliffe F: A review of maternal and fetal growth factors in diabetic pregnancy. Curr Diabetes Rev. 6:116–125. 2010. View Article : Google Scholar : PubMed/NCBI
9	Berkowitz GS, Lapinski RH, Wein R and Lee D: Race/ethnicity and other risk factors for gestational diabetes. Am J Epidemiol. 135:965–973. 1992.PubMed/NCBI
10	Dabelea D, Snell-Bergeon JK, Hartsfield CL, Bischoff KJ, Hamman RF and McDuffie RS: Increasing prevalence of gestational diabetes mellitus (GDM) over time and by birth cohort: Kaiser Permanente of Colorado GDM Screening Program. Diabetes Care. 28:579–584. 2005. View Article : Google Scholar : PubMed/NCBI
11	Lawrence JM, Contreras R, Chen W and Sacks DA: Trends in the prevalence of preexisting diabetes and gestational diabetes mellitus among a racially/ethnically diverse population of pregnant women, 1999–2005. Diabetes Care. 31:899–904. 2008.PubMed/NCBI
12	Araneta MR, Wingard DL and Barrett-Connor E: Type 2 diabetes and metabolic syndrome in Filipina-American women: a high-risk nonobese population. Diabetes Care. 25:494–499. 2002. View Article : Google Scholar : PubMed/NCBI
13	Yue J, Xie X, Lin ZQ, Gou WL and Di W: Gestational diabetes mellitus. Obstetrics and Gynecology. Yue J: 7th edition. People's Medical Publishing House; Beijing: pp. 150–154. 2007
14	Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF and Turner RC: Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 28:412–419. 1985. View Article : Google Scholar : PubMed/NCBI
15	Das S, Behera MK, Misra S and Baliarsihna AK: Beta-cell function and insulin resistance in pregnancy and their relation to fetal development. Metab Syndr Relat Disord. 8:25–32. 2009. View Article : Google Scholar : PubMed/NCBI
16	Su JB, Wang XQ, Chen JF, Wu G, Jin Y, Xu F, Wang XH and Liu YT: Glycemic variability in gestational diabetes mellitus and its association with β cell function. Endocrine. 43:370–375. 2013.
17	Metzger BE, Lowe LP, Dyer AR, et al; HAPO Study Cooperative Research Group. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 358:1991–2002. 2008. View Article : Google Scholar
18	Sermer M, Naylor CD, Farine D, Kenshole AB, Ritchie JW, Gare DJ, Cohen HR, McArthur K, Holzapfel S and Biringer A: The Toronto Tri-Hospital Gestational Diabetes Project. A preliminary review. Diabetes Care. 21(Suppl 2): B33–B42. 1998.PubMed/NCBI
19	Leinonen A, Hiilesmaa V, Andersen H, Teramo K and Kaaja R: Diurnal blood glucose profiles in women with gestational diabetes with or without hypertension. Diabet Med. 21:1181–1184. 2004. View Article : Google Scholar : PubMed/NCBI
20	Ergin T, Lembet A, Duran H, Kuscu E, Bagis T, Saygili E and Batioglu S: Does insulin secretion in patients with one abnormal glucose tolerance test value mimic gestational diabetes mellitus? Am J Obstet Gynecol. 186:204–209. 2002. View Article : Google Scholar : PubMed/NCBI
21	Di Cianni G, Seghieri G, Lencioni C, Cuccuru I, Anichini R, De Bellis A, Ghio A, Tesi F, Volpe L and Del Prato S: Normal glucose tolerance and gestational diabetes mellitus: what is in between? Diabetes Care. 30:1783–1788. 2007.PubMed/NCBI
22	Shrestha A and Chawla CD: The glucose challenge test for screening of gestational diabetes. Kathmandu Univ Med J (KUMJ). 9:22–25. 2011.PubMed/NCBI
23	Kim HS, Chang KH, Yang JI, Yang SC, Lee HJ and Ryu HS: Clinical outcomes of pregnancy with one elevated glucose tolerance test value. Int J Gynaecol Obstet. 78:131–138. 2002. View Article : Google Scholar : PubMed/NCBI
24	Gorgal R, Goncalves E, Barros M, Namora G, Magalhaes A, Rodrigues T and Montenegro N: Gestational diabetes mellitus: a risk factor for non-elective cesarean section. J Obstet Gynaecol Res. 38:154–159. 2012. View Article : Google Scholar : PubMed/NCBI
25	Segregur J, Bukovic D, Milinovic D, Oreskovic S, Pavelic J, Zupic T, Persec J and Pavic M: Fetal macrosomia in pregnant women with gestational diabetes. Coll Antropol. 33:1121–1127. 2009.PubMed/NCBI
26	Lindsay RS, Westgate JA, Beattie J, Pattison NS, Gamble G, Mildenhall LF, Breier BH and Johnstone FD: Inverse changes in fetal insulin-like growth factor (IGF)-1 and IGF binding protein-1 in association with higher birth weight in maternal diabetes. Clin Endocrinol (Oxf). 66:322–328. 2007. View Article : Google Scholar : PubMed/NCBI
27	Karakash SD and Einstein FH: Diabetes in pregnancy: glycemia control guidelines and rationale. Curr Opin Endocrinol Diabetes Obes. 18:99–103. 2011. View Article : Google Scholar : PubMed/NCBI
28	Thanasuan S and Borriboonhirunsarn D: Incidence of gestational diabetes mellitus among pregnant women with one abnormal value of oral glucose tolerance test. J Med Assoc Thai. 89:1109–1114. 2006.PubMed/NCBI
29	Serlin DC and Lash RW: Diagnosis and management of gestational diabetes mellitus. Am Fam Physician. 80:57–62. 2009.
30	Yee LM, Cheng YW, Liddell J, Block-Kurbisch I and Caughey AB: 50-gram glucose challenge test: is it indicative of outcomes in women without gestational diabetes mellitus? J Matern Fetal Neonatal Med. 24:1102–1106. 2011. View Article : Google Scholar : PubMed/NCBI