EPIDEMIOLOGY IN GESTATIONAL DIABETES MELLITUS Methodology Dr NamHan

EPIDEMIOLOGY IN GESTATIONAL DIABETES MELLITUS Methodology Dr. Nam-Han Cho Associate Professor of Preventive Medicine Director of Center for Clinical Epidemiology Ajou University School of Medicine Suwon, Korea

GESTATIONAL DIABETES MELLITUS Gestational Diabetes Mellitus(GDM), defined as carbohydrate intolerance with onset or first recognition during pregnancy: • Occurs in approximately 2 to 5% of all pregnancies, with marked worldwide variations reported; • Is associated with an increased risk of fetal macrosomia, as well as perinatal morbidity and mortality; • Is linked with future developments of diabetes mellitus in women post-pregnancy.

METHODOLOGICAL INCONSISTENCIES IN EPIDEMIOLOGICAL STUDIES OF GDM SCREENING • Glucose loads range from 50 g to 100 g • Threshold values range from 125 mg/dl to 150 mg/dl DIAGNOSTIC OGTT • Glucose loads range from 50 g to 100 g • Two and Three hour tests are used • Differences in diagnostic procedures and values

DIFFERENCE IN SCREENING THRESHOLD VALUES AND ETHNIC DIFFERENCES IN THE RATE OF GDM Author Site Green S. F >150 mg/dl White Black Hispanic 1. 6 1. 7 4. 2 Berkowitz New York 135 mg/dl White Black Hispanic 2. 3 3. 7 4. 1 Dooley Chicago 130 mg/dl White Black Hispanic 2. 7 3. 3 4. 4 * 50 g-1 hr, 100 g-3 hr OGTT Threshold for OGTT Race Prevalence*

RESEARCH AREA Maternal High Risk for PIH High Risk for DM Offspring High Risk for birth complications High Risk for Obesity High Risk for IGT/DM Potential Risk for the future Hypertension

Risk Factors for DM after GDM Impaired ß-cell function Higher PIBW Family history (30% M, 11% F)

Overview: Minor adverse health effects for offspring Normal Birth Wt (g) GDM DM P 3303± 64 3649± 51 3849± 72 <0. 01 Macrosomia(%) 8 36 47 <0. 01 C-S 5 10 14 <0. 01 Hypoglycemia 2 28 52 <0. 01 Hypocalcemia 0 4 7 <0. 01 Hyperbilirubinemia 15 23 21 <0. 01 7 11 <0. 01 Polycythemia 0 Cord C-Pep 1. 18± 0. 1 2. 07± 0. 12 2. 98± 0. 22 <0. 01 Cord Glu 100± 3. 6 103± 2. 9 114± 5. 5 <0. 01

MACROSOMIA GDM Birth Wt (g) LGA Non-diabetic 3512± 711 p-value 3333± 479 <0. 05 40. 4% 13. 7% <0. 001 Macrosomia(%) 32. 0% 11. 0% <0. 01

Overview: Major adverse health effects for offspring Normal DM CNS 6. 4% 18. 4% Congenital heart disease 7. 5% 21. 0% Respiratory disease 2. 9% 7. 9% Intestinal atresia 0. 6% 2. 6% Anal atresia 1. 0% 2. 6% Renal & Urinary defect 3. 1% 11. 8% Upper limb deficiences 2. 3% 3. 9% Lower limb deficiences 1. 2% 6. 6% Upper + Lower spine 0. 1% 6. 6% Caudal dysgenesis 0. 1% 5. 3%

NEONATAL COMPLICATIONS DM GDM Normal p-value T. hypoglycemia(%) 52 28 3 <0. 01 P. hypoglycemia(%) 6 2 0 <0. 01 Hypocalcemia(%) 5 5 0 <0. 01 Hyperbilirubinemia(%) 21 23 15 <0. 01 5 2 0 <0. 01 11 7 0 <0. 01 RDS(%) 5 2 0 <0. 01 IUGR(%) 2 1 0 <0. 05 Trans tachypnea(%) Polycythemia(%)

ONGOING GDM EPIDEMIOLOGIC STUDIES : Prevalence Study Sites l Chicago l Cheil Samsung l Ajou University Hospital

METHODOLOGY SCREENING 50 g / 1 hr at 24 -28 weeks gestation 130 mg/dl requires 100 g, 3 hr OGTT DIAGNOSTIC OGTT Fasting (105 mg/dl) 1 hour (190 mg/dl) 2 hour (165 mg/dl) 3 hour (145 mg/dl)

ONGOING GDM EPIDEMIOLOGIC STUDIES : Prevalence Study Prevalence of GDM SITE Chicago Seoul Suwon RACE PREVALENCE White Black Hispanic Korean American Korean 2. 7% 3. 3% 4. 4% 4. 5 -13. 6% 2. 2% 5. 0%

LONGITUDINAL STUDY OF GDM Site and Measurements Ajou University Hospital l Samsung Cheil General l Cha Hospital l Il-Sin Christian Hospital l Anthropometric Demographic 75 gm-2 hr OGTT Stress Diet BIP Lipid Profile

LONGITUDINAL STUDY OF GDM Standardization Skin fold caliper l Questionnaire l BIP (GIF-891 DX) l Insulin assay l Inter-Variation (0. 97 -0. 98) Intra-Variation (cv=0. 23 -0. 38%) Sampling Tube - Device