26 • Probe •Vol LXII • No. 4 • Sep–Dec 2023 Gynecology Progression to Type 2 Diabetes Mellitus After Gestational Diabetes Mellitus Diagnosed Using IADPSG Criteria This systematic review and meta-analysis aims to estimate the progression rates to type 2 diabetes mellitus (T2DM) in women with gestational diabetes mellitus (GDM), diagnosed through the International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria. Selection criteria for the studies were IADPSGdiagnosed GDM, studies that included both GDM women and controls, and at least 1-year postpartum follow-up duration. Data were pooled using random effects meta-analysis models. Heterogeneity was assessed using I2 statistic. The pooled relative risk for the incidence of T2DM and prediabetes between GDM women and controls was estimated. Reasons for heterogeneity among studies were investigated using a prespecified subgroup and meta-regression analysis. Publication bias was assessed using the Begg’s and Egger’s tests. This meta-analysis of 6 studies assessed 61,932 individuals (21,978 women with GDM and 39,954 controls). Women with IADPSG-diagnosed GDMwere 6.43 times more likely to develop T2DM in the future compared with controls. For GDMwomen, the cumulative incidence of T2DMwas 12.1%, while the pooled cumulative incidence of T2DMwas estimated to be 8% in studies with 1 to 5 years of follow-up and increased to 19% in studies with more than 5 years of follow-up. Women with IADPSG-diagnosed GDM had 3.69 times higher risk of developing prediabetes than controls. Women with IADPSG-diagnosed GDM are at a higher risk of developing T2DM and prediabetes. The risk of T2DM in GDM women is higher with longer follow-up duration. Source: Juan J, et al. Front Endocrinol (Lausanne). 2022;13:1012244. Early Pregnancy Hyperglycemia as a Significant Predictor of Large-forGestational-Age Neonates This study determined the effect of early pregnancy hyperglycemia on having a large-for-gestational-age (LGA) neonate. A prospective cohort study was conducted among pregnant women in their first trimester (T1). Onestep plasma glucose (PG) evaluation was performed to assess gestational diabetes mellitus (GDM) and diabetes mellitus (DM) during pregnancy, as defined by the WHO criteria, with the International Association of Diabetes in Pregnancy Study Group (IADPSG) thresholds. The main outcome studied was delivery of LGA neonates. A total of 2709 participants were recruited with a mean age of 28 years and a median gestational age (GA) of 8 weeks. The prevalence of GDM in T1 was 15%. Previously undiagnosed DM was detected among 2.5% of the participants. Out of 2285 live births with a median GA of 38 weeks at delivery, 7% were LGA neonates. The cumulative incidence of LGA neonates in women with GDM and DM was 11.1 and 15.5 per 100 women, respectively. The relative risk of having an LGA neonate among women with DM and GDM was 2.30 and 1.80, respectively. The attributable risk percentage of an LGA neonate for hyperglycemia was 15.01%. T1 fasting PG significantly correlated with both neonatal birth weight and birth weight centile. The proposed WHO criteria for hyperglycemia during pregnancy are valid, even in T1, for predicting LGA neonates. The use of IADPSG threshold for fasting PG for risk assessment in early pregnancy in the high-risk population is recommended. Source: Jayasinghe IU, et al. Acta Diabetol. 2022;59(4):535–543. Abstracts From Literature
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