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Dysglycemia common among pregnant American Indian women
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American Indian women often experience dysglycemia during some part of their pregnancy, according to recent study findings published in The Journal of Clinical Endocrinology & Metabolism.
“In our study, we were able to assess the prevalence of dysglycemia at the first trimester of pregnancy in women from a minority population that is particularly affected by the diabetes epidemic,” the researchers wrote. “In doing so, we were surprised to find a very low prevalence of undiagnosed [type 2 diabetes] (0.4%).”
Madona Azar, MD, of the section of endocrinology, diabetes and metabolism at the University of Oklahoma Health Sciences Center, and colleagues conducted a prospective cohort study of American Indian women to determine the prevalence of dysglycemia in the first trimester of pregnancy and incidence of gestational diabetes in the second trimester. At the first trimester, researchers performed a 75-g, 2-hour oral glucose tolerance test, measured HbA1c and skin autofluorescence (SCOUT), and determined fasting insulin, homeostasis model assessment for insulin resistance (HOMA-IR) and serum 1,5-anhydroglucitol levels for 244 participants. At the second trimester, a subset of participants (n = 114) had repeat OGTT and SCOUT.
Madona Azar
In the first trimester, one participant had undiagnosed type 2 diabetes (0.4%).
In the first trimester when using American Diabetes Association criteria and elevated HbA1c, the researchers found that 15% of participants were dysglycemic (five identified by fasting glucose alone, 16 by HbA1c alone, 11 by 2-hour OGTT alone and the remainder by more than one value), and 85% were euglycemic. Twenty-four percent of participants were identified as having gestational diabetes using Endocrine Society criteria only. However, when combining abnormal HbA1c with Endocrine Society fasting blood glucose criteria, 27% were found to be dysglycemic.
In the second trimester, 23% of participants had gestational diabetes based on fasting, 1-hour and 2-hour OGTT. Of those with normal glucose tolerance in the first trimester (n = 104), 19% developed gestational diabetes in the second trimester. Sixty percent of participants with dysglycemia by ADA criteria in the first trimester (n = 10) developed gestational diabetes in the second trimester, and 50% of participants with dysglycemia by Endocrine Society criteria in the first trimester (n = 30) developed gestational diabetes in the second trimester.
Prepregnancy weight and BMI, waist and hip circumference, elevated blood pressure and fasting insulin and HOMA-IR were all associated with first trimester dysglycemia (all P < .05).
In the subset of participants evaluated during the second trimester, 91% had previous normal glucose tolerance based on ADA criteria and 9% were dysglycemic.
The probability of gestational diabetes in the second trimester was associated with the following first trimester clinical factors: higher weight and BMI, presence of hypertension, greater waist and hip circumference, higher diastolic BP, higher fasting insulin, higher total cholesterol level and higher triglyceride levels (all P < .05).
“Screen for impaired glucose tolerance early in pregnancy in women at risk and consider treating, if only by lifestyle changes (better diet, exercise) until we have more studies,” Azar told Endocrine Today. “A unified screening and management strategy for diabetes is critically needed due to clinician and patient confusion due to numerous guidelines out there.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.
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