Glucose test values not significant predictors of gestational diabetes risk
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After adjusting for confounders, high fasting blood glucose and 2-hour oral glucose tolerance test values are not significantly associated with an increased risk for developing diabetes after gestational diabetes, according to study data.
Unadjusted data show an association between elevated fasting blood glucose (FBG) and OGTT values and an increased risk for developing diabetes after gestational diabetes, but that the association is weakened in adjusted data, Linn E. Moore, PhD, a postdoctoral fellow in the department of obstetrics and gynecology at the University of Alberta in Edmonton, Canada, and colleagues wrote in a study published in the Journal of Diabetes and its Complications.
“There were distinct elevations in antepartum FBG and OGTT mean values among those who developed diabetes during the mean follow-up of 7.1 years vs. those who did not develop diabetes,” the researchers wrote. “Elevated FBG and 2-hour OGTT levels were associated with up to fourfold higher odds of developing diabetes in the future; however, these associations were attenuated when the ORs were adjusted for common confounding factors, such as maternal body mass index, age at delivery and family history of diabetes.”
Researchers conducted a systemic review and meta-analysis on articles published in four major biomedical databases from 1982 to Feb. 4, 2020. The four databases queried were MEDLINE, Embase, Web of Science and CENTRAL. Key words included terms relevant to gestational diabetes, diabetes and OGTT.
The review included prospective and retrospective observational cohort studies using OGTT, including FBG and post-load tests, that were measured between weeks 24 and 28 of gestation as a predictive measure for the development of diabetes more than 6 months postpartum for women diagnosed with gestational diabetes. Researchers extracted the number of participants from each study, duration of follow-up, age of participants, OGTT results, and ORs for developing diabetes. The mean FBG and OGTT values were also extracted if available.
The review included 17 articles reporting data from 5,017 women. There were 13 retrospective studies and four prospective studies. The mean follow-up time was 7.2 years, and 26.8% of all participants in the 17 studies developed diabetes after gestational diabetes.
In unadjusted pooled data from three retrospective studies, women with an elevated postpartum FBG had a higher likelihood for developing diabetes (OR = 3.62; 95% CI, 1.3-10.12). After adjustments were made for confounding factors, however, the pooled ORs for developing diabetes with an elevated FBG were not significant in three prospective studies and four retrospective studies.
Unadjusted data from two retrospective studies showed women with an elevated 2-hour OGTT were more likely to develop diabetes (OR = 3.96; 95% CI, 1.17-13.4). Pooled data from two retrospective studies that adjusted for covariates showed there was no significant association between 2-hour OGTT values and a risk for developing diabetes.
“Both FBG and the 2-hour values from the antepartum OGTT emerged as associated with increased risk of diabetes following gestational diabetes; however, confounding factors may be largely responsible for these relationships as the association between FBG and 2-hour OGTT were diminished in the meta-analysis using adjusted data,” the researchers wrote. “Further research is needed before we can determine if there are particular antepartum FBG and/or OGTT values or ranges of values where the risk for diabetes becomes high following pregnancies affected by gestational diabetes.”
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