E Cosson1, E Vicaut2, D Sandre-Banon3, F Gary3, I Pharisien2, J-J Portal2, C Baudry3, C Cussac-Pillegand3, D Costeniuc3, P Valensi3, L Carbillon4. 1. Paris 13 University, Sorbonne Paris Cité, AP-HP, Jean-Verdier Hospital, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, 93143 Bondy, France; Paris 13 University, Sorbonne Paris Cité, UMR U557 INSERM, U11125 INRA CNAM, Université Paris 13, Unité de Recherche Épidémiologique Nutritionnelle, 93000 Bobigny, France. Electronic address: emmanuel.cosson@aphp.fr. 2. Université Denis-Diderot, AP-HP, Unité de Recherche Clinique Saint-Louis-Lariboisière, 75010 Paris, France. 3. Paris 13 University, Sorbonne Paris Cité, AP-HP, Jean-Verdier Hospital, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, 93143 Bondy, France. 4. Paris 13 University, Sorbonne Paris Cité, AP-HP, Jean-Verdier Hospital, Department of Obstetrics and Gynecology, 93143 Bondy, France.
Abstract
AIM: Our study evaluated the performance of a selective screening strategy for hyperglycaemia in pregnancy (HIP) based on the presence of risk factors (RFs; body mass index≥25kg/m2, age≥35years, family history of diabetes, personal history of HIP or macrosomic infant) to diagnose HIP and to predict HIP-related events. METHODS: Women with no known diabetes who had undergone complete universal screening (early, before 22weeks of gestation and, if normal, in the second part of pregnancy) at our department (2012-2016) were selected, resulting in four groups of women according to the presence of HIP and/or RFs, with a predefined composite endpoint (preeclampsia or large-for-gestational-age infant or shoulder dystocia). RESULTS: Included were 4518 women: 23.5% had HIP and 71.1% had at least one RF. The distribution among our four groups was: HIP-/RF- (n=1144); HIP-/RF+ (n=2313); HIP+/RF- (n=163); and HIP+/RF+ (n=898). HIP was more frequent when RFs were present rather than absent (33.1% vs 15.4%, respectively; P<0.001). Incidence of the composite endpoint differed significantly (P<0.0001) across groups [HIP-/RF- 6.3%; HIP-/RF+ 13.2%; HIP+/RF- 8.6%; and HIP+/RF+ 17.1% (HIP effect: P<0.05; RF effect: P<0.001; interaction HIP * RF: P=0.94)] and significantly increased with the number of RFs (no RF: 6.3%, 1 RF: 10.8%, 2 RFs: 14.7%, 3 RFs: 28.0%, 4-5 RFs: 25.0%; P<0.0001). CONCLUSION: RFs are predictive of HIP, although 15.4% of women with HIP have no RFs. Also, irrespective of HIP status, RFs are predictive of HIP-related events, suggesting that overweight/obesity, the only modifiable RFs, could be targets of interventions to improve pregnancy prognosis.
AIM: Our study evaluated the performance of a selective screening strategy for hyperglycaemia in pregnancy (HIP) based on the presence of risk factors (RFs; body mass index≥25kg/m2, age≥35years, family history of diabetes, personal history of HIP or macrosomic infant) to diagnose HIP and to predict HIP-related events. METHODS:Women with no known diabetes who had undergone complete universal screening (early, before 22weeks of gestation and, if normal, in the second part of pregnancy) at our department (2012-2016) were selected, resulting in four groups of women according to the presence of HIP and/or RFs, with a predefined composite endpoint (preeclampsia or large-for-gestational-age infant or shoulder dystocia). RESULTS: Included were 4518 women: 23.5% had HIP and 71.1% had at least one RF. The distribution among our four groups was: HIP-/RF- (n=1144); HIP-/RF+ (n=2313); HIP+/RF- (n=163); and HIP+/RF+ (n=898). HIP was more frequent when RFs were present rather than absent (33.1% vs 15.4%, respectively; P<0.001). Incidence of the composite endpoint differed significantly (P<0.0001) across groups [HIP-/RF- 6.3%; HIP-/RF+ 13.2%; HIP+/RF- 8.6%; and HIP+/RF+ 17.1% (HIP effect: P<0.05; RF effect: P<0.001; interaction HIP * RF: P=0.94)] and significantly increased with the number of RFs (no RF: 6.3%, 1 RF: 10.8%, 2 RFs: 14.7%, 3 RFs: 28.0%, 4-5 RFs: 25.0%; P<0.0001). CONCLUSION: RFs are predictive of HIP, although 15.4% of women with HIP have no RFs. Also, irrespective of HIP status, RFs are predictive of HIP-related events, suggesting that overweight/obesity, the only modifiable RFs, could be targets of interventions to improve pregnancy prognosis.
Keywords:
Diabetes in pregnancy; Early gestational diabetes mellitus; Guidelines; International Association of Diabetes and Pregnancy Study Groups; Prognosis; Screening
Authors: Philippe Oriot; Charlotte Leroy; Virginie Van Leeuw; Jean Christophe Philips; Jean François Vanderijst; Aline Vuckovic; Elena Costa; Christian Debauche; Frederic Chantraine Journal: Heliyon Date: 2022-04-12
Authors: Gagan Priya; Sarita Bajaj; Bharti Kalra; Ankia Coetzee; Sanjay Kalra; Deep Dutta; Vivien Lim; Hema Diwakar; Vaishali Deshmukh; Roopa Mehta; Rakesh Sahay; Yashdeep Gupta; J B Sharma; Arundhati Dasgupta; S Patnala; Faria Afsana; Mimi Giri; Aisha Sheikh; Manash P Baruah; A R Asirvatham; Shehla Sheikh; Samanthi Cooray; Kirtida Acharya; Y A Langi; Jubbin J Jacob; Jaideep Malhotra; Belinda George; Emmy Grewal; Sruti Chandrasekharan; Sarah Nadeem; Roberta Lamptey; Deepak Khandelwal Journal: J Family Med Prim Care Date: 2021-12-27