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Gestational Diabetes and Preeclampsia
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Obstetrisk forskning/Axelsson)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Obstetrisk forskning/Axelsson)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Obstetrisk forskning/Axelsson)
2004 (English)In: European Journal of Obstetrics, Gynecology, and Reproductive Biology, ISSN 0301-2115, E-ISSN 1872-7654, Vol. 113, no 1, 12-16 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To determine whether gestational diabetes mellitus (GDM) increases the risk for preeclampsia independent of other risk factors.

STUDY DESIGN: The association between GDM and preeclampsia was analyzed in a population of women who had given birth to singletons registered in Swedish Medical Birth Register from 1992 through 1996 (n=430,852).

RESULTS: GDM occurred in 0.8% and preeclampsia in 2.9% of all pregnancies. The rate of preeclampsia was higher in the GDM than in the non-GDM group (6.1% versus 2.8%). High age, nullipara, chronic hypertension, kidney disease, and high body mass index (BMI) were all independently associated with increased risk for preeclampsia. Smoking was associated with decreased risk. Adjusted odds ratio for GDM as a risk factor for preeclampsia was 1.61 (95% confidence interval (CI) 1.39-1.86) when prepregnancy BMI, which was a true confounder, was included in the last step of the multiple logistic regression analysis.

CONCLUSIONS: There is an independent and significant association between GDM and preeclampsia. Obesity is a major confounding factor but could not explain the total excess risk.

Place, publisher, year, edition, pages
2004. Vol. 113, no 1, 12-16 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-90098DOI: 10.1016/j.ejogrb.2003.07.001PubMedID: 15036703OAI: oai:DiVA.org:uu-90098DiVA: diva2:162288
Available from: 2003-01-16 Created: 2003-01-16 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Aspects of Gestational Diabetes: Screening System, Maternal and Fetal Complications
Open this publication in new window or tab >>Aspects of Gestational Diabetes: Screening System, Maternal and Fetal Complications
2003 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The appropriateness of universal screening for gestational diabetes mellitus (GDM) has been strongly questioned, since it does not satisfy ethical principles for screening.

The aims of these studies were to determine the prevalence of GDM, expressed in terms of impaired glucose tolerance (IGT) and diabetes mellitus (DM), to evaluate different screening models using traditional anamnestic risk factors and repeated random B-glucose, to determine whether GDM increases risks for maternal complications such as preeclampsia, and to determine whether IGT during pregnancy, if left untreated, is associated with increased maternal or neonatal morbidity.

Of 4,918 pregnant non-diabetic women attending maternal health care, 73.5% agreed to have a 75 g oral glucose tolerance test (OGTT). GDM was diagnosed in 1.7%, IGT in 1.3% and DM in 0.4%. Traditional risk factor criteria were fulfilled by 15.8%. Prior GDM and a prior macrosomic infant showed the highest association with GDM. No selective or two-step universal screening model would have detected all cases of GDM. A constructed model comprising prior GDM, a prior LGA/macrosomic infant, or a cut-off random B-glucose level of 8 mmol/l as an indication for OGTT reduced the need for OGTT to 7.3% compared to the selective screening model with traditional risk factors. Such a universal two-step screening model had 100% sensitivity for DM, and 44.7% sensitivity for IGT.

The Swedish Medical Birth Register was used to evaluate GDM as risk factor for preeclampsia. GDM occurred in 0.8% and preeclampsia in 2.9% of 430,852 singleton pregnancies. There is an independent and significant association between GDM and preeclampsia. Obesity is a major confounding factor, but cannot explain the total excess risk.

In a prospective population-based case-control study 213 women with untreated IGT during pregnancy were identified. For each case, four controls were recruited from the same delivery department. The analyses confirmed that maternal and fetal morbidity were increased in the cases in terms of cesarean section rate, pre-term delivery, Erb’s palsy and admission to NICU. There was a marked, independent increase in the proportion of LGA infants (OR 7.3; 95% CI 4.1-12.7). To determine whether treatment has an effect when IGT is diagnosed during pregnancy, a randomized study is required.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2003. 38 p.
Series
Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 0282-7476 ; 1220
Keyword
Obstetrics and gynaecology, Gestational diabetes, screening, preeclampsia, random B-glucose, impaired glucose tolerance, macrosomia, Obstetrik och kvinnosjukdomar
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:uu:diva-3267 (URN)91-554-5511-5 (ISBN)
Public defence
2003-02-07, Wilandersalen, Universitetssjukhuset Örebro, Uppsala, 09:15
Opponent
Available from: 2003-01-16 Created: 2003-01-16Bibliographically approved

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