Top

Published in:

Open Access 01-12-2008 | Research

Risk assessment does not explain high prevalence of gestational diabetes mellitus in a large group of Sardinian women

Authors: Cinzia Murgia, Rachele Berria, Luigi Minerba, Simonetta Sulis, Michela Murenu, Elaine Portoghese, Nicoletta Garau, Pierina Zedda, Gian Benedetto Melis

Published in: Reproductive Biology and Endocrinology | Issue 1/2008

Abstract

Background

A very high prevalence (22.3%) of gestational diabetes mellitus (GDM) was recently reported following our study on a large group of Sardinian women. In order to explain such a high prevalence we sought to characterise our obstetric population through the analysis of risk factors and their association with the development of GDM.

Methods

The prevalence of risk factors and their association with the development of GDM were evaluated in 1103 pregnancies (247 GDM and 856 control women). The association of risk factors with GDM was calculated according to logistic regression. Sensitivity and specificity of risk assessment strategy were also calculated.

Results

None of the risk factors evaluated showed an elevated frequency in our population. The high risk patients were 231 (20.9%). Factors with a stronger association with GDM development were obesity (OR 3.7, 95% CI 2.08–6.8), prior GDM (OR 3.1, 95% CI 1.69–5.69), and family history of Type 2 diabetes (OR 2.6, 95% CI 1.81–3.86). Only patients over 35 years of age were more represented in the GDM group (38.2% vs 22.6% in the non-GDM cases, P < 0.001). Type 2 diabetes in second-degree relatives was equally represented in GDM and non-GDM subjects, while prior poor obstetrical outcomes mostly characterized non-GDM women (17.5% vs 10.6%, P < 0.001). The "average risk" assessment better characterized non-GDM patients (76.8% vs 57.8%, P < 0.001). The logistic regression analysis confirmed that Type 2 diabetes in second-degree relatives, prior poor obstetrical outcomes and the "average risk" definition did not predict the development of GDM.

Conclusion

Such a high prevalence of GDM in our population does not seem to be related to the abnormal presence of some known risk factors, and appears in contrast with the prevalence of Type 2 diabetes in Sardinia. Further studies are needed to explain the cause such a high prevalence of GDM in Sardinia. The "average risk" definition is not adequate to predict GDM in our population.

Metzger BE, Coustan DR: Proceedings of the Fourth International Workshop- Conference on Gestational Diabetes Mellitus. Diab Care. 1998, 21: B1-B167.

H King: Epidemiology of Glucose Intolerance and Gestational Diabetes in Women of Childbearing Age. Diabetes Care. 1998, 21 (suppl 2): B9-13. 10.2337/diacare.21.1.9.

Jimenez-Moleon JJ, Bueno-Cavanillas A, Luna-del-Castillo J, M Garcia-Martin, P Lardelli-Claret, R Calvez-Vargas: Prevalence of gestational diabetes mellitus: variation related to screening strategy used. Eur J Endocrinol. 2002, 146: 831-837. 10.1530/eje.0.1460831.CrossRefPubMed

Ben-Haroush A, Yogev Y, Hod M: Epidemiology of gestational Diabetes mellitus and its association with Type 2 Diabetes. Diabet Med. 2004, 21: 103-113. 10.1046/j.1464-5491.2003.00985.x.CrossRefPubMed

Solomon CG, Willett WC, Carey VJ, Rich-Edwards J, Hunter DJ, Coldittz GA: A prospective study of pregravid determinants of gestational diabetes mellitus. JAMA. 1997, 278: 1078-1083. 10.1001/jama.278.13.1078.CrossRefPubMed

Dooley SL, Metzger BE, Cho NH: Gestational diabetes mellitus: influence of race on disease prevalence and perinatal outcome in a U.S. population. Diabetes. 1991, 40: 25-29.CrossRefPubMed

Coustan DR, Nelson C, Carpenter MW, Carr SR, Rotondo L, Widness JA: Maternal age and screening for gestational diabetes: a population based study. Obstet Gynecol. 1989, 73: 557-561.PubMed

O'Sullivan JB, Mahan CM, Charles D, Dandrow RV: Screening criteria for high risk gestational diabetic patients. Am J Obstet Gynecol. 1973, 116: 895-900.PubMed

Danilenko-Dixon DR, Van Winter JT, Nelson RL, jr Ogburn PL: Universal versus selective gestational Diabetes screening: application of 1997 American Diabetes Association recommendations. Am J Obstet Gynecol. 1999, 181: 798-802. 10.1016/S0002-9378(99)70304-2.CrossRefPubMed

10.

American DiabetesAssociation: Gestational Diabetes Mellitus. Diabetes Care. 2003, 26 (Suppl 1): S103-5. 10.2337/diacare.26.7.2194.

11.

Coustan DR: Gestational Diabetes. Obstet Gynecol. 2001, 98: 525-538.

12.

Berkowitz GS, Lapinski RH, Wein R, Lee D: Race/ethnicty and other risk factors for gestational diabetes. Am J Epidemiol. 1991, 135: 965-973.

13.

Dornhorst A, Patersen CM, Nicholls JSD, Wadsworth J, Chiu DC, Elkeles RS, Johnston DG, Beard RW: High prevalence of gestational diabetes in women from ethnic minority groups. Diabet Med. 1992, 9: 820-825.CrossRefPubMed

14.

WHO Ad Hoc Diabetic Reporting Group: Diabetes and impaired glucose tolerance in women aged between 20 and 39 years. WHO Health Stats. 1992, 45: 321-327.

15.

Dornhorst A, Bailey PC, Vanyaoku, Elkeles RS, Johnston DG, Beard RW: Abnormalities of glucose tolerance following gestational dibetes. J Med. 1990, 77 (284): 1219-1228.

16.

Henry OA, Beisher NA: Long term implication of gestational diabetes for the mother. Baillieres Clin Obstet Gynaecol. 1991, 5: 461-483. 10.1016/S0950-3552(05)80107-5.CrossRefPubMed

17.

Kautzky-Willer A, Bancher-Todesca D, Weitgasser R, Prokoszovich T, Steiner H, Shnawa N, Schernthaner G, Birnbacher R, Schneiders B, Marth Ch, Roden M, Leichleitner M: The impact of risk factors and more stringent diagnostic criteria of gestational diabetes on outocomes in central European Women. J Clin Endocrinol Metab. 2008, 19 ():

18.

Naylor CD, Sermer M, Chen E, Farine D: Selective screening for gestational diabetes mellitus. Toronto Trihospital Gestational Diabetes Investigators. N Engl J Med. 1997, 337: 1591-1596. 10.1056/NEJM199711273372204.CrossRefPubMed

19.

Songini M, Muntoni S: High incidence of type 1 diabetes in Sardinia. Lancet. 1991, 337: 1047-10.1016/0140-6736(91)92714-D.CrossRefPubMed

20.

Green A, Gale EAM, CC Patterson for the EURODIAB ACE Study Group: Incidence of childhood-onset insulin dependent diabetes mellitus: the Eurodiab Ace Study. Lancet. 1992, 339: 905-909. 10.1016/0140-6736(92)90938-Y.CrossRefPubMed

21.

Muntoni S, Songini M, and the Sardinian Collaborative Group for Epidemiology of IDDM: High incidence rate of IDDM in Sardinia. Diab Care. 1992, 15: 1317-1322. 10.2337/diacare.15.10.1317.CrossRef

22.

Casu A, Pascutto C, Bernarinelli L, the Sardinian IDDM Epidemiology Study Group and, Songini M: Type 1 Diabetes among Sardinian Children is increasing. Diab Care. 2004, 27: 1623-1629. 10.2337/diacare.27.7.1623.CrossRef

23.

Velluzzi F, Caradonna A, Boy MF, Pinna MA, Cabula R, Lai MA, Piras E, Corda G, Mossa P, Atzeni F, Loviselli A, Usai P, S Mariotti.: Thyroid and celiac disease: clinical sierological and ecographic study. Am J Gastroenterol. 1998, 93: 976-979. 10.1111/j.1572-0241.1998.291_u.x.CrossRefPubMed

24.

Meloni GF, Tomasi PA, Bertoncelli A, Fanciulli G, Delitala G, Meloni T: Prevalence of silent celiac disease in patients with autoimmune thyroiditis from northern Sardinia. J Endocrinol Invest. 2001, 24: 298-302.CrossRefPubMed

25.

Marrosu MG, Cocco E, Lai M, Spinicci G, Pischedda MP, Contu P: Patients with multiple sclerosis and risk of type 1 diabetes mellitus in Sardinia, Italy. A cohort study. Lancet. 2002, 359: 1461-1465. 10.1016/S0140-6736(02)08431-3.CrossRefPubMed

26.

Pugliatti M, Riise T, Sotgiu MA, Sotgiu S, Satta WM, Mannu L, Sanna G, Rosati G: Increasing incidence of multiple sclerosis in the province of Sassari, northern Sardinia. Neuroepidemiology. 2005, 25: 129-134. 10.1159/000086677.CrossRefPubMed

27.

Muntoni S, Pintus F, Mascia P, Pintus P, Cabiddu G, Tronci P, Ganga E: Indagine sul diabete noto e ignorato in Sardegna. Giornale Italiano di Diabetologia. 1988, 8: 311-316.

28.

Murgia C, Berria R, Minerba L, Malloci B, Daniele C, Zedda P, Ciccotto MG, Sulis S, Murenu M, Tiddia F, Manai M, GB Melis: Gestational Diabetes Mellitus in Sardinia: Results from an Early, Universal Screening Procedure. Diab Care. 2006, 29: 1713-10.2337/dc06-0635.CrossRef

29.

Miselli V, Pagliani U, Bisi S, Foracchia A, Dorigatti C, Pinotti M, Zappavigna A: Epidemiology of gestational diabetes in Scandiano health district. Minerva Endocrinol. 1994, 19: 63-66.PubMed

30.

Di Cianni G, Volpe L, Lencioni C, Miccoli R, Cuccuru I, Ghio A, Chatzianagnostou K, Bottone P, Teti G, DelPrato S, L Benzi: Prevalence and risk factors for gestational diabetes assessed by universal screening. Diabetes Res Clin Pract. 2003, 62: 131-137. 10.1016/j.diabres.2003.07.004.CrossRefPubMed

31.

Corrado F, Stella NC, Mancuso A, Triolo O, Bruno L, Artenisio AC: Screening for gestational diabetes in Sicily. J Reprod Med. 1999, 44: 875-878.PubMed

32.

Lapolla A, Mazzon S, Marini S, Fedele D: A screening program for gestational diabetes in a north Mediterranean area. Diabetes Nutr Metab. 1995, 8: 33-41.

33.

Piva I, Thiella M, Pellizzari G: Screening of gestational diabetes in Vicenza-Northern Italy. Diabetes Nutr Metab. 1997, 10: 9-13.

34.

Hyvonen K: Gestatiodiabetesksen esiintyvyys ja seulonta. [The incidence and screening of gestational diabetes mellitus in Finland (in Finnish with English summary).]. Publications of the University of Kuopio, Finland. 1991

35.

Larijani B, Hossein-Neezhad A, Rizvi SW, Munir S, Vassigh AR: Cost analysis of different screening strategies for gestational diabetes mellitus. Endocr Pract. 2003, 9: 504-509.CrossRefPubMed

36.

Yogev Y, Langer O, Xenakis EM, Rosenn B: Glucose screening in Mexican- American women. Obstet Gynecol. 2004, 103: 1241-1245.CrossRefPubMed

37.

Jovanovich L, CM Petersen: Screening for gestational: optimum timing and criteria for retesting. Diabetes Nutr Metab. 1985, 34 (Suppl 2): 21-23.

38.

Benjamin F, Wilson SJ, Deutsch S, Seltzer VL, Droesch K, Droesch J: Effect of advancing pregnancy on the glucose tolerance test and on the 50-g oral glucose load screening test for gestational diabetes. Obstet Gynecol. 1986, 68: 362-365.CrossRefPubMed

39.

Ostlund I, Hanson U: Occurrence of gestational diabetes mellitus and the value of different screening indicators for the oral glucose tolerance test. Acta Obstet Gynecol Scand. 2002, 82: 103-108. 10.1034/j.1600-0412.2003.00001.x.CrossRef

Title: Risk assessment does not explain high prevalence of gestational diabetes mellitus in a large group of Sardinian women
Authors: Cinzia Murgia
Rachele Berria
Luigi Minerba
Simonetta Sulis
Michela Murenu
Elaine Portoghese
Nicoletta Garau
Pierina Zedda
Gian Benedetto Melis
Publication date: 01-12-2008
Publisher: BioMed Central
Published in: Reproductive Biology and Endocrinology / Issue 1/2008
Electronic ISSN: 1477-7827
DOI: https://doi.org/10.1186/1477-7827-6-26

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Risk assessment does not explain high prevalence of gestational diabetes mellitus in a large group of Sardinian women

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2008

The Krüppel-like factor 9 (KLF9) network in HEC-1-A endometrial carcinoma cells suggests the carcinogenic potential of dys-regulated KLF9 expression

Angiogenic, hyperpermeability and vasodilator network in utero-placental units along pregnancy in the guinea-pig (Cavia porcellus)

The expression of hyperpolarization activated cyclic nucleotide gated (HCN) channels in the rat ovary are dependent on the type of cell and the reproductive age of the animal: a laboratory investigation

Regulatory RNAs and chromatin modification in dosage compensation: A continuous path from flies to humans?

Spermatogonial stem cell sensitivity to capsaicin: An in vitro study

TLR3 and TLR4 expression in healthy and diseased human endometrium