Diabetes & Metabolism Journal

Original Articles

A Comparative Study of Eating Habits and Food Intake in Women with Gestational Diabetes according to Early Postpartum Glucose Tolerance Status: You Jeong Hwang, Bo Kyung Park, Sunmin Park, Sung-Hoon Kim; Diabetes Metab J. 2011;35(4):354-363. Published online August 31, 2011; DOI: https://doi.org/10.4093/dmj.2011.35.4.354

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Background

Women with gestational diabetes mellitus (GDM) are at high risk for type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD); continuous life-style intervention, especially diet, is central to managing T2DM and CVD. However, little is known about the dietary patterns of women with GDM after delivery. The goal of this study was to compare the eating habits and food intakes of women diagnosed with GDM during the early postpartum period.

Methods

We performed a 75 g oral glucose tolerance test (OGTT) in 184 women with GDM between 6 and 12 weeks after delivery. Based on the results of the OGTT, the subjects were divided into three groups according to the American Diabetes Association criteria; normal glucose tolerance (NGT) (n=100), pre-diabetes (n=73), and diabetes mellitus (DM) (n=11). Eating habits and usual food intake after delivery were investigated using a questionnaire, based on 24 hour-recall, which was administered by a trained dietitian. The daily intake data were analyzed using CAN Pro 3.0. Blood tests were performed pre- and post-delivery.

Results

Eating habits were not significantly different among the three groups. However, animal fat consumption was significantly different among the three groups. The intake ratio of fat calories to total calories was also significantly higher in the pre-diabetes and DM groups.

Conclusion

Although diet in the period 6 to 12 weeks postpartum did not influence glucose level, it may be important to educate women with GDM about the risks of excessive animal fat intake during pregnancy and the postpartum period in order to prevent later onset of T2DM.

Citations

Citations to this article as recorded by

Intuitive eating is associated with weight and glucose control during pregnancy and in the early postpartum period in women with gestational diabetes mellitus (GDM): A clinical cohort study
Dan Yedu Quansah, Justine Gross, Leah Gilbert, Celine Helbling, Antje Horsch, Jardena J. Puder
Eating Behaviors.2019; 34: 101304. CrossRef
Prevention of Diabetes after Gestational Diabetes: Better Translation of Nutrition and Lifestyle Messages Needed
Sharleen O'Reilly
Healthcare.2014; 2(4): 468. CrossRef
Gestational Diabetes Mellitus in Korean Women: Similarities and Differences from Other Racial/Ethnic Groups
Catherine Kim
Diabetes & Metabolism Journal.2014; 38(1): 1. CrossRef
A Study of Snack Consumption, Night-Eating Habits, and Nutrient Intake in Gestational Diabetes Mellitus
Hee-jin Park, JinJu Lee, Ji-Myung Kim, Hyun Ah Lee, Sung-Hoon Kim, Yuri Kim
Clinical Nutrition Research.2013; 2(1): 42. CrossRef
Risk Factors for Gestational Diabetes Mellitus in a Large Population of Women Living in Spain: Implications for Preventative Strategies
Ana M. Ramos-Leví, Natalia Pérez-Ferre, M. Dolores Fernández, Laura del Valle, Elena Bordiu, Ana Rosa Bedia, Miguel A. Herraiz, M. José Torrejón, Alfonso L. Calle-Pascual
International Journal of Endocrinology.2012; 2012: 1. CrossRef
The Influence of Ethnicity on the Development of Type 2 Diabetes Mellitus in Women with Gestational Diabetes: A Prospective Study and Review of the Literature
Christian M. Girgis, Jenny E. Gunton, N. Wah Cheung
ISRN Endocrinology.2012; 2012: 1. CrossRef
Low Density Lipoprotein Cholesterol Target Goal Attainment Rate in Korean Patients with Diabetes
Eun Hae Lee, Chul Woo Ahn
Diabetes & Metabolism Journal.2011; 35(6): 578. CrossRef

Insulin Secretion and Incretin Hormone Concentration in Women with Previous Gestational Diabetes Mellitus: Sung Hoon Yu, Bongjun Cho, Yejin Lee, Eunhye Kim, Sung Hee Choi, Soo Lim, Ka Hee Yi, Young Joo Park, Kyong Soo Park, Hak Chul Jang; Diabetes Metab J. 2011;35(1):58-64. Published online February 28, 2011; DOI: https://doi.org/10.4093/dmj.2011.35.1.58

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Abstract PDF PubReader

Background

We examined the change in the levels of incretin hormone and effects of glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide 1 (GLP-1) on insulin secretion in women with previous gestational diabetes (pGDM).

Methods

A 75-g oral glucose tolerance test (OGTT) was conducted on 34 women with pGDM. In addition, 11 women with normal glucose tolerance, matched for age, height and weight, were also tested. The insulin, GIP, GLP-1, and glucagon concentrations were measured, and their anthropometric and biochemical markers were also measured.

Results

Among 34 women with pGDM, 18 had normal glucose tolerance, 13 had impaired glucose tolerance (IGT) and 1 had diabetes. No significant differences were found in GLP-1 concentration between the pGDM and control group. However, a significantly high level of glucagon was present in the pGDM group at 30 minutes into the OGTT. The GIP concentration was elevated at 30 minutes and 60 minutes in the pGDM group. With the exception of the 30-minute timepoint, women with IGT had significantly high blood glucose from 0 to 120 minutes. However, there was no significant difference in insulin or GLP-1 concentration. The GIP level was significantly high from 0 to 90 minutes in patients diagnosed with IGT.

Conclusion

GLP-1 secretion does not differ between pGDM patients and normal women. GIP was elevated, but that does not seem to induce in increase in insulin secretion. Therefore, we conclude that other factors such as heredity and environment play important roles in the development of type 2 diabetes.

Citations

Citations to this article as recorded by

Association of GLP-1 secretion with parameters of glycemic control in women after gestational diabetes mellitus
Eleni Pappa, Kristina Busygina, Saori Harada, Hana Hermann, Cornelia Then, Andreas Lechner, Uta Ferrari, Jochen Seissler
BMJ Open Diabetes Research & Care.2024; 12(1): e003706. CrossRef
Inadequate Glucagon Suppression During OGTT in Prediabetes: A Systematic Review and Meta-analysis
Lina Chang, Ying Liu, Yian Gu, Siyu Yan, Li Ding, Ming Liu, Qing He
The Journal of Clinical Endocrinology & Metabolism.2024; 109(10): 2673. CrossRef
Increased Pro-Inflammatory T Cells, Senescent T Cells, and Immune-Check Point Molecules in the Placentas of Patients With Gestational Diabetes Mellitus
Yea Eun Kang, Hyon-Seung Yi, Min-Kyung Yeo, Jung Tae Kim, Danbit Park, Yewon Jung, Ok Soon Kim, Seong Eun Lee, Ji Min Kim, Kyong Hye Joung, Ju Hee Lee, Bon Jeong Ku, Mina Lee, Hyun Jin Kim
Journal of Korean Medical Science.2022;[Epub] CrossRef
Simulation of Oral Glucose Tolerance Tests and the Corresponding Isoglycemic Intravenous Glucose Infusion Studies for Calculation of the Incretin Effect
Myeungseon Kim, Tae Jung Oh, Jung Chan Lee, Karam Choi, Min Young Kim, Hee Chan Kim, Young Min Cho, Sungwan Kim
Journal of Korean Medical Science.2014; 29(3): 378. CrossRef
Metabolic, hormonal characteristics and genetic variants of TCF7L2 associated with development of gestational diabetes mellitus in Mexican women
Ruth Reyes‐López, Elva Pérez‐Luque, Juan Manuel Malacara
Diabetes/Metabolism Research and Reviews.2014; 30(8): 701. CrossRef
Reduced postprandial GLP‐1 responses in women with gestational diabetes mellitus
L. Bonde, T. Vilsbøll, T. Nielsen, J. I. Bagger, J. A. Svare, J. J. Holst, S. Larsen, F. K. Knop
Diabetes, Obesity and Metabolism.2013; 15(8): 713. CrossRef
Women with normal glucose tolerance and a history of gestational diabetes show significant impairment of β-cell function at normal insulin sensitivity
P. Molęda, K. Homa, K. Safranow, Z. Celewicz, A. Fronczyk, L. Majkowska
Diabetes & Metabolism.2013; 39(2): 155. CrossRef

Adipokine Concentrations in Pregnant Korean Women with Normal Glucose Tolerance and Gestational Diabetes Mellitus.: Eun Suk Oh, Jung Hee Han, Sung Min Han, Jee Aee Im, Eun Jung Rhee, Cheol Young Park, Ki Won Oh, Won Young Lee; Korean Diabetes J. 2009;33(4):279-288. Published online August 1, 2009; DOI: https://doi.org/10.4093/kdj.2009.33.4.279

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Abstract PDF

BACKGROUND
The aims of this study were to compare adipokine concentrations of pregnant women in the 24th~28th weeks of gestation to those of non-pregnant women. We compared the concentrations of adipokines in women with gestational diabetes mellitus (GDM), gestational impaired glucose tolerance (GIGT) and normal glucose tolerance (NGT). We also investigated the role of adipokines in the development of gestational glucose intolerance. METHODS: We surveyed 129 pregnant women who underwent a 100 g oral glucose tolerance test (OGTT) during the 24th~28th weeks of gestation. Participants were classified into three groups: (1) NGT (n = 40), (2) GIGT (n = 45), and (3) GDM (n = 44). Pregnant subjects with NGT were matched to non-pregnant controls for BMI and age (n = 41). RESULTS: Pregnant women with NGT exhibited significantly decreased adiponectin levels and elevated leptin levels compared to non-pregnant controls. Mean plasma resistin levels were significantly higher in women with GDM and GIGT than in women with NGT. Resistin and fasting glucose were significant predictors for the development of gestational glucose intolerance. CONCLUSION: Plasma adiponectin levels were decreased and leptin levels were increased in pregnant subjects with NGT compared to BMI and age matched non-pregnant controls. Women with GDM and GIGT exhibit significantly elevated concentrations of resistin compared with women with NGT. Increased resistin levels were also associated with the development of gestational glucose intolerance. Resistin may play an important role on the development of gestational glucose intolerance in Korean women.

Citations

Citations to this article as recorded by

Maternal serum level of resistin is associated with risk for gestational diabetes mellitus: A meta-analysis
Shi-Min Hu, Meng-Shi Chen, Hong-Zhuan Tan
World Journal of Clinical Cases.2019; 7(5): 585. CrossRef
Letter: Adipokines and Insulin Resistance According to Characteristics of Pregnant Women with Gestational Diabetes Mellitus (Diabetes Metab J 2017;41:457-65)
Ohk-Hyun Ryu
Diabetes & Metabolism Journal.2018; 42(1): 87. CrossRef
Adipokines and Insulin Resistance According to Characteristics of Pregnant Women with Gestational Diabetes Mellitus
Eon Ju Jeon, Seong Yeon Hong, Ji Hyun Lee
Diabetes & Metabolism Journal.2017; 41(6): 457. CrossRef

Mutation Screening of HNF-1alpha Gene in Korean Women with Gestational Diabetes Mellitus.: Hun Sung Kim, Sun Hee Hwang, Eun Sun Choi, So Young Park, Chang Hoon Yim, Ki Ok Han, Hyun Koo Yoon, Ho Yeon Chung, Kyung Seon Kim, Jeong Bok, Jong Young Lee, Sung Hoon Kim; Korean Diabetes J. 2008;32(1):38-43. Published online February 1, 2008; DOI: https://doi.org/10.4093/kdj.2008.32.1.38

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Abstract PDF

BACKGROUND
S: Gestational diabetes mellitus (GDM) is defined as glucose intolerance with onset or first detection during pregnancy and mostly caused by insulin resistance and beta-cell dysfunction like type 2 diabetes. However, autoimmune or monogenic diabetes can contribute to GDM. Maturity-onset diabetes of the young (MODY) is a monogenic form of diabetes characterized by an early age of onset and an autosomal dominant pattern of inheritance. Most MODY cases are attributable to mutations in HNF-1alpha gene, also known as MODY3. We investigated whether mutations in HNF-1alpha gene are present in Korean women with GDM. METHODS: A total of 96 Korean women with GDM who have a family history of DM were screened for mutations in the HNF-1alpha gene. We evaluated the clinical characteristics of GDM women with HNF-1alpha gene mutations. RESULTS: Five of 96 patients (5.2%) were found to have a mutation in HNF-1alpha gene. Four of those (-23C > G, 833G > A (Arg278Gln), 923C > T, IVS5 + 106A > G) were novel and one (-124G > C) in promoter region was reported in previous study. The mean age of GDM women with mutations of HNF-1alpha gene was 34 years. Four women with MODY3 gene mutations required insulin therapy during pregnancy. GDM women with MODY3 gene mutations appeared to be decreased insulin secretion (HOMA-%B) than those without mutations. CONCLUSIONS: We have found the existence of MODY3 as well as novel HNF-1alpha gene mutations in Korean women with GDM.

Citations

Citations to this article as recorded by

Update on Monogenic Diabetes in Korea
Ye Seul Yang, Soo Heon Kwak, Kyong Soo Park
Diabetes & Metabolism Journal.2020; 44(5): 627. CrossRef
Maturity-Onset Diabetes of the Young: What Do Clinicians Need to Know?
Sung-Hoon Kim
Diabetes & Metabolism Journal.2015; 39(6): 468. CrossRef

Case Reports

A Case of Diabetic Ketoacidosis in Gestational Diabetes Mellitus.: Myung Hwan Kim, Eui Dal Jung, Seung Pyo Hong, Gyu Hwan Bae, Sun Young Ahn, Eon Ju Jeon, Seong Yeon Hong, Ji Hyun Lee, Ho Sang Son; Korean Diabetes J. 2007;31(4):368-371. Published online July 1, 2007; DOI: https://doi.org/10.4093/jkda.2007.31.4.368

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Abstract PDF: Gestational diabetes mellitus (GDM) is defined as glucose intolerance of variant severity with onset or first recognition during present pregnancy. Recently the prevalence of GDM in Korean has reported as 1.7~4.0%. Diabetic ketoacidosis is a serious metabolic complication of diabetes with high mortality if undetected. Its occurrence is very rare in gestational diabetes patients, but is harmful to fetal and maternal health. A 26 years-old pregnant woman was admitted at 37 weeks gestation because of progressive generalized weakness, anorexia and weight loss. Initial physical examination reveals that she had been dehydrated, and blood pressure 130/80 mmHg, pulse rate 100/min, respiratory rate 20/min, and body temperature was 36.9 degrees C. Serum glucose was 545 mg/dL, pH 7.282, HCO3- 10.5 mmol/L, urine ketone 3+, urine glucose 2+ when initial laboratory work was done. She was treated with intravenous fluid and insulin under the impression of diabetic ketoacidosis. Her delivery was performed after 24 hours from admission because of suggestive fetal distress. After recovery, she is being treated with insulin at outpatient department. We experienced a appropriately treated case of diabetic ketoacidosis in pregnant woman with GDM, and report it with a literature review.

Clinical Courses of Two Women with Gestational Diabetes Mellitus Who are GAD Antibody Positive.: Sung Hoon Yu, Min Jun Song, Sung Hoon Kim, Chang Hoon Yim, Ki Ok Han, Won Kun Park, Hyun Koo Yoon, Ho Yeon Chung; Korean Diabetes J. 2006;30(5):398-402. Published online September 1, 2006; DOI: https://doi.org/10.4093/jkda.2006.30.5.398

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Abstract PDF: Gestational diabetes mellitus (GDM) is defined as glucose intolerance of various degrees with onset or first recognition during pregnancy. Women with GDM are at high risk of developing type 2 diabetes later in life, but the risk of developing type 1 diabetes is also increased. Positivity for glutamic acid decarboxylase (GAD) antibodies during pregnancy confers a high risk for subsequent progression to type 1 diabetes. Here, we reported the two cases with GDM who were GAD antibody positive and progressed to type 1 diabetes with different time-courses. One woman with GDM progressed rapidly to classical type 1 diabetes while the other became slowly progressive IDDM (SPIDDM) [or latent autoimmune diabetes in adults (LADA)].

Original Articles

Pregnancy Outcome in Korean Women with Gestational Diabetes Mellitus Diagnosed by the Carpenter-Coustan Criteria.: Hak Chul Jang, Young Min Cho, Kyong Soo Park, Seong Yeon Kim, Hong Kyu Lee, Moon Young Kim, Jae Hyug Yang, Son Moon Shin; Korean Diabetes J. 2004;28(2):122-130. Published online April 1, 2004

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Abstract PDF: BACKGROUND
The American Diabetes Association recently proposed the Carpenter-Coustan criteria for the diagnosis of gestational diabetes mellitus(GDM) based on the results of the Toronto Tri-Hospital Study. The prevalence of GDM in Korean women increased, on average, by 60% when the Carpenter-Coustan criteria were applied. However, the pregnancy outcome of Korean women with GDM with regard to the Carpenter-Coustan criteria tremains to be reported. The pregnancy outcomes of those Korean women with GDM by the Carpenter- Coustan criteria, but not by the NDDG criteria were assessed. METHODS: In this study, a total of 2776 pregnant women underwent universal screening for GDM, between January 1993 and December 1994, as recommended by the Third International Workshop-Conference on Gestational Diabetes Mellitus with minor modifications. The primary pregnancy outcomes were preeclampsia, premature delivery, delivery by C-section, birth weight and LGA infants. RESULTS: Of the 2776 women, 656 screened-positive for GDM. Of these, 37 and 74 had GDM by the Carpenter-Coustan and NDDG criteria, respectively. With increasing glucose intolerance, there was a stepwise increase in premature deliveries, deliveries by C-section and preeclampsia from those screening negative to GDM by the NDDG criteria, with a similar trend for the frequency of LGA infants. The LGA infant screening-negative and positive were 13.5 and 16.1%, but those with a normal glucose tolerance were 27.0 and 33.8% in those screening positive to GDM by the Carpenter-Coustan and NDDG criteria, respectively(P<0.001). CONCLUSION: Our study demonstrated that increasing glucose tolerance was associated with increasing frequencies of adverse pregnancy outcomes in Korean women. The maternally complicated and LGA infants were significantly higher in women with GDM by the Carpenter-Coustan criteria. Thus the Carpenter- Coustan criteria are recommended for the diagnosis of GDM in Korean Women.

Pospartum Assessment of Insulin Secretion and Sensitivity in Women with Gestational Diabetes Mellitus (GDM).: Eun Soon Hong, Hye Jin Lee, Young Sun Hong, Eon Ah Sung, Yeon Jin Jang; Korean Diabetes J. 2002;26(5):319-327. Published online October 1, 2002

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Abstract PDF: BACKGROUND
Gestational diabetes mellitus (GDM) affects 2~4% of all pregnant women. Women with a history of GDM are at high risk of developing type 2 DM, in the future; with a cumulative incidence is 40~60%. Therefore, the assessment of insulin secretion and sensitivity in women with a history of GDM should help in the elucidation of some of the underlying defects of insulin secretion or action in the evolution of type 2 DM. This study was performed to evaluate the characteristics of insulin secretory capacity and sensitivity in women with gestational diabetes following child birth. METHODS: Oral glucose tolerance tests were carried out at 6~8 weeks postpartum in 22 women with a history of GDM, and 20 age and weight matched non- pregnant controls. Frequently sampled intravenous glucose tolerance test (FSIGT) were done at 10~14 weeks postpartm, and insulin secretion was measured as the acute insulin response to glucose (AIRg) and insulin sensitivity as minimal model derived sensitivity index (SI). AIRg*SI was used as an index for beta-cell function because AIRg can be modulated by SI. RESULTS: According to the results of OGTT, the subjects with a history of GDM were classified into 2 groups, one of normal glucose tolerance (postpartum-NGT) (n=11) and the other of an impaired glucose tolerance (postpartum-IGT)(n=11). There were no significant differences in WHR (waist to hip ratio), blood pressure, and serum lipid concentrations among the controls, postpartum-NGT and postpartum-IGT group. The fasting glucose level was significantly higher in the postpartum-IGT group compared to the postpartum-NGT and control groups (p<0.05). The fasting serum insulin level was significantly lower in the postpartum-NGT and -IGT groups than in the control group (p<0.05). The AIRg and AIRg*SI were significantly lower in the postpartum-NGT and -IGT groups compared to the control group (p<0.05), however the SI was lower in the postpartum-NGT and -IGT groups compared to the control group, but the difference did not reach statistical significance. The percentage of parental with history of type 2 diabetes was significantly greater in the postpartum-IGT group compared to the postpartum-NGT group (p<0.05). No significant predictive factors for subsequent IGT were found inform a logistic regression analysis. CONCLUSION: The insulin secretory capacity of women previously having suffered GDM was impaired, even though their glucose tolerance was restored to normal following child birth. Our results suggest that impaired insulin secretion may be a major path-ophysiological factor in the development of type 2 DM in women with a previous history of GDM.

Effect of Self-monitoring of Blood Glucose on Pregnancy Outcome in Women with Mild Gestational Diabetes.: Hak Chul Jang, Jeong Eun Park, Chang Hoon Yim, Ho Yeun Chung, Ki Ok Han, Hyun Koo Yoon, In Kwon Han, Moon Young Kim, Jae Hyug Yang, Mi Jung Kim, Sun Young Ko, Yeon Kyung Lee; Korean Diabetes J. 2001;25(1):93-102. Published online February 1, 2001

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Abstract PDF: BACKGROUND
Self-monitoring of blood glucose (SMBG) and intensive therapy with insulin demonstrated to have a positive effects in the reduction of the neonatal complications in women with gestational diabetes (GDM). However the utility of SMBG in the mild GDM who does not requiring insulin has not been formally reported. Therefore, to evaluate the effectiveness of SMBG in the management of mild GDM, we compared the pregnancy outcome and the postpartum glucose tolerance of women who monitored their glycemic control by SMBG to those of women who monitored by laboratory glucose test at each office visit during pregnancy. METHODS: We studied 185 women diagnosed as a GDM by NDDG criteria and their fasting glucose concentration < 5.8 mM. All subjects had singleton pregnancy,and no medical diseases that may affect fetal growth, and were certain of gestational age by early ultrasonography. They were treated with an identical GDM management protocol except glucose monitoring. One hundred five women were monitored by laboratory glucose test at each office visit (office group) and 80 women were monitored by SMBG (SMBG group). Pregnancy outcome including rates of cesarian section, obstetric complication, LGA infant and glucose tolerance status at postpartum were compared between two groups. RESULTS: The age, height, prepregnancy weight, weight at delivery and parity were not significantly different between the two groups. Fasting, 1-h, 2-h glucose concentration during the diagnostic test of GDM in SMBG group were similar to those of office group. However, 3-h glucose concentration of office group was 0.3 mM higher than that of SMBG group. The rate of primary cesarian section, preterm labor and pregnancy-induced hypertension of SMBG group were similar to those of office group. The mean postprandial 2-h glucose concentration of office group measured at each office was 0.5 mM higher than that of SMBG group. Although 5% of office group were treated with insulin, 24% of SMBG group were requiring insulin therapy. The birth weight and LGA infant rate of office group were 3403 432 g and 28%, those were heavier and higher than those of SMBG group (3169 447 g, 13.8%). The 90% of office group and 84% of SMBG group were performed 75 g oral glucose tolerance test at postpartum 6-8 weeks. There was no significant difference in rates of diabetes and IGT between office and SMBG group (9.5%, 11.6%; 7.5%, 9.0% respectively). CONCLUSIONS: This study demonstrated that SMBG is very seful in early detection of maternal hyperglycemia and lowing the postprandial glucose, as well as reducing the rate of LGA infants in women with mild GDM.

Can the Oral Glucose Tolerance Test (OGTT) done at Postpartum (PPT) 1 Wddk Substitute OGTT at PPT 6 Week OGTT at PPT 6 Week in Diagnosing Rersistent PPT Glucose Intolerance in the Patients with Gastrational Diagetes Melltus (GDM)?.: Yoo Lee Kim, Yong Wook Cho, Seok Won Park, Yun Kyung Cho, Hwa Young Lee, In Hyun Kim, Jong Gun Won, Hye Sun Jun, Ho Taek Lee, Seog Ki Lee, Sang Jong Lee; Korean Diabetes J. 2000;24(2):267-280. Published online January 1, 2001

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Abstract PDF: BACKGROUND
Although 75 g-OGTT at PPT 6 week is necessary to diagnose persistent PPT glucose intolerance (PPGI) in GDM patients, it 1s difficult to perform this test because many patients drop-out during the follow-up period. Thus we tested whether OGTT done at PPT 1 week can substitute OGTT at PPT 6 week in diagnosing PPGI in GDM patients. METHOD: In 370 GDM patients, 75 g-OGTT was performed at PPT 1 week and repeat OGTT was done in 196 patients at PPT 6 week. Results of OGTT were classified as normal glucose tolerance(NGT), impaired glucose tolerance(IGT), and diabetes mellitus (DM) according to National Diabetes Data Group(NDDG) criteria. Changes in glucose tolerance state between PPT 1 and 6 week were assessed, and the predictability of clinical characteristics for these changes were investigated by logistic regression analysis. RESULTS: Among 370 GDM patients who performed OGTT at PPT 1 week, 79.4% had NGT, 12.2% had IGT, and 8.4% had DM. 53% (196/370) of subjects repeated OGTT at PPT 6 week. In OGTT at PPT 6 week, 77.6% (152/196, 140/149 in NGT, 4/26 in IGT and 8/21 in DM) were in the same glucose tolerance state as at PPT 1 week. The glucose tolerance improved in 14.8% (29/196, 16/26 in IGT and 13/21 in DM) and deteriorated in 7,6% (15/196, 9/149 in NGT and 6/26 in IGT). 94%(140/149) of patients who had NGT at PPT 1 week had NGT at PPT b week and 48.9/o (23/47) of patients who had abnormal glucose tolerance at PPT 1 week had abnormal glucose tolerance at PPT 6 week. Mean fasting plasma glucose level on OGTT became lower at PPT 1 week than during pregnancy (4.6+/-0,8 vs 5.1+/-1.2mmol/L, p<0.05) and became higher at PPT 6 week than at PPT 1 week (5.4+/-1.1 vs 4.6+/-0.8 mmol/L, p<0.05). Mean plasma glucose level at 2 hour after glucose load was significantly lower at PPT 6 week than at PPT 1 week (7.2+/-2.7 vs 8.3+/-2.5 mmol/L). When the subjects were grouped into NGT, IGT, and DM according to glucose tolerance state at PPT 6 week, the NGT group already showed normal glucose tolerance at PPT 1 week. The IGT and DM group showed slightly lower glucose levels at PPT 1 week than during pregnancy but became high to the level during pregnancy at PPT 6 week. In the patients group showing deterioration in glucose tolerance state between PPT 1 and 6 week, prevalence of insulin treatment was higher (63.4% vs 9.4, 20.7%), the gestational age at diagnosis of GDM were lower (25.0+/-6.2 week vs 29.8+/-3.3, 29.9+/-4,8 waek), and prepregnant weight was higher (113.4+/-21.2% vs 102.5+/-12.4, 102.4+/-14.6%) than those in the patients groups showing no change and improvement in glucose tolerance state, Weight gain until diagnosis of GDM during pregnancy(5.7+/-4.4kg vs 9.4+/-3.4kg) and weight change between prepregnancy and PPT 5 week(-1,3+/-3.5kg vs 1.5+/-29kg) was smaller in the deterioration group than those in the no change group. Logistic regression analysis performed using improvement and deterioration of glucose tolerance state between PPT 1 and 6 week as an outcome of interest revealed that an earlier diagnosis of GDM and a smaller weight at PPT 6 week than prepregnant weight were independent predictors for deterioration of glucose tolerance between PPT 1 and 6 week. In conclusion, OGTT done at PPT 1 week can substitute OGTT at PPT 6 week in a large subgroup of GDM patients who has NGT at PPT 1 week without any risk factors for deterioration in glucose tolerance.

Antepartum Characteristics Predicting Persistent Postpartum Glucose lntolerance in the Patients with Gestational Diabetes Mellitus (GDM).: Yoo Lee Kim, Yong Wook Cho, Seok Won Park, Seog Ki Lee, In Sup Ahn, Byung Wook Na, Jun Lee, Yun Kyung Cho, Hwa Young Lee, Sang Jong Lee; Korean Diabetes J. 2000;24(1):46-59. Published online January 1, 2001

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Abstract PDF: BACKGROUND
The aim of this study is to investigate the prevalence of persistent postpartum glucose intolerance and to examine antepartum clinical characteri-stics for their predictability of persistent postpartum glucose intolerance in the patients with GDM. METHODS: In 211 GDM patients who showed more than two abnormal glucose values of O'Sullivan and Mahan's criteria on 100g-oral glucose tolerance test (OGTT), 75g-OGTT were performed at 6 weeks postpartum. The incidence of postpartum normal glucose tolerance (NGT), impaired glucose tolerance (IGT), and diabetes mellitus (DM) were investigated and antepartum ciinical parameters were compared among the three groups, Predictability of antepartum clinical characteristics for postpartum IGT and DM were also investigated by logistic regression analysis. RESULTS: When we grouped the patients into postpartum NGT, IGT, DM according to the results of 75g-OGTT performed 6 weeks postpartum, The incidence were 81,5% of subjects had NGT, 9.0% had IGT, and 9.5% had DM. Plasma glucose levels and GAUC on antepartum 100 g-OGTT(NGT: 1660+/-159, IGT: 1948+/-730, DM: 2538+/-629mmol/L ' min), and proportion of patients receiving insulin therapy increased progressively and significantly in association with worsening postpartum glucose tolerance. Frequency of positive family history of DM in qroups with IGT and DM (63,2% & 80.0%) were significantly higher than that in group with NGT(37,2%). Weight gain before diagnosis of GDM in groups with IGT and DM(6.7+/-3.9kg & 6.8+/-4.1 kg) were significantly smaller than that of group with NGT(9.5+/-3,5kg), Gestational age at diagnosis of GDM in group with DM(25.8+/-5.4 weeks) was significantly shorter than that in group with NGT(30.0+/-3,3 weeks), Proportion of subjects diagnosed earlier than 24 weeks of gestation were significantly higher in groups with IGT (15.8%) and DM (25.0%) than in group with NGT (1.2%). Proportions of subjects delivered heavier infants, > or =4 kg,were significantly higher in the DM group (40.0%) than in the NGT group (9.3%). In the patients having fasting plasma glucose levels hlgher than 5.8 mmol/L on antepartum 100g-OGTT, the prevalence of persistent glucose intolerance was significantly higher than in the patients FPG level lower than 5.8 mmol/L (61.9% vs 7.7%), Logistic regression analysis were performed using IGT and DM as the outcome of interest. The GAUC on antepartum 100g-OGTT, family history of DM, and the gestational age at diagnosis of GDM were independent predictors for both postpartum DM and postpartum IGT. CONCLUSION: The prevalence of persistent postpartum glucose intolerance in GDM patients were 18.5% and the most important independent predictor for persistent postpartum glucose intolerance was the degree of severity in glucose intolerance during pregnancy.

Fetal Hyperinsulinemia and Ultrasonographic Measurement of Fetal Growth in Pregnancy Complicated by Gestational Diabetes Mellitus.: In Kwon Han, Chang Hoon Yim, Ho Yeon Jeong, Hak Chul Chang, Ki Ok Han, Hyun Ku Yoon, Park Jeong Eun, Soo Young Lee, Young Ho Lee; Korean Diabetes J. 1999;23(4):506-517. Published online January 1, 2001

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Abstract PDF: BACKGROUND
Recently we reported that the large for gestational age (LGA) fetus of women with gestational diabetes mellitus (GDM) had disproportionate growth characterized by larger abdominal circumference (AC) but similar biparietal diameter (BPD) at third trimester compared to the fetus of normal pregnant women. The AC of LGA fetus appeared to be accelerated after 33 weeks gestation, and measurement of AC could be an effective method for prediction of LGA. Thus this study was performed to find the relationship between fetal hyperinsulinemia and disproportionate growth and to find the highly sensitive index for prediction of LGA infant in GDM. METHODS: We prospectively studied ultrasono- graphic growth patterns at 30, 34, 38 gestational weeks in 20 women with GDM and 15 normal pregnant women. The ultrasonographic measurements of fetus included biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), femur length (FL), mid-thigh circumference (MTC), mid-upper arm circumference (MUAC), mid-thigh subcutaneous fat thickness (MTFT), mid-upper arm subcutaneous fat thickness (MUAFT), fetal liver length (FLL), chest circumference (CC) and heart circumference (HTC). RESULTS: Compared to the fetus of normal pregnant women and appropriate for gestational age (AGA) fetus of GDM, LGA fetus of GDM had thicker MUAFT (3.9+0.9, 5.0+1.1, 5.6+1.7 mm, p=0.008) at 34 weeks, MUAFT (5.3+0.8, 5.6+0.9, 7.2+1.4 mm p=0.045) at 38 weeks and MTFT (5.2 +1.1, 5.5+0.8, 7.1+1.5 mm, p=0.019) at 38 weeks. They also had longer MUAC (120.3+9.9, 119.4+ 8.3, 138.7+11.2 mm, p=0.020) and CC(322.6+11.7, 324.4+15.7, 351.7+15.0mm, p=.025, respectively). There was a positive correlation between umbilical venous C-peptide concentration and birthweight (r=0.626, p=0.005) and symmetry index (r=0.523, p=0.03) of newborns. There was also a positive correlation between C-peptide concentration and MUAC (r=0.449, p=0.038) and MUAFT (r=0.426, p=0.045) in GDM group. CONCLUSION: The LGA fetus of women with GDM showed an accelerated growth of predominantly subcutaneous fat tissues that should be caused by the fetal hyperinsulinemia. Ultrasonographic measurement of subcutaneous tissues may be the most sensitive index for prediction of growth abnormalities in GDM at late gestation.

Prediction of Large for Gestational Age Infant in Women with Gestational Age Infant in Women with Gestational Diabetes Mellitus by Yltrasound Examination.: In Kwon Han, Hun Kee Min, Chang Hoon Yim, Ho Yeon Jeong, Hak Chul Chang, Ki Ok Han, Hyun Ku Yoon, Jeong Eun Park, Jae Eun Park, So Ra Park, Soo Young Lee, Young Ho Lee; Korean Diabetes J. 1999;23(3):326-335. Published online January 1, 2001

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Abstract PDF: BACKGROUND
In pregnancies complicated by diabetes, fetal hyperinsulinemia increases the deposition of fat, protein and glycogen in insulin-sensitive tissues leading to macrosomia, characterized by shoulder and truncal obesity. This may result in a shoulder dystocia, birth injury or fetal asphyxia. Thus, antenatal prediction of a large fetus for gestational age (LGA) can provide important information for the prevention of obstetric and perinatal complications. However, the measurement of materrml blood glucose concentration has yielded a low sensitivity for the prediction of LGA infants. This study was performed to determine whether fetal ultrasound examination could establish the onset of accelerated fetal growth in women with gestational diabetes mellitus (GDM) and to find the ultrasound indices for prediction of LGA infant. METHODS: The study subjects consisted of 77 women with GDM who had a singleton, and 156 women with a negative screen for GDM matched for age, height, and weight. All subjects had an early ultrasound examination before 14 weeks, assuring accurate dating and did not have any other medical condition that might affect fetal growth. Two ultrasound measurements including biparietal diameter (BPD), abdominal circumference (AC) and femur length (FL) were performed at the 2nd trimester (24.7+2.7 vs. 24.1+2.4 wks, p>0.05) and the 3rd trimester (35.0+1.9 vs. 35.3+1.3 wks,p>0.05, respectively). RESULTS: Although gestational age at delivery of GDM group was earlier than the control group (39.0 +1.4 vs. 39.7+1.1, p<0.01), birth weight and frequency of LGA infant were similar between two groups (3204+439 vs. 3288+371 g, p>0.05; 27.3% vs. 20.5%, p>0.05, respectively). However, the LGA subgroup of GDM had a larger AC and longer FL at the 3rd trimester compared to the appropriate gestational age (AGA) subgroup and control group. The AC of LGA subgroup of GDM appeared to be accelerated at 33 weeks gestation compared to the control group. When the upper limit of 95% confidential interval of AC of the control group was used for a cutoff value for predicting LGA in GDM at the 3rd trimester, sensitivity and specificity was 71% and 78%, respectively. CONCLUSION: The prediction of LGA infant in women with GDM might be achieved by an ultrasound examination of fetal AC at the 3rd trimester, especially after 33 weeks gestation.

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