EPIDEMIOLOGY IN GESTATIONAL DIABETES MELLITUS

1. EPIDEMIOLOGY IN GESTATIONAL DIABETES MELLITUS Methodology Dr. Nam-Han Cho Associate Professor of Preventive Medicine Director of Center for Clinical Epidemiology Ajou University School of Medicine Suwon, Korea

3. GESTATIONAL DIABETES MELLITUS Gestational Diabetes Mellitus(GDM), defined as carbohydrate intolerance with onset or first recognition during pregnancy: • Occurs in approximately 2 to 5% of all pregnancies, with marked worldwide variations reported; • Is associated with an increased risk of fetal macro- somia, as well as perinatal morbidity and mortality; • Is linked with future developments of diabetes mellitus in women post-pregnancy.

4. SCREENING • Glucose loads range from 50g to 100g • Threshold values range from 125 mg/dl to 150 mg/dl • Glucose loads range from 50g to 100g • Two and Three hour tests are used • Differences in diagnostic procedures and values METHODOLOGICAL INCONSISTENCIES IN EPIDEMIOLOGICAL STUDIES OF GDM DIAGNOSTIC OGTT

5. DIFFERENCE IN SCREENING THRESHOLD VALUES AND ETHNIC DIFFERENCES IN THE RATE OF GDM Author Site Threshold for OGTT Race Prevalence* Green S. F >150mg/dlWhite 1.6 Black 1.7 Hispanic 4.2 Berkowitz New York  135mg/dl White 2.3 Black 3.7 Hispanic 4.1 Dooley Chicago  130mg/dl White 2.7 Black 3.3 Hispanic 4.4 * 50g-1hr, 100g-3 hr OGTT

6. RESEARCH AREA Maternal • High Risk forPIH • High Risk forDM Offspring • High Risk for birthcomplications • High Risk forObesity • High Risk forIGT/DM • Potential Risk for the futureHypertension

8. Risk Factors for DM after GDM • Impaired ß-cell function • Higher PIBW • Family history (30% M, 11% F)

9. Overview:Minor adverse health effects for offspring NormalGDMDMP Birth Wt (g) 3303±64 3649±51 3849±72 <0.01 Macrosomia(%) 8 36 47 <0.01 C-S 5 10 14 <0.01 Hypoglycemia 2 28 52 <0.01 Hypocalcemia 0 4 7 <0.01 Hyperbilirubinemia 15 23 21 <0.01 Polycythemia 0 7 11 <0.01 Cord C-Pep 1.18±0.1 2.07±0.12 2.98±0.22 <0.01 Cord Glu 100±3.6 103±2.9 114±5.5 <0.01

10. MACROSOMIA GDMNon-diabetic p-value Birth Wt (g) 3512±711 3333±479 <0.05 LGA 40.4% 13.7% <0.001 Macrosomia(%) 32.0% 11.0% <0.01

11. Overview:Major adverse health effects for offspring NormalDM CNS 6.4% 18.4% Congenital heart disease 7.5% 21.0% Respiratory disease 2.9% 7.9% Intestinal atresia 0.6% 2.6% Anal atresia 1.0% 2.6% Renal & Urinary defect 3.1% 11.8% Upper limb deficiences 2.3% 3.9% Lower limb deficiences 1.2% 6.6% Upper + Lower spine 0.1% 6.6% Caudal dysgenesis 0.1% 5.3%

12. NEONATAL COMPLICATIONS DMGDMNormal p-value T. hypoglycemia(%) 52 28 3 <0.01 P. hypoglycemia(%) 6 2 0 <0.01 Hypocalcemia(%) 5 5 0 <0.01 Hyperbilirubinemia(%) 21 23 15 <0.01 Trans tachypnea(%) 5 2 0 <0.01 Polycythemia(%) 11 7 0 <0.01 RDS(%) 5 2 0 <0.01IUGR(%) 2 1 0 <0.05

13. ONGOING GDM EPIDEMIOLOGIC STUDIES :Prevalence Study Study Sites • Chicago • Cheil Samsung • Ajou University Hospital

14. METHODOLOGY SCREENING 50g / 1 hr at 24-28 weeks gestation 130 mg/dl requires 100g, 3 hr OGTT DIAGNOSTIC OGTT Fasting (105 mg/dl) 1 hour (190 mg/dl) 2 hour (165 mg/dl) 3 hour (145 mg/dl)

15. ONGOING GDM EPIDEMIOLOGIC STUDIES :Prevalence Study Prevalence of GDM SITE RACE PREVALENCE Chicago White 2.7% Black 3.3% Hispanic 4.4% Korean American 4.5 -13.6% Seoul Korean 2.2% Suwon Korean 5.0%

16. Ajou University Hospital Samsung Cheil General Cha Hospital Il-Sin Christian Hospital Anthropometric Demographic 75gm-2 hr OGTT Stress Diet BIP Lipid Profile LONGITUDINAL STUDY OF GDM Site and Measurements

17. Skin fold caliper Questionnaire BIP (GIF-891DX) Insulin assay Inter-Variation (0.97-0.98) Intra-Variation (cv=0.23-0.38%) Sampling Tube - Device LONGITUDINAL STUDY OF GDM Standardization

18. GDM screening  Maternal follow-up  Offspring follow-up LONGITUDINAL STUDY OF GDM Projects

19. SUCCESS TO THE PROJECT Dept. of Prev. Med. Center for Clinical Epidemiology Dept. of Ob-Gyn Dept. of Endocr.