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Glucose tolerance test with a single abnormal value in pregnancy and the risk of type-2 diabetes mellitus

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the association between a single abnormal value on a 3-h 100 g oral glucose tolerance test (OGTT) results and future type-2 diabetes mellitus (Type-2 DM).

Methods

Retrospective cohort study of women between 18 and 45 years of age who underwent a 3-h OGTT during pregnancy and delivered in a tertiary medical center between 2007 and 2014. The women  were followed for a median period of 64 months postpartum. According to OGTT values, women were divided into three groups: normoglycemic (normal OGTT), single abnormal OGTT value (SAV) and gestational diabetes mellitus (two or more abnormal OGTT values, GDM). General pre-pregnancy characteristics, cardiovascular risk factors and future diagnosis of Type-2 DM, as the primary outcome, were recorded.

Results

During the study period, 5295 women underwent an OGTT and were followed for a median period of 64 months (interquartile range of 32). The cohort was divided as following: 3639 (68.73%) were normoglycemic, 854 (16.13%) had a SAV in the OGTT and 802 (15.15%) were diagnosed with GDM. Compared with normoglycemic controls, women with SAV and GDM tended to be older (32.20, 33.10 and 31.35 years for SAV, GDM and controls, respectively, p < 0.001); with higher rates of pre-pregnancy obesity (18.62%, 20.77% and 13.22% for SAV, GDM and controls, respectively, p < 0.001), pre-pregnancy hyperlipidemia (13.35%, 15.30% and 10.52% for SAV, GDM and controls, respectively, p = 0.021) and pre-pregnancy chronic hypertension (5.50%, 4.43% and 3.18% for SAV, GDM and controls, respectively, p = 0.01). Post-pregnancy Type-2 DM was diagnosed at a higher rate among women with SAV or GDM (2.69% for SAV, 7.39% for GDM and 0.66% for normoglycemic controls, p < 0.001). Using a cox proportional hazard regression, SAV and GDM were significantly and independently associated with a higher rate of future overt type-2 diabetes (adjusted aOR 3.59 for SAV and 11.38 for GDM, p < 0.001).

In a sub-analysis of the OGTT values, overall, abnormal fasting glucose had the highest correlation with developing future Type-2 DM (8.95% compared with 6.02% for OGTT_60, 6.03% for OGTT_120 and 7.35% for OGTT_180, p < 0.001).

A predictive model, combining multiple risk factors, as pre-pregnancy obesity and hypertension with SAV complicating the index pregnancy showed a risk as high as 3.40% for developing future Type-2 DM.

Conclusion

SAV is independently associated with a significant higher rate of future Type-2 DM, as early as 5 years following the index pregnancy.

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Funding

This study was not supported by any funding.

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Authors and Affiliations

  1. Helen Schneider Hospital for Women, Rabin Medical Center, 39 Zabotinski St., 4941492, Petach Tikva, Israel

    Alexandra Berezowsky, Oded Raban, Hadas Zafrir-Danieli, Eyal Krispin & Eran Hadar

  2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Alexandra Berezowsky, Oded Raban, Amir Aviram, Hadas Zafrir-Danieli, Eyal Krispin & Eran Hadar

  3. Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada

    Amir Aviram

Authors
  1. Alexandra Berezowsky
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  2. Oded Raban
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  3. Amir Aviram
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  4. Hadas Zafrir-Danieli
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  5. Eyal Krispin
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  6. Eran Hadar
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Contributions

AB: protocol development, data analysis, and manuscript writing. OR and AA: protocol development, data analysis manuscript editing. HZ-D: data collection, data analysis, and manuscript writing. EK: protocol development, data management and analysis, and manuscript writing. EH: protocol development and manuscript editing.

Corresponding author

Correspondence to Alexandra Berezowsky.

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Conflict of interest

The authors report no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional Rabin Medical Center Helsinki Committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Study’s Number is 0183-14-RMC, the study was approved at May 5, 2014.

Informed consent

As per committee’s approval, this study is of a retrospective nature and thus does not require patient consent.

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Berezowsky, A., Raban, O., Aviram, A. et al. Glucose tolerance test with a single abnormal value in pregnancy and the risk of type-2 diabetes mellitus. Arch Gynecol Obstet 305, 869–875 (2022). https://doi.org/10.1007/s00404-021-06207-3

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  • DOI: https://doi.org/10.1007/s00404-021-06207-3

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