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Cross-sectional Study of Glucose Disturbances of Pregnant Women in Bulgaria

Received: 16 December 2020     Accepted: 23 December 2020     Published: 18 January 2021
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Abstract

Hyperglycemia is one of the most common conditions during pregnancy. The International Diabetes Federation (IDF) estimates that one in six live births (16.8%) are in women with some form of Hyperglycemia during pregnancy. The aim is to analyze the frequency of Hyperglycemia during pregnancy through a cross-sectional multicenter population-based study in 84 settlements in Bulgaria, as well as to study the dynamics of this frequency during pregnancy. Material: We studied 547 pregnant women with a mean age of 30±5 years, divided into two groups - up to 24 gestational week – g.w. (n-386, 70.6%) and after 24 g.w. (n-161, 29.4%). Methods: BMI before pregnancy and the current one at the time of the study were calculated. A two-hour, 75 g oral glucose tolerance test (OGTT) was performed. Plasma glucose was quantitatively determined using enzymatic reference method with hexokinase (Roche reagent) on Cobas е501 analyzer, in one Central laboratory on the day of the blood sampling. The results were in mmol / l. The statistical analysis was performed using standard SPSS 13.0 for Windows. Results: Hyperglycemia was observed in 79 (14.4%) pregnant women after fasting state or in the course of classic OGTT, according to the criteria of WHO’2019, FIGO’2015, NICE’2015, and in the remaining 468 (85.6%) pregnant women - Normoglycemia. There was no significant difference in the level of glycemia between the three trimesters for each of the points of OGTT (0, 60, 120 minutes) in the subgroups of pregnant women with Hyperglycemia (up to 12 g.w, 13-24 g.w, after 24 g.w.). It turned out that the number and frequency of pregnant women with Hyperglycemia in the period up to 24 g.w. is 7.5% (29/386) and increases in the period after 24 g.w. reaching 31% (50/161), P < 0.01. According to the generally accepted population diagnostic criteria for diabetes in non-pregnant women, we found that 8.9% (7/79) of pregnant women with Hyperglycemia had Diabetes in Pregnancy (DIP), all of whom had a risk factor for Diabetes (two of them even 3 risk factors). Conclusion: As soon as pregnancy is established, verbal screening for diabetes risk factors should be performed as a first step in selecting pregnant women for glucose tolerance screening with classic OGTT to determine the glucose status of the pregnant woman.

Published in Clinical Medicine Research (Volume 10, Issue 1)
DOI 10.11648/j.cmr.20211001.12
Page(s) 9-15
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Pregnancy, Verbal Screening, Hyperglycemia, Gestational Diabetes Mellitus, Diabetes in Pregnancy

References
[1] O'Sullivan JB, Mahan CM. (1964). Criteria for the oral glucose tolerance test in pregnancy. Diabetes 13: 278-285.
[2] International Diabetes Federation. (2019). IDF Diabetes Atlas, 9th edn. Brussels, Belgium: International Diabetes Federation.
[3] Yuen L, Saeedi P, Riaz M, Karuranga S, Divakar H, Levitt N, Yang X, Simmons D. (2019). Projections of the prevalence of hyperglycaemia in pregnancy in 2019 and beyond: results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract 157: 107841. https://doi.org/10.1016/j. diabres.2019.107841.
[4] Cho NH, Shaw JE, Karuranga S, Huang Y, da Rocha Fernandes J. D, Ohlrogge A. W, Malanda B. (2018). IDF diabetes atlas: global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract 138: 271–328.
[5] World Health Organization. (2019). Classification of Diabetes mellitus 2019. ISBN 978-92-4-151570-2.
[6] Hod M, Kapur A, Sacks D. A, Hadar E, Agarwal M, Di Renzo G. C, Roura L. C, McIntyre H. D, Morris J. L, Divakar H. The International Federation of Gynecology and Obstetrics. (2015). Initiative on gestational diabetes mellitus: A pragmatic guide for diagnosis, management, and care. International Journal of Gynecology and Obstetrics 131, S173–S211.
[7] NICE (2015). Diabetes in pregnancy: management from preconception to the postnatal period. https://www.nice.org.uk/terms-and conditions#notice-ofrights).
[8] Farrar D, Simmonds M, Bryant M, Sheldon T. A, Tuffnell D, Golder S, Lawlor D. A. (2017). Treatments for gestational diabetes: a systematic review and meta-analysis. BMJ Open 7 (6): e015557. https://doi.org/10.1136/bmjopen-2016-015557.
[9] Bogdanet D, Reddin C, Macken E, Griffin T. P, Narjes Fhelelboom, Linda Biesty, Shakila Thangaratinam, Dempsey E, Crowther C, Galjaard S, Maresh M, Loeken M. R, Napoli A, Anastasiou E, Noctor E, de Valk H. W, van Poppe M. N. M, Agostini A, Clarson C, Egan A. M, O’Shea P. M, Devane D, Dunne F. P. (2019). Follow-up at 1 year and beyond of women with gestational diabetes treated with insulin and/or oral glucose-lowering agents: a core outcome set using a Delphi survey. Diabetologia 62: 2007–2016.
[10] World Medical Association (2013). "Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects". JAMA. 310 (20): 2191–2194. doi: 10.1001/jama.2013.28105.
[11] Bulgarian Society of Endocrinology. (2019). Recommendations for good clinical practice in diabetes mellitus, edited by Prof. Borisova A-M, Simolini Publishing House, Sofia, Bulgaria.
[12] International Diabetes Federation. (2011). Diabetes in pregnancy – Protecting Maternal Health, Policy Briefing. Sept. 2011.
[13] McCance D, Maresh M, Sacks DA. A practical manual of diabetes in pregnancy. John Wiley & Sons, 2017. doi: 10.1002/9781119043805.
[14] Hurwitz D, Jensen DN. (1946). Carbohydrate metabolism in normal pregnancy. N Engl J Med 234 (10): 327–329. https://doi.org/10.1056/NEJM194603072341004.
[15] Lawlor DA. (2013). The Society for Social Medicine John Pemberton Lecture 2011. Developmental overnutrition–an old hypothesis with new importance? Int J Epidemiol 42 (1): 7–29. https://doi.org/10.1093/ije/dys209.
[16] Elliott H. R. & Sharp G. S. & Relton C. L. & Lawlor D. A. (2019). Epigenetics and gestational diabetes: a review of epigenetic epidemiology studies and their use to explore epigenetic mediation and improve prediction. Diabetologia 62: 2171–2178.
[17] IDF (2015). GDM model of Care. Implementation Protocol Guidelines for Healthcare Professionals.
[18] International Association of Diabetes and Pregnancy Study Groups Consensus Panel. Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P, Dyer AR, Leiva Ad, Hod M, Kitzmiler JL, Lowe LP, McIntyre HD, Oats JJ, Omori Y, Schmidt MI. (2010). International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 33 (3): 676-682.
[19] Kim C, Ferrara A, McEwen LN, Marrero DG, Gerzoff RB, Herman WH, TRIAD Study Group. (2005). Preconception care in managed care: the translating research into action for diabetes study. Am J Obstet Gynecol. 192 (1): 227–232.
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  • APA Style

    Anna-Maria Borissovа, Boyana Trifonova, Lilia Dakovska, Eugenia Mihailova, Mircho Vukov. (2021). Cross-sectional Study of Glucose Disturbances of Pregnant Women in Bulgaria. Clinical Medicine Research, 10(1), 9-15. https://doi.org/10.11648/j.cmr.20211001.12

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    ACS Style

    Anna-Maria Borissovа; Boyana Trifonova; Lilia Dakovska; Eugenia Mihailova; Mircho Vukov. Cross-sectional Study of Glucose Disturbances of Pregnant Women in Bulgaria. Clin. Med. Res. 2021, 10(1), 9-15. doi: 10.11648/j.cmr.20211001.12

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    AMA Style

    Anna-Maria Borissovа, Boyana Trifonova, Lilia Dakovska, Eugenia Mihailova, Mircho Vukov. Cross-sectional Study of Glucose Disturbances of Pregnant Women in Bulgaria. Clin Med Res. 2021;10(1):9-15. doi: 10.11648/j.cmr.20211001.12

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  • @article{10.11648/j.cmr.20211001.12,
      author = {Anna-Maria Borissovа and Boyana Trifonova and Lilia Dakovska and Eugenia Mihailova and Mircho Vukov},
      title = {Cross-sectional Study of Glucose Disturbances of Pregnant Women in Bulgaria},
      journal = {Clinical Medicine Research},
      volume = {10},
      number = {1},
      pages = {9-15},
      doi = {10.11648/j.cmr.20211001.12},
      url = {https://doi.org/10.11648/j.cmr.20211001.12},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cmr.20211001.12},
      abstract = {Hyperglycemia is one of the most common conditions during pregnancy. The International Diabetes Federation (IDF) estimates that one in six live births (16.8%) are in women with some form of Hyperglycemia during pregnancy. The aim is to analyze the frequency of Hyperglycemia during pregnancy through a cross-sectional multicenter population-based study in 84 settlements in Bulgaria, as well as to study the dynamics of this frequency during pregnancy. Material: We studied 547 pregnant women with a mean age of 30±5 years, divided into two groups - up to 24 gestational week – g.w. (n-386, 70.6%) and after 24 g.w. (n-161, 29.4%). Methods: BMI before pregnancy and the current one at the time of the study were calculated. A two-hour, 75 g oral glucose tolerance test (OGTT) was performed. Plasma glucose was quantitatively determined using enzymatic reference method with hexokinase (Roche reagent) on Cobas е501 analyzer, in one Central laboratory on the day of the blood sampling. The results were in mmol / l. The statistical analysis was performed using standard SPSS 13.0 for Windows. Results: Hyperglycemia was observed in 79 (14.4%) pregnant women after fasting state or in the course of classic OGTT, according to the criteria of WHO’2019, FIGO’2015, NICE’2015, and in the remaining 468 (85.6%) pregnant women - Normoglycemia. There was no significant difference in the level of glycemia between the three trimesters for each of the points of OGTT (0, 60, 120 minutes) in the subgroups of pregnant women with Hyperglycemia (up to 12 g.w, 13-24 g.w, after 24 g.w.). It turned out that the number and frequency of pregnant women with Hyperglycemia in the period up to 24 g.w. is 7.5% (29/386) and increases in the period after 24 g.w. reaching 31% (50/161), P Conclusion: As soon as pregnancy is established, verbal screening for diabetes risk factors should be performed as a first step in selecting pregnant women for glucose tolerance screening with classic OGTT to determine the glucose status of the pregnant woman.},
     year = {2021}
    }
    

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  • TY  - JOUR
    T1  - Cross-sectional Study of Glucose Disturbances of Pregnant Women in Bulgaria
    AU  - Anna-Maria Borissovа
    AU  - Boyana Trifonova
    AU  - Lilia Dakovska
    AU  - Eugenia Mihailova
    AU  - Mircho Vukov
    Y1  - 2021/01/18
    PY  - 2021
    N1  - https://doi.org/10.11648/j.cmr.20211001.12
    DO  - 10.11648/j.cmr.20211001.12
    T2  - Clinical Medicine Research
    JF  - Clinical Medicine Research
    JO  - Clinical Medicine Research
    SP  - 9
    EP  - 15
    PB  - Science Publishing Group
    SN  - 2326-9057
    UR  - https://doi.org/10.11648/j.cmr.20211001.12
    AB  - Hyperglycemia is one of the most common conditions during pregnancy. The International Diabetes Federation (IDF) estimates that one in six live births (16.8%) are in women with some form of Hyperglycemia during pregnancy. The aim is to analyze the frequency of Hyperglycemia during pregnancy through a cross-sectional multicenter population-based study in 84 settlements in Bulgaria, as well as to study the dynamics of this frequency during pregnancy. Material: We studied 547 pregnant women with a mean age of 30±5 years, divided into two groups - up to 24 gestational week – g.w. (n-386, 70.6%) and after 24 g.w. (n-161, 29.4%). Methods: BMI before pregnancy and the current one at the time of the study were calculated. A two-hour, 75 g oral glucose tolerance test (OGTT) was performed. Plasma glucose was quantitatively determined using enzymatic reference method with hexokinase (Roche reagent) on Cobas е501 analyzer, in one Central laboratory on the day of the blood sampling. The results were in mmol / l. The statistical analysis was performed using standard SPSS 13.0 for Windows. Results: Hyperglycemia was observed in 79 (14.4%) pregnant women after fasting state or in the course of classic OGTT, according to the criteria of WHO’2019, FIGO’2015, NICE’2015, and in the remaining 468 (85.6%) pregnant women - Normoglycemia. There was no significant difference in the level of glycemia between the three trimesters for each of the points of OGTT (0, 60, 120 minutes) in the subgroups of pregnant women with Hyperglycemia (up to 12 g.w, 13-24 g.w, after 24 g.w.). It turned out that the number and frequency of pregnant women with Hyperglycemia in the period up to 24 g.w. is 7.5% (29/386) and increases in the period after 24 g.w. reaching 31% (50/161), P Conclusion: As soon as pregnancy is established, verbal screening for diabetes risk factors should be performed as a first step in selecting pregnant women for glucose tolerance screening with classic OGTT to determine the glucose status of the pregnant woman.
    VL  - 10
    IS  - 1
    ER  - 

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Author Information
  • Clinic of Endocrinology, University Hospital Sofiamed, Sofia, Bulgaria

  • Clinic of Endocrinology, University Hospital Sofiamed, Sofia, Bulgaria

  • Clinic of Endocrinology, University Hospital Sofiamed, Sofia, Bulgaria

  • Clinic of Endocrinology, University Hospital Sofiamed, Sofia, Bulgaria

  • Clinic of Endocrinology, University Hospital Sofiamed, Sofia, Bulgaria

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