Download PDF
Horm Metab Res 2011; 43(11): 788-793
DOI: 10.1055/s-0031-1287795
Humans, Clinical
© Georg Thieme Verlag KG Stuttgart · New York

The Prevalence and Predictors of Gestational Diabetes Mellitus in Hungary

A. Kun
1   Tolna County Balassa János Hospital, Department of Obstetrics and Gynaecology, Szekszárd, Hungary
,
J. Tornóczky
2   Tolna County Balassa János Hospital, Diabetes Care Outpatient Unit, Szekszárd, Hungary
,
A. G. Tabák
3   Semmelweis University Faculty of Medicine, 1st Department of Medicine, Budapest, Hungary
4   University College London, Department of Epidemiology and Public Health, London, UK
› Author Affiliations
Further Information

Publication History

received 30 March 2011

accepted 29 August 2011

Publication Date:
18 October 2011 (online)

Also available at
    Permissions and Reprints

Abstract

There are conflicting results regarding the frequency of gestational diabetes (GDM) in Hungary. The aim of this study was to estimate the prevalence of GDM and to clarify the association between selected maternal characteristics and GDM risk. In a population-based screening program of GDM in Tolna County, Hungary, 75 g OGTTs were offered to all pregnant women between 24–28 weeks of gestation and evaluated according to WHO criteria in 2000 (WHO GDM). Women were also classified based on the IADPSG criteria (IADPSG GDM). Selected risk factors were recorded by district nurses. OGTT results were available for 1 835 (81.2%) pregnancies out of 2 261. Altogether 159 (8.7%) were diagnosed as WHO GDM and 304 (16.6%) as IADPSG GDM. Gestational diabetes was related to older age, higher BMI, and an increasing number of deliveries (all p<0.005). The risk of IADPSG GDM monotonously increased with age, ­pre-pregnancy BMI and number of deliveries. The risk of WHO GDM increased linearly with age, however, women with the highest BMI (≥ 29.2 kg/m2) had decreased risk compared to women with a BMI of 26.1–29.1 kg/m2 (p<0.05). There was an inverse U-shaped association between GDM risk and number of deliveries with the highest risk observed in those with 3 deliveries (pquadratic term=0.008). We found a high prevalence of GDM in this Caucasian Hungarian population. Our results suggest that pre-pregnancy BMI and previous deliveries elevate the risk of WHO GDM only to a certain level, above which the risk decreases.

Key words

gestational diabetes mellitus - screening - risk factors - body mass index - obesity - age - parity
 

  • References

  • 1 National Diabetes Data Group . Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. Diabetes 1979; 28: 1039-1057
    CrossrefPubMedGoogle Scholar
  • 2 Standards of medical care in diabetes – 2009. Diabetes Care 2009; 32 (Suppl. 01) S13-S61
    CrossrefPubMedGoogle Scholar
  • 3 Diagnosis and classification of diabetes mellitus. Diabetes Care 2011; 34 (Suppl. 01) S62-S69
    CrossrefPubMedGoogle Scholar
  • 4 Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 1998; 15: 539-553
    CrossrefPubMedGoogle Scholar
  • 5 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
    CrossrefPubMedGoogle Scholar
  • 6 Livingston RC, Bachman-Carter K, Frank C, Mason WB. Diabetes mellitus in Tohon O’odham pregnancies. Diabetes Care 1993; 16: 318-321
    CrossrefPubMedGoogle Scholar
  • 7 Tamas G, Kerenyi Z. Gestational diabetes: current aspects on pathogenesis and treatment. Exp Clin Endocrinol Diabetes 2001; 109 (Suppl. 02) S400-S411
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P, Dyer AR, Leiva A, Hod M, Kitzmiler JL, Lowe LP, McIntyre HD, Oats JJ, Omori Y, Schmidt MI. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010; 33: 676-682
    Google Scholar
  • 9 HAPO Study Cooperative Research Group . Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, Coustan DR, Hadden DR, McCance DR, Hod M, McIntyre HD, Oats JJ, Persson B, Rogers MS, Sacks DA. Hyperglycemia and adverse pregnancy outcomes. New England J Med 2008; 358: 1991-2002
    CrossrefPubMedGoogle Scholar
  • 10 Anna V, van der Ploeg HP, Cheung NW, Huxley RR, Bauman AE. Sociodemographic correlates of the increasing trend in prevalence of gestational diabetes mellitus in a large population of women between 1995 and 2005. Diabetes Care. 2008 31. 2288-2293
    PubMedGoogle Scholar
  • 11 Dabelea D, Snell-Bergeon JK, Hartsfield CL, Bischoff KJ, Hamman RF, McDuffie RS. Increasing prevalence of gestational diabetes mellitus (GDM) over time and by birth cohort: Kaiser Permanente of Colorado GDM Screening Program. Diabetes Care 2005; 28: 579-584
    CrossrefPubMedGoogle Scholar
  • 12 Ferrara A, Kahn HS, Quesenberry CP, Riley C, Hedderson MM. An increase in the incidence of gestational diabetes mellitus: Northern California, 1991–2000. Obstet Gynecol 2004; 103: 526-533
    CrossrefPubMedGoogle Scholar
  • 13 Moum KR, Holzman GS, Harwell TS, Parsons SL, Adams SD, Oser CS, Spence MR, Helgerson SD, Gohdes D. Increasing rate of diabetes in pregnancy among American Indian and white mothers in Montana and North Dakota. 1989–2000. Matern Child Health J 2004; 8: 71-76
    CrossrefPubMedGoogle Scholar
  • 14 Kerenyi Z, Tamas G. Diabetes in pregnancy: Epidemiology, classification, treatment and outcome. In: Williams DRR, Papoz L, Fuller JH (eds.). Diabetes in Europe. London: John Libbey, 1994; 95-108
    PubMedGoogle Scholar
  • 15 Kerenyi Z, Tamas G, Kivimaki M, Peterfalvi A, Madarasz E, Bosnyak Z, Tabak AG. Maternal glycemia and risk of large-for-gestational-age babies in a population-based screening. Diabetes Care 2009; 32: 2200-2205
    CrossrefPubMedGoogle Scholar
  • 16 Tabak AG, Kerenyi Z, Nagy E, Bosnyak Z, Madarasz E, Tamas G. Height and gestational diabetes mellitus. Diabet Med 2002; 19: 344-345
    CrossrefPubMedGoogle Scholar
  • 17 Melczer Z, Banhidy F, Csomor S, Toth P, Kovacs M, Winkler G, Cseh K. Influence of leptin and the TNF system on insulin resistance in pregnancy and their effect on anthropometric parameters of newborns. Acta Obstet Gynecol Scand 2003; 82: 432-438
    CrossrefPubMedGoogle Scholar
  • 18 Reece EA, Leguizamon G, Wiznitzer A. Gestational diabetes: the need for a common ground. Lancet 2009; 373: 1789-1797
    CrossrefPubMedGoogle Scholar
  • 19 Winkler G, Cseh K, Baranyi E, Melczer Z, Speer G, Hajos P, Salamon F, Turi Z, Kovacs M, Vargha P, Karadi I. Tumor necrosis factor system in insulin resistance in gestational diabetes. Diabetes Res Clin Pract 2002; 56: 93-99
    CrossrefPubMedGoogle Scholar
  • 20 Bellamy L, Casas JP, Hingorani AD, Williams D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet 2009; 373: 1773-1779
    CrossrefPubMedGoogle Scholar
  • 21 Madarasz E, Tamas G, Tabak AG, Kerenyi Z. Carbohydrate metabolism and cardiovascular risk factors 4 years after a pregnancy complicated by gestational diabetes. Diabetes Res Clin Pract 2009; 85: 197-202
    CrossrefPubMedGoogle Scholar
  • 22 Chu SY, Callaghan WM, Kim SY, Schmid CH, Lau J, England LJ, Dietz PM. Maternal obesity and risk of gestational diabetes mellitus. Diabetes Care 2007; 30: 2070-2076
    CrossrefPubMedGoogle Scholar
  • 23 Dye TD, Knox KL, Artal R, Aubry RH, Wojtowycz MA. Physical activity, obesity, and diabetes in pregnancy. Am J Epidemiol 1997; 146: 961-965
    CrossrefPubMedGoogle Scholar
  • 24 Harris SB, Caulfield LE, Sugamori ME, Whalen EA, Henning B. The epidemiology of diabetes in pregnant Native Canadians. A risk profile. Diabetes Care 1997; 20: 1422-1425
    CrossrefPubMedGoogle Scholar
  • 25 Kim SY, England L, Wilson HG, Bish C, Satten GA, Dietz P. Percentage of gestational diabetes mellitus attributable to overweight and obesity. Am J Public Health 2010; 100: 1047-1052
    CrossrefPubMedGoogle Scholar
  • 26 Roseman JM, Go RC, Perkins LL, Barger BD, Bell DH, Goldenberg RL, DuBard MB, Huddleston JF, Sedlacek CM, Acton RT. Gestational diabetes mellitus among African-American women. Diabetes Metab Rev 1991; 7: 93-104
    CrossrefPubMedGoogle Scholar
  • 27 Solomon CG, Willett WC, Carey VJ, Rich-Edwards J, Hunter DJ, Colditz GA, Stampfer MJ, Speizer FE, Spiegelman D, Manson JE. A prospective study of pregravid determinants of gestational diabetes mellitus. JAMA 1997; 278: 1078-1083
    CrossrefPubMedGoogle Scholar
  • 28 Torloni MR, Betran AP, Horta BL, Nakamura MU, Atallah AN, Moron AF, Valente O. Prepregnancy BMI and the risk of gestational diabetes: a systematic review of the literature with meta-analysis. Obes Rev 2009; 10: 194-203
    CrossrefPubMedGoogle Scholar
  • 29 Weijers RN, Bekedam DJ, Smulders YM. Determinants of mild gestational hyperglycemia and gestational diabetes mellitus in a large dutch multiethnic cohort. Diabetes Care 2002; 25: 72-77
    CrossrefPubMedGoogle Scholar
  • 30 Xiong X, Saunders LD, Wang FL, Demianczuk NN. Gestational diabetes mellitus: prevalence, risk factors, maternal and infant outcomes. Int J Gynaecol Obstet 2001; 75: 221-228
    CrossrefPubMedGoogle Scholar
  • 31 Yogev Y, Melamed N, Bardin R, Tenenbaum-Gavish K, Ben-Shitrit G, Ben-Haroush A. Pregnancy outcome at extremely advanced maternal age. Am J Obstet Gynecol 2010; 203: 558.e1-558.e7
    CrossrefPubMedGoogle Scholar
  • 32 Kramer MS, McLean FH, Boyd ME, Usher RH. The validity of gestational age estimation by menstrual dating in term, preterm, and postterm gestations. JAMA 1988; 260: 3306-3308
    CrossrefPubMedGoogle Scholar
  • 33 Tabak AG, Tamas G, Peterfalvi A, Bosnyak Z, Madarasz E, Rakoczi I, Kerenyi Z. The effect of paternal and maternal history of diabetes mellitus on the development of gestational diabetes mellitus. J Endocrinol Invest 2009; 32: 606-610
    PubMedGoogle Scholar
  • 34 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
    PubMedGoogle Scholar