GENERAL ORAL GLUCOSE TOLERANCE TEST DURING PREGNANCY, AN OPPORTUNITY FOR IMPROVED PREGNANCY OUTCOME AND IMPROVED FUTURE HEALTH.
Gestational diabetes mellitus (GDM) is associated with a risk of adverse pregnancy outcome and is a predictor of subsequent diabetes. The aims of this work were to describe a reliable routine to diagnose abnormal glucose tolerance during pregnancy, to investigate women’s opinions of the specialist care provided, to determine the prevalence of diabetes one year after giving birth, and to elucidate the effect of abnormal glucose tolerance on pregnancy outcome and on the women’s future health. Routines for a general decentralised oral glucose tolerance test (OGTT) at antenatal clinics, with high quality and high compliance of the patients are described. Perinatal outcome was determined and compared for the years 1995-1999 and 2000-2003, and in two geographical areas with different screening routines (OGTT and random glucose measurements, RGM). The routine use of OGTTs identified twice as many cases of GDM as RGM. Those not identified with RGM were as affected. The women’s opinions of the extended care programme were analysed using a questionnaire. The results showed great satisfaction with the care provided, especially the sound knowledge of the staff. However, a desire for better preparation before the OGTT, better information flow and more information on normal pregnancy was expressed. Women delivered in 2003-2005 who had undergone an OGTT during pregnancy participated in a follow-up study 1-2 years after delivery. Different cut-off limits were used for 2-h capillary plasma glucose concentrations at OGTT during pregnancy. GDM >10.0 mmol/L, gestational impaired glucose tolerance (GIGT) 8.6-9.9 mmol/L, and a control group <8.6 mmol/L. At follow-up, 11% (n=160) of the GDM group, 4% (n=309) of the GIGT group and none of the controls had diabetes. When diagnosed with GIGT a retest was offered. Two-thirds of the women with diabetes after GIGT were found in the group diagnosed as having GDM after retest during pregnancy. Adverse pregnancy outcome was observed in both the GDM and GIGT groups compared with the controls. Women with previous GDM were more than 3 times as likely as a group to consume health care resources in a year after delivery (odds ratio 3.5, 95% CI 2.5-5.0), leading to an average 50% higher cost (p<0.001). Annual excess cost was apparent up to 7 years after childbirth (p<0.01). A general routine OGTT during pregnancy identifies women with GDM, providing the opportunity to improve the pregnancy outcome and to make lifestyle changes that can improve the future health of both mother and child.
Gynaecology, Obstetrics and Reproductive Medicine, opinions on care, Gestational diabetes mellitus, general oral glucose tolerance test, screening, follow-up, postpartum, pregnancy outcome, use of health care
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