Diabetes, Metabolic Syndrome and Obesity (Sep 2024)
The Plasma Glucose Threshold Values Associated with Adverse Pregnancy Outcomes Among Asian Indian Pregnant Women: MAASTHI Birth Cohort Analysis
Abstract
Ravi Deepa,1,2 Melissa Glenda Lewis,3 Onno Van Schayck,2 Giridhara R Babu4 1Indian Institute of Public Health-Bangalore, Public Health Foundation of India (PHFI), Bengaluru, Karnataka, India; 2Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Limburg, the Netherlands; 3Indian Council of Medical Research-National Institute of Cholera and Enteric Diseases (NICED), Kolkata, India; 4Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, QatarCorrespondence: Giridhara R Babu, Email [email protected]: To assess the association of adverse pregnancy and infant outcomes with different cut-off levels of glucose intolerance during pregnancy in the MAASTHI cohort.Design: Pregnant women (n = 1470) underwent Oral glucose tolerance test between 24 and 36 weeks using a 75-g oral glucose load, with plasma glucose estimations measured at fasting and two hours later. Follow-up was done within 72 hours of delivery for recording type of delivery, infant weight, mid-upper arm circumference, and skinfold thickness.Results: The odds of having higher skinfold thickness (> 90th percentile) were 43% higher (AOR = 1.43; 95% CI: 1.18, 1.74) and the odds of being overweight at birth was 34% higher (AOR = 1.34; 95% CI: 1.09, 1.62) for every 1 standard deviation (9.9 mg/dL) increase in fasting plasma glucose (FPG) in male infants. The odds of delivering via caesarean section were 45% higher in women with female foetus (1.45,95% CI 1.15,1.82) for every one SD (23.4 mg/dl) increase in 2-h post-load Glucose.Conclusion: The impact of maternal glucose levels on infant and maternal outcomes differed notably between sex of the child. Compared to female infants, male infants exhibited a stronger association with elevated risks for adverse outcomes, including higher infant weight and increased skinfold thickness.Plain Language Summary: Glucose intolerance, in simple terms, refers to a condition where the body has difficulty processing sugar (glucose) properly. Normally, when we eat, our body breaks down carbohydrates into glucose, which is then used by cells for energy. However, in glucose intolerance, this process does not work as efficiently. This can lead to higher-than-normal blood sugar levels, which, if persistent, can increase the risk of developing type 2 diabetes over time. In this study, the researchers investigated how glucose intolerance during pregnancy results in negative health outcomes in mothers and infants in a South Indian City. This is significant as the adverse impact of glucose intolerance in Indian women is not widely studied. The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study was considered by WHO for defining GDM diagnosis primarily focused on Caucasian populations. Given the known ethnic differences in glucose metabolism and the high prevalence of gestational diabetes in India, understanding glucose intolerance, specifically in Indian women, is essential. In this research, all pregnant mothers underwent an oral glucose tolerance test between the 24th and 36th weeks of pregnancy. They fasted for 12 hours before their blood samples were taken to measure their fasting glucose levels. Then, they drank a glucose solution containing 75 g of glucose. After waiting for 2 hours, their glucose levels were measured again. Those with fasting glucose levels equal to or greater than 92 mg/dl and 2-hour post-load plasma glucose levels equal to or greater than 153 mg/dl were diagnosed with gestational diabetes mellitus (GDM). After delivery, the weight and fat deposition under the skin; known as skinfold thickness (adiposity) were measured using a skinfold caliper.The risks of higher weight and skinfold were seen in male infants compared to female infants. The overall risk of adiposity and C-section were higher than those reported in the HAPO study, highlighting the need for large-scale studies among the Indian population to better understand and address these associations.Keywords: gestational diabetes, hyperglycaemia, caesarean section, adiposity, obesity
