TEMPLATE DESIGN © PREDICTIVE FACTORS OF ABNORMAL GLUCOSE TOLERANCE AT 6 WEEKS POST PARTUM IN WOMEN WITH GESTATIONAL DIABETES IN HUSM, KELANTAN Hasna H, Nik Ahmad Zuky NL, Mohd Pazudin I, Che Anuar CY Department of Obstetric and Gynaecology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia Objectives General objective To evaluate the prevalence and predictive factors of abnormal glucose tolerance at 6 weeks post partum in women with gestational diabetes mellitus (GDM). Specific Objectives 1.To determine the prevalence of abnormal glucose tolerance (OGTT) among women with GDM at 6 weeks post partum 2.To determine association between pre pregnancy factors (i.e. age, race, educational level, occupation, pre pregnancy BMI, gravida, family history of DM, and abnormal OGTT at 6 weeks post partum, among GDM mothers 3. To identify association between pregnancy related factors (i.e. previous history of GDM, gestational age at the time of GDM diagnosis, HBA1c at diagnosis of GDM, OGTT 0 min and 120 during pregnancy, treatment with diet only, treatment with insulin, gestational week at start of insulin therapy, and abnormal OGTT at 6 weeks post partum among GDM mothers Content goes here… Methods Methodology It was a prospective cohort study, conducted in Hospital Universiti Sains Malaysia (HUSM) from Feb 2010 till Nov 2010, involving 101 pregnant women diagnosed GDM who attended Antenatal Clinic, HUSM and fulfilled the inclusion and exclusion criteria. Approved by the Research and Ethical Committee, School of Medical Sciences, USM on 20 Jan Inclusion Criteria GDM diagnosed during pregnancy Exclusion Criteria Established diabetes mellitus (Type 1 or Type 2) Had other medical illness (e.g. HPT, HPL, cardiovascular disease) Flow Chart of the Study. Results Figure 1: Prevalence of OGTT at 6 weeks post partum Table 1: Association between pre pregnancy related factors (occupation) and abnormal OGTT at 6 weeks post partum (simple logistic regression). (n=101) Backward LR method applied, Hosmer and Lemeshow test, p value = 1.00,Classification table 60.4% correctly classified, Area under Receiver Operating Characteristic (ROC) curve was Table 2: Association between pregnancy related factors (HbA1C at diagnosis and mode of treatment) and abnormal OGTT at 6 weeks post partum (simple logistic regression). (n=101) Backward LR method applied, Hosmer and Lemeshow test, p value = 0.494, Classification table 60.4% correctly classified, Area under Receiver Operating Characteristic (ROC) curve was 0.795, No multicollinearity and no interaction found Table3: Association between pregnancy related factors (previous history of GDM, Gestational age at the time of GDM diagnosis) and abnormal OGTT at 6 weeks post partum ( multiple logistic regression). Backward LR method applied, Hosmer and Lemeshow test, p value = Classification table 66.3% correctly classified, Area under Receiver Operating Characteristic (ROC) curve was 0.690, No multicollinearity and no interaction found Content goes here… Conclusions References 1. The prevalence of abnormal glucose tolerance test at 6 weeks post partum was 39.6% including 35.64% of IGT and 3.96% of DM. 2. Working status as a teacher was significantly associated with abnormal glucose tolerance at 6 weeks post partum by 3.5 times. (adjusted OR=3.50;95%CI:1.33,9.26, p=0.011) 3.HbA1c at diagnosis of GDM was significantly associated with abnormal glucose tolerance at 6 weeks post partum. Women who had HBA1c of ≥ 6.5% has 3.88 times of having abnormal glucose tolerance as compared to women who had HBA1c of <6.5%. (adjusted OR 3.88; 95% CI: 1.08, ; p=0.038). 4.Insulin therapy was significantly associated with abnormal glucose tolerance at 6 weeks post partum. Women who are on insulin therapy has 5.34 times of having abnormal glucose tolerance as compared with women who are only on diet therapy (adjusted OR=5.34; 95% CI 1.70, 16.76; p=0.004). 5.Previous history of GDM was significantly associated with abnormal glucose tolerance at 6 weeks post partum. Women with GDM on insulin who have previous history of GDM has 3.77 times odds of having abnormal glucose tolerance at 6 weeks post partum as compared with women who had no previous history of GDM. (adjusted OR=3.77; 95% CI: 1.40, ; p=0.009). 6. Gestational age at the time of GDM diagnosis was significantly associated with abnormal glucose tolerance at 6 weeks post partum. The earlier the diagnosis of GDM, the higher the chances of having abnormal glucose tolerance at 6 weeks post partum. (adjusted OR= 0.33; 95% CI: 0.12, 0.88; p=0.026). OPTIONAL LOGO HERE 1.American Diabetes Association ( 2003). Gestational diabetes mellitus, Diabetes Care 26: s1-s2 2. Ogonowski, J. & Miazgowski, T. (2009) The prevalence of 6 weeks postpartum abnormal glucose tolerance in Caucasian women with gestational diabetes. Diabetes Res Clin Pract, 84, The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 2003; 26: (Suppl. 1). 4.World Health Organization. Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications. Report of a WHO Consultation, Part 1: Diagnosis and Classification of Diabetes Mellitus. Geneva, Switzerland. World Health Org ; VariablesβAdjusted OR (95% CI)p value HbA1c at diagnosis of GDM (%) <6.51 ≥ (1.08, 13.99)0.038 Mode of treatment Diet only1 Insulin (1.70, 16.76)0.004 VariablesβAdjusted OR (95% CI) p value Previous history of GDM No1 Yes (1.40, 10.17)0.009 Gestational age at the time of GDM diagnosis <20 week week (0.12,0.88)0.026 ≥30 week (0.07,0.90)0.034 VariablesβAdjusted OR (95% CI)P value Occupation Housewife1 Clerk (0.57, 9.01)0.245 Teacher (1.33, 9.26)0.011 Others (0.15,2.54)0.505 Status of GDM Previous history of GDM Gestational age at the time of GDM diagnosis HbA1c at the time of GDM diagnosis FBS/OGTT during pregnancy 2HPP/OGTT during pregnancy Treatment with diet only Treatment with insulin Gestational week at start of insulin therapy Socio demographic Age Race Educational level Occupation Pre pregnancy BMI Gravida Family history of DM in first degree relative ORAL GLUCOSE TOLERANCE TEST (OGTT) AT 6 WEEKS POST PARTUM