2. EPIDEMIOLOGY IN GESTATIONAL DIABETES MELLITUS Methodology Dr. Nam-Han Cho Associate Professor of Preventive Medicine Director of Center for Clinical Epidemiology Ajou University School of Medicine Suwon, Korea

4. GESTATIONAL DIABETES MELLITUS Gestational Diabetes Mellitus(GDM), defined as carbohydrate intolerance with onset or first recognition during pregnancy: Occurs in approximately 2 to 5% of all pregnancies, with marked worldwide variations reported; Is associated with an increased risk of fetal macro- somia, as well as perinatal morbidity and mortality; Is linked with future developments of diabetes mellitus in women post-pregnancy.

5. METHODOLOGICAL INCONSISTENCIES IN EPIDEMIOLOGICAL STUDIES OF GDM Glucose loads range from 50g to 100g Threshold values range from 125 mg/dl to 150 mg/dl SCREENING Glucose loads range from 50g to 100g Two and Three hour tests are used Differences in diagnostic procedures and values DIAGNOSTIC OGTT

6. DIFFERENCE IN SCREENING THRESHOLD VALUES AND ETHNIC DIFFERENCES IN THE RATE OF GDM Author SiteThreshold for OGTT Race Prevalence* Green S. F >150mg/dl White 1.6 Black 1.7 Hispanic 4.2 Berkowitz New York  135mg/dl White 2.3 Black 3.7 Hispanic 4.1 Dooley Chicago  130mg/dl White 2.7 Black 3.3 Hispanic 4.4 * 50g-1hr, 100g-3 hr OGTT

7. RESEARCH AREA 4 4 High Risk for PIH 4 4 High Risk for DM 4 High Risk for birth complications 4 High Risk for Obesity 4 High Risk for IGT/DM 4 Potential Risk for the future Hypertension Offspring Maternal

9. Risk Factors for DM after GDM 4 4 Impaired ß-cell function 4 4 Higher PIBW 4 4 Family history (30% M, 11% F)

10. Overview: Minor adverse health effects for offspring Birth Wt (g)3303±643649±51 3849±72 <0.01 Macrosomia(%)83647<0.01 C-S 51014<0.01 Hypoglycemia 22852<0.01 Hypocalcemia 0 4 7<0.01 Hyperbilirubinemia152321<0.01 Polycythemia 0 711<0.01 Cord C-Pep 1.18±0.1 2.07±0.12 2.98±0.22 <0.01 Cord Glu 100±3.6 103±2.9 114±5.5 <0.01 NormalGDMDMP

11. MACROSOMIA Birth Wt (g) 3512±711 3333±479 <0.05 LGA 40.4% 13.7% <0.001 Macrosomia(%) 32.0% 11.0% <0.01 GDM Non-diabetic p-value

12. Overview: Major adverse health effects for offspring CNS6.4%18.4% Congenital heart disease7.5%21.0% Respiratory disease2.9%7.9% Intestinal atresia0.6%2.6% Anal atresia1.0%2.6% Renal & Urinary defect3.1%11.8% Upper limb deficiences2.3%3.9% Lower limb deficiences1.2%6.6% Upper + Lower spine0.1%6.6% Caudal dysgenesis0.1%5.3% Normal DM

13. NEONATAL COMPLICATIONS T. hypoglycemia(%) 5228 3<0.01 P. hypoglycemia(%) 6 2 0<0.01 Hypocalcemia(%) 5 5 0<0.01 Hyperbilirubinemia(%) 212315<0.01 Trans tachypnea(%) 5 2 0<0.01 Polycythemia(%) 11 7 0<0.01 RDS(%) 5 2 0<0.01 IUGR(%) 2 1 0<0.05 DM GDMNormal p-value

14. ONGOING GDM EPIDEMIOLOGIC STUDIES :Prevalence Study Study Sites l l Chicago l l Cheil Samsung l l Ajou University Hospital

15. METHODOLOGY 50g / 1 hr at 24-28 weeks gestation  130 mg/dl requires 100g, 3 hr OGTT Fasting (105 mg/dl) 1 hour (190 mg/dl) 3 hour (145 mg/dl) SCREENING DIAGNOSTIC OGTT 2 hour (165 mg/dl)

16. ONGOING GDM EPIDEMIOLOGIC STUDIES :Prevalence Study Prevalence of GDM SITE RACE PREVALENCE ChicagoWhite2.7% Black3.3% Hispanic4.4% Korean American4.5 -13.6% SeoulKorean2.2% SuwonKorean5.0%

17. LONGITUDINAL STUDY OF GDM l Ajou University Hospital l Samsung Cheil General l Cha Hospital l Il-Sin Christian Hospital 4 Anthropometric 4 Demographic 4 75gm-2 hr OGTT 4 Stress 4 Diet 4 BIP 4 Lipid Profile Site and Measurements

18. LONGITUDINAL STUDY OF GDM l Skin fold caliper l Questionnaire l BIP (GIF-891DX) l Insulin assay 4 Inter-Variation (0.97-0.98) 4 Intra-Variation (cv=0.23-0.38%) 4 Sampling Tube - Device Standardization

19. LONGITUDINAL STUDY OF GDM GDM screening  GDM screening  Maternal follow-up  Maternal follow-up  l Offspring follow-up Projects

20. SUCCESS TO THE PROJECT Dept. of Prev. Med. Dept. of Endocr. Dept. of Ob-Gyn Center for Clinical Epidemiology