Prediction of women's long-term cardiometabolic risks using glycemic indices during pregnancy.
OBJECTIVE
To study the prediction of abnormal glucose tolerance (AGT), diabetes mellitus (DM), hypertension (HT) and metabolic syndrome (MetS) among Chinese women using glycemic indices in the mid-trimester of pregnancy.


METHODS
A cohort of Chinese women who had had either normal glucose tolerance or gestational diabetes mellitus (GDM) during a pregnancy were assessed at a median of 8 and 15 years post-delivery. All women underwent a 50-g glucose challenge test (GCT) and a 75-g oral glucose tolerance test in the mid-trimester of the index pregnancy. A receiver operating characteristic curve was used to assess the prediction of AGT, DM, HT and MetS.


RESULTS
All glycemic indices were significant predictors of AGT and DM, and the 2-h plasma glucose (PG) and GCT were predictive of HT, at both 8 and 15 years post-delivery. MetS can only be predicted by the fasting plasma glucose (FPG) and was confined to 15 years post-delivery. After adjustment for confounding variables, all glycemic indices were still independent predictors of AGT and DM at both 8 and 15 years post-delivery, except for FPG in predicting DM at 8 years, while only the 2-h PG remains an independent predictor of HT at 15 years. The optimal cut-off values for FPG, 2-h PG and GCT are 4.2 mmol/L, 7.2 mmol/L and 7.7 mmol/L, respectively; all are lower than the current cut-off thresholds for the screening and diagnosis of GDM.


CONCLUSIONS
Women who had a glycemic level below the criteria for a positive screening test and below the diagnostic threshold for GDM still have a significant cardiometabolic risk.
Departments of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China. tamwh@cuhk.edu.hk
Wing Hung
WH
Tam
Ronald Ching Wan
RC
Ma
Xilin
X
Yang
Gary Tin Choi
GT
Ko
Terence Tzu Hsi
TT
Lao
Daljit Singh
DS
Sahota
Michael Ho Ming
MH
Chan
Christopher Wai Kei
CW
Lam
Clive Stewart
CS
Cockram
Juliana Chung Ngor
JC
Chan
D000328:Adult; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D016640:Diabetes, Gestational / Q000097:blood / Q000503:physiopathology*; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D044882:Glucose Metabolism Disorders / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology*; D024821:Metabolic Syndrome / Q000175:diagnosis / Q000453:epidemiology*; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D012306:Risk; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D055815:Young Adult