title: Epidemiology of Dysglycemia in Pregnant Oklahoma American Indian Women.
abstract: BACKGROUND
  Minority communities are disproportionately affected by diabetes, and minority women are at an increased risk for glucose intolerance (dysglycemia) during pregnancy.
  
  
  OBJECTIVE
  In pregnant American Indian women, the objectives of the study were to use current criteria to estimate the prevalence of first-trimester (Tr1) dysglycemia and second-trimester (Tr2) incidence of gestational diabetes mellitus (GDM) and to explore new candidate measures and identify associated clinical factors.
  
  
  METHODS
  This was a prospective cohort study. In Tr1 we performed a 75-g, 2-hour oral glucose tolerance test (OGTT) and glycated hemoglobin (HbA1c) to determine the following: fasting insulin; homeostasis model assessment of insulin resistance; serum 1,5-anhydroglucitol; noninvasive skin autofluorescence (SCOUT). We defined dysglycemia by American Diabetes Association and Endocrine Society criteria and as HbA1c of 5.7% or greater. In Tr2 in an available subset, we performed a repeat OGTT and SCOUT.
  
  
  METHODS
  Pregnant American Indian women (n = 244 at Tr1; n = 114 at Tr2) participated in the study.
  
  
  RESULTS
  The prevalence of dysglycemia at Tr1 and incidence of GDM at Tr2 were measured.
  
  
  RESULTS
  At Tr1, one woman had overt diabetes; 36 (15%) had impaired glucose tolerance (American Diabetes Association criteria and/or abnormal HbA1c) and 59 (24%) had GDM-Tr1 (Endocrine Society criteria). Overall, 74 (30%) had some form of dysglycemia. Associated factors were body mass index, hypertension, waist/hip circumferences, SCOUT score, fasting insulin, and homeostasis model assessment of insulin resistance. At Tr2, 114 of the Tr1 cohort underwent a repeat OGTT and SCOUT, and 26 (23%) had GDM. GDM-Tr2 was associated with increased SCOUT scores (P = .029) and Tr1 body mass index, waist/hip circumferences, diastolic blood pressure, fasting insulin, and triglyceride levels. Overall, dysglycemia at Tr1 and/or Tr2 affected 38% of the women.
  
  
  CONCLUSIONS
  Dysglycemia at some point during pregnancy was common among American Indian women. It was associated with features of insulin resistance and may confer long-term health risks for mother and child.
authors.affiliation: Section of Endocrinology, Diabetes, and Metabolism (M.A.), Oklahoma Shared Clinical and Translational Resources (L.S.), University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73014; Department of Biostatistics and Epidemiology (J.A.S., H.D.D.), College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104; Division of Maternal and Fetal Medicine (J.R.G.), Loyola University Medical Center, Maywood, Illinois 60153; Medical Device and Diagnostics Consulting (J.M.), Albuquerque, New Mexico; and Centre for Experimental Medicine (T.J.L.), Queen's University of Belfast, Belfast BT7 1NN, Northern Ireland, United Kingdom.
authors.forename: Madona
authors.initials: M
authors.lastname: Azar
authors.affiliation: Section of Endocrinology, Diabetes, and Metabolism (M.A.), Oklahoma Shared Clinical and Translational Resources (L.S.), University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73014; Department of Biostatistics and Epidemiology (J.A.S., H.D.D.), College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104; Division of Maternal and Fetal Medicine (J.R.G.), Loyola University Medical Center, Maywood, Illinois 60153; Medical Device and Diagnostics Consulting (J.M.), Albuquerque, New Mexico; and Centre for Experimental Medicine (T.J.L.), Queen's University of Belfast, Belfast BT7 1NN, Northern Ireland, United Kingdom.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Stoner
authors.affiliation: Section of Endocrinology, Diabetes, and Metabolism (M.A.), Oklahoma Shared Clinical and Translational Resources (L.S.), University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73014; Department of Biostatistics and Epidemiology (J.A.S., H.D.D.), College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104; Division of Maternal and Fetal Medicine (J.R.G.), Loyola University Medical Center, Maywood, Illinois 60153; Medical Device and Diagnostics Consulting (J.M.), Albuquerque, New Mexico; and Centre for Experimental Medicine (T.J.L.), Queen's University of Belfast, Belfast BT7 1NN, Northern Ireland, United Kingdom.
authors.forename: Hanh Dung
authors.initials: HD
authors.lastname: Dao
authors.affiliation: Section of Endocrinology, Diabetes, and Metabolism (M.A.), Oklahoma Shared Clinical and Translational Resources (L.S.), University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73014; Department of Biostatistics and Epidemiology (J.A.S., H.D.D.), College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104; Division of Maternal and Fetal Medicine (J.R.G.), Loyola University Medical Center, Maywood, Illinois 60153; Medical Device and Diagnostics Consulting (J.M.), Albuquerque, New Mexico; and Centre for Experimental Medicine (T.J.L.), Queen's University of Belfast, Belfast BT7 1NN, Northern Ireland, United Kingdom.
authors.forename: Lancer
authors.initials: L
authors.lastname: Stephens
authors.affiliation: Section of Endocrinology, Diabetes, and Metabolism (M.A.), Oklahoma Shared Clinical and Translational Resources (L.S.), University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73014; Department of Biostatistics and Epidemiology (J.A.S., H.D.D.), College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104; Division of Maternal and Fetal Medicine (J.R.G.), Loyola University Medical Center, Maywood, Illinois 60153; Medical Device and Diagnostics Consulting (J.M.), Albuquerque, New Mexico; and Centre for Experimental Medicine (T.J.L.), Queen's University of Belfast, Belfast BT7 1NN, Northern Ireland, United Kingdom.
authors.forename: Jean R
authors.initials: JR
authors.lastname: Goodman
authors.affiliation: Section of Endocrinology, Diabetes, and Metabolism (M.A.), Oklahoma Shared Clinical and Translational Resources (L.S.), University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73014; Department of Biostatistics and Epidemiology (J.A.S., H.D.D.), College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104; Division of Maternal and Fetal Medicine (J.R.G.), Loyola University Medical Center, Maywood, Illinois 60153; Medical Device and Diagnostics Consulting (J.M.), Albuquerque, New Mexico; and Centre for Experimental Medicine (T.J.L.), Queen's University of Belfast, Belfast BT7 1NN, Northern Ireland, United Kingdom.
authors.forename: John
authors.initials: J
authors.lastname: Maynard
authors.affiliation: Section of Endocrinology, Diabetes, and Metabolism (M.A.), Oklahoma Shared Clinical and Translational Resources (L.S.), University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73014; Department of Biostatistics and Epidemiology (J.A.S., H.D.D.), College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104; Division of Maternal and Fetal Medicine (J.R.G.), Loyola University Medical Center, Maywood, Illinois 60153; Medical Device and Diagnostics Consulting (J.M.), Albuquerque, New Mexico; and Centre for Experimental Medicine (T.J.L.), Queen's University of Belfast, Belfast BT7 1NN, Northern Ireland, United Kingdom.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Lyons
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D016640:Diabetes, Gestational / Q000453:epidemiology / Q000208:ethnology*; D005260:Female; D018149:Glucose Intolerance / Q000453:epidemiology / Q000208:ethnology*; D005951:Glucose Tolerance Test; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D009825:Oklahoma / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood / Q000453:epidemiology / Q000208:ethnology*; D011261:Pregnancy Trimester, First / Q000097:blood / Q000208:ethnology; D011262:Pregnancy Trimester, Second / Q000097:blood / Q000208:ethnology; D015995:Prevalence; D055815:Young Adult