obsolete abnormal glucose tolerance in mother complicating pregnancy childbirth and/or puerperium

Definition and History

Abnormal glucose tolerance in mother complicating pregnancy, childbirth AND/OR puerperium (39763004) is a medical condition that was previously recognized as a disorder. It was defined as abnormal glucose tolerance that complicated pregnancy, childbirth, or the postpartum period.

• The first diagnostic criteria for this condition were developed in the 1960s to identify women at increased risk of developing type 2 diabetes mellitus (T2DM) later in life [12].
• However, with advancements in medical knowledge and changes in diagnostic criteria, this condition is no longer considered a distinct disorder.

Comparison with Gestational Diabetes Mellitus

Gestational diabetes mellitus (GDM), which is still recognized today, shares similarities with the obsolete abnormal glucose tolerance. Both conditions involve glucose intolerance during pregnancy. * GDM was defined as carbohydrate intolerance of variable severity with onset or first recognition during pregnancy [7]. * Abnormal glucose tolerance in mother complicating pregnancy, childbirth AND/OR puerperium (39763004) was also characterized by increased risk of macrosomia and birth complications, similar to GDM [8].

Diagnostic Criteria

The diagnostic criteria for abnormal glucose tolerance in mother complicating pregnancy, childbirth AND/OR puerperium (39763004) were not explicitly stated. However, the condition was associated with hyperglycemia diagnosed in the second or third trimester of pregnancy that was not overt diabetes prior to gestation [13].

Comparison with Modern Understanding

The obsolete abnormal glucose tolerance is no longer considered a distinct disorder due to changes in diagnostic criteria and advancements in medical knowledge. * The current understanding of GDM emphasizes the importance of early detection and management to prevent complications for both mother and child [9]. * Women should be screened for diabetes between 6 weeks and 6 months postpartum, with a 75 g oral glucose tolerance test, and given ongoing education regarding their condition [9].

Conclusion

Abnormal glucose tolerance in mother complicating pregnancy, childbirth AND/OR puerperium (39763004) is an obsolete medical condition that was previously recognized as a disorder. It shares similarities with gestational diabetes mellitus but is no longer considered a distinct condition due to changes in diagnostic criteria and advancements in medical knowledge.

References: [1] 4 [2] 13 [3] 8 [4] 9 [5] 12

Warning Signs and Symptoms

Abnormal glucose tolerance in mothers during pregnancy, childbirth, and the postpartum period can manifest in various ways. While some women may not exhibit any noticeable symptoms, others may experience:

• Increased risk of macrosomia: Babies born to mothers with abnormal glucose tolerance are at a higher risk of being larger than average for their gestational age [5].
• Birth complications: Abnormal glucose levels during pregnancy can increase the risk of complications during delivery, such as cesarean sections or fetal distress [9].
• Maternal type 2 diabetes after pregnancy: Women who experience abnormal glucose tolerance during pregnancy are at a higher risk of developing type 2 diabetes later in life [7][14].

Early Warning Signs

Some women may experience early warning signs of abnormal glucose tolerance, including:

• Nausea and increased insulin sensitivity: During the first trimester, some women may experience nausea and increased insulin sensitivity due to hormonal changes [6].
• Accelerated weight gain: Women with a history of obesity or those who are overweight before pregnancy may be at a higher risk of developing abnormal glucose tolerance, leading to accelerated weight gain during pregnancy [13].

Postpartum Complications

In some cases, women who experience abnormal glucose tolerance during pregnancy may also face postpartum complications, such as:

• Obesity and impaired glucose tolerance in the offspring: Babies born to mothers with abnormal glucose tolerance are at a higher risk of developing obesity and impaired glucose tolerance later in life [4].
• Diabetes and cardiovascular disease in the mothers: Women who experience abnormal glucose tolerance during pregnancy are also at a higher risk of developing diabetes and cardiovascular disease later in life [4].

It is essential for pregnant women to be aware of these potential signs and symptoms, as early detection and management can help prevent long-term complications.

Diagnostic Tests for Abnormal Glucose Tolerance in Pregnancy

Abnormal glucose tolerance during pregnancy can complicate childbirth and the postpartum period (puerperium). Several diagnostic tests are used to detect gestational diabetes, a condition characterized by high blood sugar levels during pregnancy.

• Glucose Challenge Test: This is a routine test performed between 24-28 weeks of gestation. It involves drinking a liquid with 50 grams of glucose and then having a blood sample taken to check the blood glucose level. If the result is higher than 140 mg/dL (7.8 mmol/L), further testing is required [1][3].
• Oral Glucose Tolerance Test (OGTT): This test measures the body's response to sugar and is typically performed if the glucose challenge test result is abnormal. The OGTT involves drinking a liquid with 100 grams of glucose, followed by blood samples taken at specific intervals over three hours [4][7].
• One-Hour Glucose Tolerance Test: This is a variation of the glucose tolerance test that is used to screen for gestational diabetes during pregnancy. It involves drinking a liquid with 50 grams of glucose and then having a blood sample taken one hour later [3].

These diagnostic tests are essential in identifying abnormal glucose tolerance during pregnancy, which can increase the risk of complications during childbirth and the postpartum period.

References:

[1] Context result 5 [2] Context result 6 [3] Context result 3 [4] Context result 7

Treatment Options for Abnormal Glucose Tolerance in Pregnancy

Abnormal glucose tolerance during pregnancy can complicate the condition, affecting both the mother and the child. In such cases, drug treatment may be necessary to manage blood sugar levels.

• Insulin: Insulin remains the preferred therapy for pregnant women with pre-gestational diabetes (1, 10). It is also used as a first-line treatment for gestational diabetes mellitus (GDM) when lifestyle measures are not enough to maintain glycemic control (11).
• Oral Antidiabetic Drugs: Oral hypoglycemic agents like metformin and glyburide may be considered as alternatives to insulin, especially in women who cannot tolerate insulin therapy or have difficulty with injections (11, 13). However, their use is not without controversy, and more research is needed to determine their safety and efficacy during pregnancy (6).
• Insulin-Metformin Combinations: The use of insulin-metformin combinations has increased in recent years, but safety studies for these medication regimens are still needed (5).

Important Considerations

• Preconception counseling should be incorporated into routine diabetes care to discuss family planning and effective contraception until a woman's treatment regimen and A1C are optimized (4).
• Women with GDM should undergo screening at six to 12 weeks postpartum with a fasting glucose measurement or 75-g two-hour glucose tolerance test, as up to 36% of women with GDM may have persistently abnormal glucose tolerance (9).

References

[1] Approximately 1% of all pregnant women require the administration of insulin or an oral antidiabetic agent. [2-3] Depending on the study population selected, the glucose intolerance screening procedure used, and the blood glucose criteria employed, abnormal glucose tolerance may complicate as many as 10% of pregnancies. [4]

[5] The use of insulin-metformin combinations and other noninsulin antidiabetic drugs during pregnancy has increased. Safety studies for these medication regimens are needed.

[6] Controversies persist over the most efficacious pharmacologic treatment for gestational diabetes mellitus.

[9] Women with GDM should undergo screening at six to 12 weeks postpartum with a fasting glucose measurement or 75-g two-hour glucose tolerance test; up

Based on the search results, it appears that there are several conditions related to abnormal glucose tolerance in mothers during pregnancy, childbirth, or postpartum.

Possible Differential Diagnoses:

• Gestational Diabetes Mellitus (GDM): A condition characterized by high blood sugar levels during pregnancy, which can increase the risk of complications for both mother and child [11].
• Pre-existing Diabetes: Women with pre-existing diabetes may experience abnormal glucose tolerance during pregnancy, childbirth, or postpartum [8].
• Postpartum Psychosis: Although not directly related to glucose tolerance, postpartum psychosis is a condition that can occur in some women after childbirth, and its diagnosis should be considered in the differential diagnosis [10].

Key Diagnostic Criteria:

• Abnormal glucose tolerance during pregnancy or postpartum can be diagnosed using various criteria, including:
  • The International Classification of Diseases (ICD-9-CM) codes for "Abnormal glucose tolerance of mother complicating pregnancy childbirth or the puerperium" (648.80, 648.81, 648.82, 648.83) [12].
  • The American Diabetes Association (ADA) criteria for diagnosing gestational diabetes mellitus (GDM), which include a 75-g oral glucose tolerance test and other factors [9].

Important Considerations:

• Women with abnormal glucose tolerance during pregnancy or postpartum should be screened for diabetes between 6 weeks and 6 months postpartum using a 75-g oral glucose tolerance test [9].
• Gestational diabetes mellitus (GDM) is associated with adverse short- and long-term outcomes for both mother and child, making early diagnosis and management crucial [11].

References:

[8] Egan AM. The degree of insulin resistance in the third trimester of pregnancy is not an important predictor of abnormal glucose tolerance within 6 months postpartum. [2020]

[9] PE Diabetes. Women should be screened for diabetes between 6 weeks and 6 months postpartum, with a 75 g oral glucose tolerance test and be given ongoing education regarding their condition. [Cited by 2]

[10] Friedman SH, Reed E, Ross NE. Postpartum Psychosis. Curr Psychiatry Rep 2023 Feb;25(2):65-72.

[11] Gestational diabetes mellitus (GDM), a common metabolic condition complicating pregnancy, is associated with adverse short and long-term outcomes both for mother and child. [2010]

[12] In 2010, at discharge, a delivery complicated by GDM was assigned codes 648.80 (Diabetes mellitus of mother complicating pregnancy childbirth or the puerperium unspecified as to episode of care), 648.81 (Diabetes mellitus of mother with delivery) and/or 648.83 (Antepartum diabetes mellitus), according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM).