Does Coffe Intake During Pregnancy Prevent Gestational Diabetes

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Transcript of Does Coffe Intake During Pregnancy Prevent Gestational Diabetes

DOES COFFE INTAKE DURING PREGNANCY PREVENT GESTATIONAL DIABETES MELITUS?

DOES COFFE INTAKE DURING PREGNANCY PREVENT GESTATIONAL DIABETES MELITUS?

Presented By :Wynna Manami, MDStaff doctor of Thailand International Hospital

10th March 2012The International Medical Scientific MeetingINTRODUCTION

introduction

DEFINITIONGestational diabetes mellitus (GDM) is defined as glucose intolerance of various degrees that is first detected during pregnancy. In women who are diagnosed with gestational diabetes, beta cells in the pancreas that produce insulin are unable to produce enough insulin to meet the body's needs

EpidemiologyGDM affects ~ 7% of all pregnancies, resulting in > 200,000 cases per year. Depending on the population sample and diagnostic criteria, the prevalence may range from 1 to 14%. Of all pregnancies complicated by diabetes, GDM accounts for ~ 90%.The prevalence of gestational diabetes is strongly related to the patient's race and culture. Prevalence rates are higher in black, Hispanic, Native American, and Asian women than in white women.

Picture 1. Insulin sensitivity indexDiagnostic CriteriaThe oral glucose tolerance test (OGTT) most commonly used to diagnose GDM.

Screening testsThe 2-step system is currently recommended in the United States. A 50-g, 1-hour glucose challenge test (GCT) is followed by a 100-g, 3-hour oral glucose tolerance test (OGTT) for those with an abnormal screening result. Current recommendations from the American Diabetes Association "Standards of Medical Care in Diabetes--2010" and the American College of Obstetricians and Gynecologists (ACOG) note that a threshold value of 140 mg/dL results in approximately 80% detection of gestational diabetes, whereas a threshold of 130 mg/dL results in 90% detection.

Screening testsOther tests maternal HbA1Crandom postprandial fasting blood sugar levelfructosamine levelThe current recommendations from the American Diabetes Association "Standards of Medical Care in Diabetes-2010"are to conduct a risk assessment for all pregnant women at the first prenatal visit.Criteria for very high risk are as follows:Severe obesityGestational diabetes mellitus during a previous pregnancy or delivery of an LGA infantPresence of glycosuriaDiagnosis of polycystic ovarian syndromeStrong family history of type 2 diabetes

Picture.3 screening for DGMComplicationThere are both fetal and maternal complications associated with GDM. Fetal complications:Macrosomianeonatal hypoglycemiaperinatal mortalitycongenital malformationHyperbilirubinemiaPolycythemiahypocalcemia,and respiratory distress syndrome. ComplicationMaternal complications associated with GDM include HypertensionPreeclampsiaand an increased risk of cesarean delivery. Coffee

Coffee contains a complex mixture of chemical compounds components including: CaffeineTrigonellinechlorogenic acidphenolic acids, amino acidsCarbohydratesmineralsCoffee containsCoffee contains minerals such as magnesium and chromium, which help the body use the hormone insulin, which controls blood sugar (glucose). In type 2 diabetes, the body loses its ability to use insulin and regulate blood sugar effectively.

Coffee in PregnancyIn August 2010, the American College of Obstetricians and Gynecologists (ACOG) stated that moderate caffeine drinking: less than 200 mg per day, or about the amount in 12 ounces of coffee doesn't appear to have any major effects on causing miscarriage, premature delivery, or fetal growth.

Coffee in PregnancyPrevious studies have found that people who drink four or more cups of coffee a day have a 50% lower risk of getting type 2 diabetes. Results are based on data from the aarrhus birth cohort, denmark. 2.138 women were included in the the study. 0f the cohort 1.6% developed GDM during pregnancy. Upper quartile of reported coffee consumption per week was 1 cup per day. Sixty two percent of the women reported no coffee intake during pregnancy. Coffee in PregnancyWomen with a high coffee intake were more like to be smokers, had a higher alcohol intake. Were older, more often multiparous and had less years of education that those with a lower intake. In the final lgistic regrssion model coffee drinking during pregnancy was associated with 27% decreased risk of GDM when controled for relevant confounding factor OR (Cl 95%) 0,73(0.51-1.03).

SUMMARY

GDM is a common medical problem that results from an increased severity of insulin resistance as well as an impairment of the compensatory increase in insulin secretion. Pregnancy, in essence, serves as a metabolic stress test and uncovers underlying insulin resistance and cell dysfunction. GDM is associated with a variety of maternal and fetal complications, most notably macrosomia.Coffee drinking during pregnancy was associated with an approximately 25% decrease in the risk of GDM when controlled for relevant confounding factors. Moderate pre-pregnancy caffeinated coffee consumption may have a protective association with GDM. Because of its widespread consumption, understanding the relationship between coffee intake and insulin secretion may have implications in the prevention and treatment of diabetes

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