DOES COFFE INTAKE DURING PREGNANCY PREVENT GESTATIONAL DIABETES MELITUS?

10th March 2012 The International Medical Scientific Meeting

Presented By : Wynna Manami, MD Staff doctor of Thailand International Hospital

INTRODUCTION

Coffee is a popular drink in the world

It is said that seven out of 10 coffee three times per day or more.

Coffee has been associated with low birth weight, birth defects, miscarriages, premature birth, inability to conceive, and sluggish sperm

INTRODUCTION

High coffe consumption

has been associated with better glucose tolerance and substantially lower risk of type 2 diabetes

Gestational Diabetes Mellitus

Gestational diabetes affects between 2 and 10 percent of women during pregnancy.

DEFINITION
Gestational 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

EPIDEMIOLOGY
GDM 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.

Autoimune diabetes

Etiology
cell dysfunction Monogenic diabetes

Picture 1. Insulin sensitivity index

DIAGNOSTIC CRITERIA
The oral glucose tolerance test (OGTT) most commonly used to diagnose GDM.

SCREENING TESTS
The 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 TESTS

Other tests

maternal HbA1C random postprandial fasting blood sugar level fructosamine level

The 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 obesity Gestational diabetes mellitus during a previous pregnancy or delivery of an LGA infant Presence of glycosuria Diagnosis of polycystic ovarian syndrome Strong family history of type 2 diabetes

Picture.3 screening for DGM

COMPLICATION
There are both fetal and maternal complications associated with GDM. Fetal complications:

Macrosomia neonatal hypoglycemia perinatal mortality congenital malformation Hyperbilirubinemia Polycythemia hypocalcemia, and respiratory distress syndrome.

COMPLICATION

Maternal complications associated with GDM include

Hypertension Preeclampsia and an increased risk of cesarean delivery.

COFFEE
Coffee contains a complex mixture of chemical compounds components including:

Caffeine Trigonelline chlorogenic acid phenolic acids, amino acids Carbohydrates minerals

COFFEE CONTAINS
Coffee 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 PREGNANCY
In 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 PREGNANCY
Previous 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 PREGNANCY

Women 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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