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. 2021 Feb;38(2):e14413.
doi: 10.1111/dme.14413. Epub 2020 Oct 14.

Metabolic phenotypes of early gestational diabetes mellitus and their association with adverse pregnancy outcomes

J Immanuel  1 , D Simmons  1   2 , J Harreiter  3 , G Desoye  4 , R Corcoy  5   6   7 , J M Adelantado  5 , R Devlieger  8   9 , A Lapolla  10 , M G Dalfra  10 , A Bertolotto  11 , E Wender-Ozegowska  12 , A Zawiejska  12 , F P Dunne  13 , P Damm  14   15 , E R Mathiesen  14   15 , D M Jensen  16   17   18 , L L T Andersen  17   18 , D J Hill  19   20 , J G M Jelsma  21 , A Kautzky-Willer  3   22 , S Galjaard  8   9   23 , F J Snoek  24 , M N M van Poppel  21   25
Affiliations

Metabolic phenotypes of early gestational diabetes mellitus and their association with adverse pregnancy outcomes

J Immanuel et al. Diabet Med. 2021 Feb.

Abstract

Aims: To describe the metabolic phenotypes of early gestational diabetes mellitus and their association with adverse pregnancy outcomes.

Methods: We performed a post hoc analysis using data from the Vitamin D And Lifestyle Intervention for gestational diabetes prevention (DALI) trial conducted across nine European countries (2012-2014). In women with a BMI ≥29 kg/m2 , insulin resistance and secretion were estimated from the oral glucose tolerance test values performed before 20 weeks, using homeostatic model assessment of insulin resistance and Stumvoll first-phase indices, respectively. Women with early gestational diabetes, defined by the International Association of Diabetes and Pregnancy Study Groups criteria, were classified into three groups: GDM-R (above-median insulin resistance alone), GDM-S (below-median insulin secretion alone), and GDM-B (combination of both) and the few remaining women were excluded.

Results: Compared with women in the normal glucose tolerance group (n = 651), women in the GDM-R group (n = 143) had higher fasting and post-load glucose values and insulin levels, with a greater risk of having large-for-gestational age babies [adjusted odds ratio 3.30 (95% CI 1.50-7.50)] and caesarean section [adjusted odds ratio 2.30 (95% CI 1.20-4.40)]. Women in the GDM-S (n = 37) and GDM-B (n = 56) groups had comparable pregnancy outcomes with those in the normal glucose tolerance group.

Conclusions: In overweight and obese women with early gestational diabetes, higher degree of insulin resistance alone was more likely to be associated with adverse pregnancy outcomes than lower insulin secretion alone or a combination of both.

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References

REFERENCES

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