Camille E Powe1, Catherine Allard2, Marie-Claude Battista2, Myriam Doyon2, Luigi Bouchard2, Jeffrey L Ecker3, Patrice Perron2, Jose C Florez4, Ravi Thadhani5, Marie-France Hivert6. 1. Diabetes Unit, Massachusetts General Hospital, Boston, MA Harvard Medical School, Boston, MA. 2. Université de Sherbrooke, Québec, Canada Centre de Recherché Clinique Étienne-Le Bel of the Centre Hospitalier Universitaire de Sherbrooke, Québec, Canada. 3. Harvard Medical School, Boston, MA Division of Maternal-Fetal Medicine, Massachusetts General Hospital, Boston, MA. 4. Diabetes Unit, Massachusetts General Hospital, Boston, MA Harvard Medical School, Boston, MA Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA. 5. Harvard Medical School, Boston, MA Division of Nephrology, Massachusetts General Hospital, Boston, MA. 6. Diabetes Unit, Massachusetts General Hospital, Boston, MA Harvard Medical School, Boston, MA Université de Sherbrooke, Québec, Canada Centre de Recherché Clinique Étienne-Le Bel of the Centre Hospitalier Universitaire de Sherbrooke, Québec, Canada Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA mhivert@partners.org.
Abstract
OBJECTIVE: To characterize physiologic subtypes of gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS: Insulin sensitivity and secretion were estimated in 809 women at 24-30 weeks' gestation, using oral glucose tolerance test-based indices. In women with GDM (8.3%), defects in insulin sensitivity or secretion were defined below the 25th percentile in women with normal glucose tolerance (NGT). GDM subtypes were defined based on the defect(s) present. RESULTS: Relative to women with NGT, women with predominant insulin sensitivity defects (51% of GDM) had higher BMI and fasting glucose, larger infants (birth weight z score 0.57 [-0.01 to 1.37] vs. 0.03 [-0.53 to 0.52], P = 0.001), and greater risk of GDM-associated adverse outcomes (57.6 vs. 28.2%, P = 0.003); differences were independent of BMI. Women with predominant insulin secretion defects (30% of GDM) had BMI, fasting glucose, infant birth weights, and risk of adverse outcomes similar to those in women with NGT. CONCLUSIONS: Heterogeneity of physiologic processes underlying hyperglycemia exists among women with GDM. GDM with impaired insulin sensitivity confers a greater risk of adverse outcomes.
OBJECTIVE: To characterize physiologic subtypes of gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS: Insulin sensitivity and secretion were estimated in 809 women at 24-30 weeks' gestation, using oral glucose tolerance test-based indices. In women with GDM (8.3%), defects in insulin sensitivity or secretion were defined below the 25th percentile in women with normal glucose tolerance (NGT). GDM subtypes were defined based on the defect(s) present. RESULTS: Relative to women with NGT, women with predominant insulin sensitivity defects (51% of GDM) had higher BMI and fasting glucose, larger infants (birth weight z score 0.57 [-0.01 to 1.37] vs. 0.03 [-0.53 to 0.52], P = 0.001), and greater risk of GDM-associated adverse outcomes (57.6 vs. 28.2%, P = 0.003); differences were independent of BMI. Women with predominant insulin secretion defects (30% of GDM) had BMI, fasting glucose, infant birth weights, and risk of adverse outcomes similar to those in women with NGT. CONCLUSIONS: Heterogeneity of physiologic processes underlying hyperglycemia exists among women with GDM. GDM with impaired insulin sensitivity confers a greater risk of adverse outcomes.
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