Katrien Benhalima1, Paul Van Crombrugge2, Carolien Moyson3, Johan Verhaeghe4, Sofie Vandeginste5, Hilde Verlaenen5, Chris Vercammen6, Toon Maes6, Els Dufraimont7, Christophe De Block8, Yves Jacquemyn9, Farah Mekahli10, Katrien De Clippel11, Annick Van Den Bruel12, Anne Loccufier13, Annouschka Laenen14, Caro Minschart3, Roland Devlieger4, Chantal Mathieu3. 1. Department of Endocrinology, UZ Gasthuisberg, KU Leuven, Herestraat 49, 3000, Leuven, Belgium. katrien.benhalima@uzleuven.be. 2. Department of Endocrinology, OLV Ziekenhuis Aalst-Asse-Ninove, Aalst, Belgium. 3. Department of Endocrinology, UZ Gasthuisberg, KU Leuven, Herestraat 49, 3000, Leuven, Belgium. 4. Department of Obstetrics & Gynecology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium. 5. Department of Obstetrics & Gynecology, OLV Ziekenhuis Aalst-Asse-Ninove, Aalst, Belgium. 6. Department of Endocrinology, Imelda Ziekenhuis, Bonheiden, Belgium. 7. Department of Obstetrics & Gynecology, Imelda Ziekenhuis, Bonheiden, Belgium. 8. Department of Endocrinology-Diabetology-Metabolism, Antwerp University Hospital, Edegem, Belgium. 9. Department of Obstetrics & Gynecology, Antwerp University Hospital, Edegem, Belgium. 10. Department of Endocrinology, Kliniek St-Jan Brussel, Brussels, Belgium. 11. Department of Obstetrics & Gynecology, Kliniek St-Jan Brussel, Brussels, Belgium. 12. Department of Endocrinology, AZ St-Jan Brugge, Brugge, Belgium. 13. Department of Obstetrics & Gynecology, AZ St-Jan Brugge, Brugge, Belgium. 14. Center of Biostatics and Statistical Bioinformatics, KU Leuven, Leuven, Belgium.
Abstract
AIMS/HYPOTHESIS: This study aimed to determine the characteristics and pregnancy outcomes across different subtypes of gestational diabetes mellitus (GDM) based on insulin resistance. METHODS: GDM subtypes were defined in 1813 pregnant women from a multicentre prospective cohort study, stratified according to insulin resistance, based on Matsuda index below the 50th percentile of women with normal glucose tolerance (NGT), during a 75 g OGTT at 24-28 weeks' gestation. GDM was diagnosed in 12.4% (n = 228) of all participants based on the 2013 WHO criteria. RESULTS: Compared with women with NGT (1113 [61.4%] of the total cohort) and insulin-sensitive women with GDM (39 [17.1%] women with GDM), women with GDM and high insulin resistance (189 [82.9%] women with GDM) had a significantly higher BMI, systolic BP, fasting plasma glucose (FPG), fasting total cholesterol, LDL-cholesterol and triacylglycerol levels in early pregnancy. Compared with women with NGT, insulin-sensitive women with GDM had a significantly lower BMI but similar BP, FPG and fasting lipid levels in early pregnancy. Compared with women with NGT, women with GDM and high insulin resistance had higher rates of preterm delivery (8.5% vs 4.7%, p = 0.030), labour induction (42.7% vs 28.1%, p < 0.001), Caesarean section (total Caesarean sections: 28.7% vs 19.4%, p = 0.004; emergency Caesarean sections: 16.0% vs 9.7%, p = 0.010), neonatal hypoglycaemia (15.4% vs 3.5%, p < 0.001) and neonatal intensive care unit admissions (16.0% vs 8.9%, p = 0.003). In multivariable logistic regression analyses using different models to adjust for demographics, BMI, FPG, HbA1c, lipid levels and gestational weight gain in early pregnancy, preterm delivery (OR 2.41 [95% CI 1.08, 5.38]) and neonatal hypoglycaemia (OR 4.86 [95% CI 2.04, 11.53]) remained significantly higher in women with GDM and high insulin resistance compared with women with NGT. Insulin-sensitive women with GDM had similar pregnancy outcomes as women with NGT. The need for insulin treatment during pregnancy and the rate of glucose intolerance in the early postpartum period were not significantly different among the GDM subtypes. CONCLUSIONS/ INTERPRETATION: GDM with high insulin resistance represents a more adverse metabolic profile with a greater risk of adverse pregnancy outcomes.
AIMS/HYPOTHESIS: This study aimed to determine the characteristics and pregnancy outcomes across different subtypes of gestational diabetes mellitus (GDM) based on insulin resistance. METHODS: GDM subtypes were defined in 1813 pregnant women from a multicentre prospective cohort study, stratified according to insulin resistance, based on Matsuda index below the 50th percentile of women with normal glucose tolerance (NGT), during a 75 g OGTT at 24-28 weeks' gestation. GDM was diagnosed in 12.4% (n = 228) of all participants based on the 2013 WHO criteria. RESULTS: Compared with women with NGT (1113 [61.4%] of the total cohort) and insulin-sensitive women with GDM (39 [17.1%] women with GDM), women with GDM and high insulin resistance (189 [82.9%] women with GDM) had a significantly higher BMI, systolic BP, fasting plasma glucose (FPG), fasting total cholesterol, LDL-cholesterol and triacylglycerol levels in early pregnancy. Compared with women with NGT, insulin-sensitive women with GDM had a significantly lower BMI but similar BP, FPG and fasting lipid levels in early pregnancy. Compared with women with NGT, women with GDM and high insulin resistance had higher rates of preterm delivery (8.5% vs 4.7%, p = 0.030), labour induction (42.7% vs 28.1%, p < 0.001), Caesarean section (total Caesarean sections: 28.7% vs 19.4%, p = 0.004; emergency Caesarean sections: 16.0% vs 9.7%, p = 0.010), neonatal hypoglycaemia (15.4% vs 3.5%, p < 0.001) and neonatal intensive care unit admissions (16.0% vs 8.9%, p = 0.003). In multivariable logistic regression analyses using different models to adjust for demographics, BMI, FPG, HbA1c, lipid levels and gestational weight gain in early pregnancy, preterm delivery (OR 2.41 [95% CI 1.08, 5.38]) and neonatal hypoglycaemia (OR 4.86 [95% CI 2.04, 11.53]) remained significantly higher in women with GDM and high insulin resistance compared with women with NGT. Insulin-sensitive women with GDM had similar pregnancy outcomes as women with NGT. The need for insulin treatment during pregnancy and the rate of glucose intolerance in the early postpartum period were not significantly different among the GDM subtypes. CONCLUSIONS/ INTERPRETATION: GDM with high insulin resistance represents a more adverse metabolic profile with a greater risk of adverse pregnancy outcomes.
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