J Immanuel1, D Simmons1,2, J Harreiter3, G Desoye4, R Corcoy5,6,7, J M Adelantado5, R Devlieger8,9, A Lapolla10, M G Dalfra10, A Bertolotto11, E Wender-Ozegowska12, A Zawiejska12, F P Dunne13, P Damm14,15, E R Mathiesen14,15, D M Jensen16,17,18, L L T Andersen17,18, D J Hill19,20, J G M Jelsma21, A Kautzky-Willer3,22, S Galjaard8,9,23, F J Snoek24, M N M van Poppel21,25. 1. Macarthur Clinical School, Western Sydney University, Sydney, NSW, Australia. 2. Institute of Metabolic Science, Addenbrookes Hospital, Cambridge, UK. 3. Department of Medicine III, Division of Endocrinology, Gender Medicine Unit, Medical University of Vienna, Vienna, Austria. 4. Department of Obstetrics and Gynecology, Medizinische Universitaet Graz, Graz, Austria. 5. Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain. 6. Institut de Recerca de l´Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. 7. CIBER Bioengineering, Biomaterials and Nanotechnology, Instituto de Salud Carlos III, Madrid, Spain. 8. KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Leuven, Belgium. 9. Gynaecology and Obstetrics, University Hospitals Leuven, Belgium. 10. Universita Degli Studi di Padova, Padua, Italy. 11. Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy. 12. Department of Reproduction, Poznan University of Medical Sciences, Poland. 13. National University of Ireland, Galway, Ireland. 14. Centre for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, Copenhagen, Denmark. 15. Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. 16. Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark. 17. Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark. 18. Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark. 19. Recherche en Santé Lawson SA, St. Gallen, Switzerland. 20. Lawson Health Research Institute, London, Ontario, Canada. 21. Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam. 22. Gender Institute Gars am Kamp, Vienna, Austria. 23. Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands. 24. Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Psychology, Amsterdam, The Netherlands. 25. Institute of Sport Science, University of Graz, Graz, Austria.
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.
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.
Authors: Beenu Bastian; Lisa Gaye Smithers; Warren Davis; Alexia Pape; Monique E Francois Journal: Aust N Z J Obstet Gynaecol Date: 2022-04-01 Impact factor: 1.884