A 20-Year Prospective Study of Childbearing and Incidence of Diabetes in Young Women, Controlling for Glycemia Before Conception

Abstract

OBJECTIVE-We sought to determine whether childbearing increases incidence of type 2 diabetes after accounting for preconception glycemia and gestational glucose intolerance. RESEARCH DESIGN AND METHODS-A prospective, biracial cohort was examined up to five times during in the multicenter, U.S. population-based Coronary Artery Risk Development in Young Adults Study. The analysis included 2,408 women (1,226 black and 1,182 white) aged 18 -30 years who were free of diabetes and had a fasting plasma glucose (FPG) Ͻ126 mg/dl at baseline. Incident diabetes was diagnosed by self-report, diabetes medication use, FPG Ն126 mg/dl, and/or plasma glucose Ն200 mg/dl after a 2-h oral glucose load. Time-dependent interim birth groups were those with zero and those with one or more births with or without gestational diabetes mellitus (GDM), stratified by baseline parity. Complementary log-log models estimated relative hazards of incident diabetes by interim births adjusted for age, race, family history of diabetes, and baseline covariates (FPG, BMI, education, smoking, and physical activity). RESULTS-Of 193 incident diabetes cases in 42,782 personyears (4.5 cases/1,000 person-years), 84 (44%) had one or more interim births. Among nulliparas at baseline, incident rates per 1,000 person-years were 3.2 (95% CI 2.4 -4.1) for those with no births, 2.9 (1.8 -3.9) for one or more births without GDM, and 18.4 (10.9 -25.9) for one or more births with GDM; adjusted relative hazards (95% CI) were 0.9 (0.6 -1.4) for one or more births without GDM and 3.8 (2.2-6.6) for one or more births with GDM versus no births.CONCLUSIONS-Childbearing did not elevate diabetes incidence among those with normal glucose tolerance during pregnancy (without GDM). GDM conferred the highest risk of developing diabetes independent of family history of diabetes and preconception glycemia and obesity. Diabetes 56: [2990][2991][2992][2993][2994][2995][2996] 2007 E vidence that childbearing is associated with future development of type 2 diabetes in women remains conflicting (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). Both nulliparity and multiparity have been associated with higher fasting glucose and insulin levels independent of body size among nondiabetic women (6 -8,13,14). In early crosssectional and retrospective studies, grand multiparity (five or more births) was associated with higher rates of diabetes in women aged Ͼ45 years, unadjusted for age, body size, or socioeconomic status (1,2). In later population-based cross-sectional studies controlling for age, obesity, and socioeconomic status, the association between lifetime parity and prevalent diabetes was direct in three (9 -11) and null in three (3,4,6). Two studies of indigenous groups with high rates of type 2 diabetes reported inverse associations (8,12). In a prospective study of 113,000 white women aged 30 -55 years, the direct association between lifetime parity and incidence of self-reported diabetes was abolished after adjustment for age and obesity, with minimal confounding by family history of...

640 Prevalence of Gestational Diabetes and Associated Maternal and Neonatal Complications in a Fast Developing Community: Global Comparisons

“…Women with GDM were at increased risk of developing pregnancy-induced hypertension (19.1%), pre-eclampsia (7.3%), antepartum hemorrhage (19.2%), preterm labor (19.8%), premature rupture of membrane (15.3%), and have cesarean section (27.9%) than those with a normal glucose tolerance. Similar results have been reported in previous studies 28,29 that pregnancy-induced hypertension (17.9%) and cesarean session (17.1%) were higher in women with GDM than in those with normal glucose. Another study also indicated similar maternal complications among GDM women in China.…”

Descriptive Study of Gestational Diabetes Mellitus and Its Outcome in a Central Indian Hospital

“…Similar results have been found by different studies that PIH (17.9%) and rates of caesarean section (17.1%) were higher in women with GDM. [14][15] Another study in China also indicated similar rate of complications in GDM mothers. Increased rates of caesarean section may also be due to increased rate of foetal distress in GDM mothers.…”

9. Microvascular Complications and Foot Care

“…In addition, rapid implementation of tight glycemic control in the setting of retinopathy is associated with worsening of retinopathy (34). Women who develop gestational diabetes mellitus do not require an eye examination during pregnancy and do not appear to be at increased risk of developing diabetic retinopathy during pregnancy (41).…”