A simple scoring method using cardiometabolic risk measurements in pregnancy to determine 10-year risk of type 2 diabetes in women with gestational diabetes

Abstract

Objective:To examine if clustering of cardiometabolic risk factors in pregnancy predicts type 2 diabetes and cardiovascular disease (CVD) risk at 10 years in women with gestational diabetes mellitus (GDM).Study design and subjects:A prospective case–control study in 150 GDM and 72 overweight women with normal glucose tolerance (NGT) measured cardiometabolic risk factors (body mass index (BMI), systolic blood pressure (SBP), fasting glucose, insulin, and triglycerides and high-density lipoprotein (HDL) cholesterol) at 28 weeks gestation and 6 months and 10 years after pregnancy. Cluster analysis of cardiometabolic risk factors in pregnancy was used to stratify GDM as ‘high' and ‘low risk' for diabetes and CVD risk at 10 years. The data in pregnancy were used to determine a simple method for assessing risk of future diabetes.Results:BMI in the 150 GDM at study entry was similar to NGT, but 35% of GDM fell into a ‘high-risk cluster' with elevated BMI, SBP, glucose, insulin and triglycerides and lower HDL levels. At 10 years, type 2 diabetes was sixfold higher in ‘high-risk' GDM (odds ratio (OR)=6.75, confidence interval (CI)=2.0, 22.7, P=0.002) compared with ‘low-risk' GDM and was not reported in NGT. The ‘high-risk' cluster predicted type 2 diabetes better than BMI>30 (OR=2.13, CI=0.71, 6.4, P=0.179) or fasting glucose >5.5 mmol l–1, (OR=4.56, CI=1.50, 13.85, P=0.007). We determined that GDM with any four of the cardiometabolic risk factors (BMI>30 kg m–2, fasting glucose>5.0 mmol l–1, insulin>7.8 mU l–1, triglycerides >2.4 mmol l–1, HDL<1.6 mmol l–1 or SBP>105 mm Hg) in pregnancy would be in a ‘high-risk' cluster.Conclusions:A metabolic syndrome-like cluster in pregnant GDM identifies risk for type 2 diabetes providing an opportunity to focus on rigorous lifestyle interventions after delivery to reduce the burden of disease attributed to this condition.

The prediction of type 2 diabetes in women with previous gestational diabetes mellitus using lipidomics

“…Similarly, in this study, total cholesteryl ester and several cholesteryl ester lipid species were positively associated with the development of type 2 diabetes. Although no other studies have profiled cholesteryl esters as predictors of diabetes in women with previous GDM, a prospective case-control study identified 35% of women with GDM as 'high-risk' for the development of diabetes 10 years after diagnosis based on cardiometabolic risk measurements in pregnancy that included LDL and HDL [28]. Interestingly, our previous studies in two populationbased cohorts also found that CE 20:4 was associated with the development of type 2 diabetes.…”

Postpartum glucose tolerance status 6 to 12 weeks after gestational diabetes mellitus: a Brazilian cohort

“…As in our cohort, family history of diabetes, glucose values in the diagnostic test and insulin use in pregnancy were predictors of a nine-fold increase in type 2 diabetes rates 15 years after GDM in an Australian retrospective cohort (11). A "metabolic syndrome-like cluster in pregnancy" with specific thresholds for BMI, insulin triglycerides, HDL-cholesterol and systolic blood pressure measured in GDM women was reported as a good predictor of type 2 diabetes development 10 years after the index pregnancy (29).…”

Metabolic, hormonal characteristics and genetic variants of TCF7L2 associated with development of gestational diabetes mellitus in Mexican women

“…With regards to lipid profile, we found HDL‐cholesterol levels significantly lower in the GDM than in the NGT group. The adverse effects of low HDL cholesterol is shown in other reports that propose this condition as a predictor for the development of diabetes after GDM . Low HDL cholesterol as a risk factor of diabetes seems to be more important in women [].…”