Contribution of gestational diabetes mellitus heterogeneity and prepregnancy body mass index to large‐for‐gestational‐age infants—A retrospective case‐control study

Abstract

Objective To study the associations between heterogeneity of gestational diabetes mellitus (GDM) subtype/prepregnancy body mass index (pre‐BMI) and large‐for‐gestational‐age (LGA) infants of Chinese women. Methods We performed a retrospective case‐control study of 299 women with GDM and 204 women with normal glucose tolerance (NGT), using oral glucose tolerance test‐based indices performed at 24‐25 weeks of gestation. Women with GDM were classified into the following three physiologic subtypes: GDM with a predominant insulin‐secretion defect (GDM‐dysfunction), GDM with a predominant insulin‐sensitivity defect (GDM‐resistance), or GDM with both defects (GDM‐mixed). We then used a binary logistic regression model to evaluate the potential associations of GDM subtypes and pre‐BMI with newborn macrosomia or LGA. Results Women with GDM‐resistance had a higher pre‐BMI (P < 0.001), whereas women in the GDM‐dysfunction and GDM‐mixed groups had pre‐BMIs comparable to the NGT group. In the logistic regression model, women in the GDM‐mixed group exhibited an increased risk of bearing newborns with macrosomia and LGA, and women in the GDM‐dysfunction group tended to have newborns with LGA after adjusting for pre‐BMI and other potential confounders. Women who were overweight or obese prepregnancy manifested an increased risk of having newborns with macrosomia and LGA relative to normal‐weight women, regardless of whether values were unadjusted or adjusted for all potential confounders. There was no significant interaction between GDM subtype and pre‐BMI for any of the studied outcomes. Conclusions Heterogeneity of GDM (GDM‐dysfunction and GDM‐mixed) and prepregnancy overweight/obesity were independently associated with LGA in Chinese women. There was no significant interaction between GDM subtypes and pre‐BMI for LGA.

Risk Factors Screening for Gestational Diabetes Mellitus Heterogeneity in Chinese Pregnant Women: A Case–Control Study

“…The heterogeneity of physiologic hyperglycemia among women with GDM may explain this inconsistency from a new perspective. Our previous research found that GDM women of the three subtypes had different clinical characteristics, 10 and we speculate that the discrepancy of risk factors also existed among the three GDM subtypes.…”

Subtypes of gestational diabetes and future risk of pre-diabetes or diabetes

“…There is currently considerable interest in elucidating the heterogeneity of diabetes, with the recognition that such understanding may enable precision medicine, as recently highlighted in a consensus report from the American Diabetes Association and the European Association for the Study of Diabetes [21]. In this context, the initial report of GDM heterogeneity by Powe et al [4] has led to a series of recent studies evaluating GDM subtypes in relation to pregnancy outcomes [5][6][7][8]. These observational studies have been fairly comparable in the maternal phenotypes identified by their subtypes but less consistent in their obstetrical/neonatal findings [4][5][6][7][8], likely reflecting the confounding effect of the clinical management of GDM on the latter associations and some differences between studies in the diagnostic criteria by which defects in insulin sensitivity and insulin secretion were defined.…”

“…In this context, the initial report of GDM heterogeneity by Powe et al [4] has led to a series of recent studies evaluating GDM subtypes in relation to pregnancy outcomes [5][6][7][8]. These observational studies have been fairly comparable in the maternal phenotypes identified by their subtypes but less consistent in their obstetrical/neonatal findings [4][5][6][7][8], likely reflecting the confounding effect of the clinical management of GDM on the latter associations and some differences between studies in the diagnostic criteria by which defects in insulin sensitivity and insulin secretion were defined. In the current study, the subtypes were defined in precisely the same manner as in the initial report by Powe et al .9%, respectively).…”

“…Indeed, in 2016, Powe and colleagues defined subtypes of GDM in this way (based on the Matsuda index of insulin sensitivity and the Stumvoll 1st phase index of insulin secretion) and reported that women with GDM who had a predominant insulin sensitivity defect had larger neonates and a greater likelihood of adverse pregnancy outcomes (including large-for-gestational-age and Caesarean delivery) than those with a predominant secretion defect [4]. Subsequent reports in other populations have supported the concept of heterogeneity of GDM yielding differential obstetrical/neonatal risks [5][6][7][8], thereby raising the possibility of potentially tailoring the antepartum management of GDM based on the subtype. While all of these studies have focused on pregnancy outcomes, a recurrent question raised in these reports has been whether the elevated future risk of pre-diabetes/diabetes associated with GDM might also vary according to the subtypes [4,5,7,8], If so, such insight could inform the targeting of postpartum surveillance efforts to the subtype(s) of GDM that confer the highest risk of developing type 2 diabetes.…”

Estimation of Glycated Hemoglobin A (HbA1c) at time of Pregnancy Diagnosis as a discriminative Early test for Women vulnerable to develop Gestational Diabetes Mellitus at the 24th Gestational Week

“…In line with these findings, multiple previous studies found women with GDM had higher BMI than women free of GDM [30,31,32] detected reduced risk of GDM with their proposed diet and exercise interventions for pregnant women versus women received no intervention. Recently, Qiu et al, [33] reported that for pre-pregnancy BMI, significant differences were found in GDM incidence between the different groups according to BMI and Wang et al, [34] found women with GDM with a predominant insulin-sensitivity defect had a higher pre-BMI. These findings could be attributed to the fact that plasma concentrations of adipokines, which may contribute directly and/or indirectly for glucose intolerance, are influenced by the amount of adipose tissue present before and/or during the pregnancy [35] .…”