Decreased stature in gestational diabetes mellitus

Abstract

Adult height is determined by genetic and acquired factors. It has been reported that middle-aged patients with impaired glucose tolerance or Type II (non-insulin-dependent) diabetes mellitus are short compared with normal control subjects [1,2]. In middle-aged diabetic patients it is, however, difficult to exclude the effect of ageing and long standing metabolic effects on height.There is a lot of evidence that Type II diabetes and gestational diabetes mellitus (GDM) are both manifestations of the same pathophysiological process, which includes insulin resistance and impaired betacell function [3,4]. Gestational diabetes mellitus is a heterogeneous disorder; it is characterised by hyperglycaemia or glucose intolerance with onset or first recognition during pregnancy. This is usually temporary and affects a younger group of people who have completed their skeletal growth and have not yet suffered age-related bone loss [5]. We considered that pregnant women with various degrees of glucose Diabetologia (1998) Summary Short stature has been associated with various degrees of abnormal glucose tolerance in middle-aged people, where the effects of age and metabolic control would be difficult to exclude. We chose to examine body stature in women with gestational diabetes mellitus (GDM), a prediabetic state affecting a young group of people. A sample of 2772 Greek pregnant women, referred for GDM screening was examined. After a 100-g oral glucose tolerance test, 1787 women were classified as normal (N), 300 women were found with one abnormal glucose value (OAV) and 685 women with GDM. Basal insulin resistance was calculated in 640 women by homeostasis model assessment. In addition, 51 pregnant women with pre-existing Type II (non-insulin-dependent) diabetes mellitus and 109 with pre-existing Type I (insulin-dependent) diabetes mellitus were included in the study. There was a gradual decrease in mean height (cm) as glucose intolerance became more severe: N: 161.0 ± 6.2, OAV:160.2 ± 6.1, GDM:158.7 ± 6.3, Type II diabetes 158.2 ± 7.0 (p < 0.001, analysis of variance]. Height in Type I diabetes (160.1 ± 5.9) did not differ from the normal group. The difference in height between the normal and GDM groups remained (p < 0.001) when body weight, age, birth before or after 1960 and educational status were also taken into account. An independent correlation was also found between height and insulin resistance (n = 640) adjusted for the above mentioned variables. In conclusion, short stature appears to be associated with glucose intolerance as an independent variable, even when this intolerance is both mild and temporary. The previously unrecognised independent association of stature with basal insulin resistance merits further investigation. [Diabetologia (1998) 41: 997± 1001]

Non classical risk factors for gestational diabetes mellitus: a systematic review of the literature

“…Although publication bias cannot be ruled out, the challenge in including short stature as a risk factor for gestational diabetes mellitus seems to be the definition of the cut-off point for this variable. In Brazil, based on the Brazilian Gestational Diabetes Study (EBDG), the study of Branchtein et al 27 defined it as ≤ 151cm, however studies in other countries observed associations using different height categories 21,25,26,29,33 .…”

“…The association remained regardless of age, weight and pre-pregnancy BMI, family history of diabetes mellitus, parity and weight gain during pregnancy. Anastasiou et al 26 , evaluating a cohort of pregnant Greek women referred to a service for screening of diabetes, found that the mean height among pregnant women with gestational diabetes mellitus was significantly lower than among those without gestational diabetes mellitus. Such findings remained true even after stratification by weight, maternal schooling and cohort effect.…”

Sex differences in glucose levels: a consequence of physiology or methodological convenience? The Inter99 study

“…This notion is supported by the observation of a higher risk of developing type 2 diabetes in men than in women with i-IGT [7], indicating that women with i-IGT may be healthier than their male counterparts. Moreover, women are more commonly diagnosed with diabetes on the basis of 2 h post-OGTT plasma glucose (2hPG) levels compared with fasting plasma glucose (FPG) levels [8], and the risk of gestational diabetes is higher in shorter compared with taller women [9].…”

Marcadores para o diagnóstico e tratamento de 924 gestações com diabetes melito gestacional

“…Os principais fatores reconhecidos até o momento são: história familiar de diabetes em familiar de primeiro grau, obesidade, idade superior a 25 anos, hipertensão arterial sistê-mica, mau passado obstétrico (antecedentes obstétricos de morte fetal ou neonatal, história de macrossomia fetal ou diabetes gestacional prévios, abortos de repetição e malformações congênitas fetais) e macrossomia, polidrâmnio, doença hipertensiva específica da gestação (DHEG) ou ganho de peso excessivo na gestação em curso (5). Mais recentemente, a baixa estatura da gestante (≤ 151 cm) e a síndrome dos ovários policísticos (SOP) também foram descritas como fatores de risco para DMG (6,7).…”