Risk of development of diabetes mellitus after diagnosis of gestational diabetes

Feig, Denice S.; Zinman, Bernard; Wang, Xuesong; Hux, Janet E.

doi:10.1503/cmaj.080012

Cited by 377 publications

(241 citation statements)

References 37 publications

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“…The women with GDM and their offspring have high risks for type 2 diabetes mellitus and cardiovascular diseases in later life18, 19, 20, 21, 22. The increasing prevalence of overweight/obesity and older age at pregnancy were accompanied by an increasing prevalence of GDM, which was further increased by modifications in the diagnostic criteria23, 24.…”

Section: Discussionmentioning

confidence: 99%

Changes in serum adipocyte fatty acid‐binding protein in women with gestational diabetes mellitus and normal pregnant women during mid‐ and late pregnancy

Zhang

Lü

et al. 2016

J of Diabetes Invest

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Aims/IntroductionTo observe the longitudinal changes in serum adipocyte fatty acid‐binding protein (AFABP), carbohydrate, and lipid metabolism parameters in women with and without gestational diabetes mellitus (GDM) during mid‐ and late pregnancy periods, as well as to identify whether there is any association between AFABP and development of GDM.Materials and MethodsA total of 40 GDM and 240 normal glucose tolerance participants were enrolled at 24–28 weeks and completed the study. The clinical features, serum AFABP, other adipocytokines (leptin, adiponectin, retinol‐binding protein 4), homeostasis model assessment of insulin resistance, and lipid profiles were measured in the second and third trimesters of pregnancy.ResultsCompared with the normal glucose tolerance group, the GDM group showed greater levels of AFABP, leptin and retinol‐binding protein 4; and a decreased level of adiponectin (P < 0.05 or P < 0.01) during mid‐ and late pregnancy periods. Prepregnancy body mass index was the independent factor impacting serum AFABP levels in the second (β = 0.567, P = 0.004) and third trimesters (β = 0.619, P = 0.001). Furthermore, GDM was independently associated with AFABP concentrations in multiple regression analysis in the second and third trimester (all P < 0.01). Serum AFABP, leptin and retinol‐binding protein 4 are risk factors for GDM; adiponectin is a protective factor for GDM (P < 0.05 or P < 0.01).ConclusionsThe GDM group had a higher level of AFABP during mid‐ and late stages of pregnancy; prepregnancy body mass index and GDM were the independent factors with respect to serum AFABP. AFABP might be closely related to obesity, insulin resistance and leptin resistance in pregnancy, and is a major risk factor for GDM.

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Section: Discussionmentioning

confidence: 99%

Changes in serum adipocyte fatty acid‐binding protein in women with gestational diabetes mellitus and normal pregnant women during mid‐ and late pregnancy

Zhang

Lü

et al. 2016

J of Diabetes Invest

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“…We demonstrated that there is significant variation in the RR and absolute risk of developing diabetes after GDM across racial/ethnic groups, where risk is the highest in black women. Another large sample population-based study assessing RR of developing diabetes associated with GDM was based on the Ontario Diabetes Database by Feig et al [13]. The authors reported an adjusted HR of 37.3 (95% CI 35.0, 40.9) associated with GDM.…”

Section: Discussionmentioning

confidence: 99%

Racial and ethnic disparities in diabetes risk after gestational diabetes mellitus

et al. 2011

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Aims/hypothesis To investigate racial/ethnic disparities in diabetes risk after gestational diabetes mellitus (GDM). Methods This is a retrospective cohort study of women enrolled in the Kaiser Permanente Southern California health plan from 1995 to 2009. GDM status was identified on the basis of plasma glucose levels during pregnancy. The incidence of diabetes after the first delivery complicated by GDM before 31 December 2009 (n=12,998) was compared with the experience for women without GDM (n=64,668) matched on maternal age at delivery, race/ethnicity and year of delivery (1:5 ratio). Matched Cox regression was used to compare the RRs of diabetes associated with GDM within and across racial/ethnic groups. Results Compared with the women without GDM, the HRs (95% CI) of diabetes for women after GDM were 6.5 (5.2, 8.0) in non-Hispanic white, 7.7 (6.8, 8.7) in Hispanic, 9.9 (7.5, 13.1) in black and 6.3 (5.0, 7.9) in Asian/Pacific Islanders after adjustment for parity, maternal education, comorbidity and number of outpatient visits before the index pregnancy. The HR of diabetes for black women was significantly higher than that for non-Hispanic white women (p=0.032). Further adjustment for prepregnancy BMI reduced the diabetes risk association with GDM for each racial/ethnic group, but did not explain the risk differences across groups. Conclusions/interpretations Racial/ethnic disparities exist in risk of diabetes after GDM. Black women with GDM had the highest risk of developing diabetes. This highlights the importance of developing an effective diabetes screening and prevention programme in women with GDM, particularly black women with GDM.

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“…The diagnosis of gestational diabetes mellitus (GDM) identifies a population of young women at high risk of subsequently developing type 2 diabetes [1,2]. As such, it is not surprising that detailed postpartum evaluation of women with a history of GDM typically reveals subtle metabolic defects, including the pathological hallmarks of type 2 diabetes: chronic insulin resistance and beta cell dysfunction [1].…”

Section: Introductionmentioning

confidence: 99%

Low adiponectin concentration during pregnancy predicts postpartum insulin resistance, beta cell dysfunction and fasting glycaemia

Retnakaran

Qi²,

Connelly

et al. 2009

Diabetologia

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Aims/hypothesis The postpartum phase following gestational diabetes (GDM) is characterised by subtle metabolic defects, including the beta cell dysfunction that is believed to mediate the increased future risk of type 2 diabetes in this patient population. Low circulating levels of adiponectin and increased leptin and C-reactive protein (CRP) have recently emerged as novel diabetic risk factors, although their relevance to GDM and subsequent diabetes has not been characterised. Thus, we sought to determine whether adiponectin, leptin and CRP levels during pregnancy relate to the postpartum metabolic defects linking GDM with type 2 diabetes.Methods Metabolic characterisation, including oral glucose tolerance testing, was undertaken in 487 women during pregnancy and at 3 months postpartum. Based on the antepartum OGTT, there were 137 women with GDM, 91 with gestational impaired glucose tolerance and 259 with normal glucose tolerance. Results Adiponectin levels were lowest (p<0.0001) and CRP levels highest (p=0.0008) in women with GDM. Leptin did not differ between the glucose tolerance groups (p = 0.4483). Adiponectin (r = 0.41, p < 0.0001), leptin (r= −0.36, p <0.0001) and CRP (r = −0.30, p < 0.0001) during pregnancy were all associated with postpartum insulin sensitivity (determined using the insulin sensitivity index of Matsuda and DeFronzo [IS OGTT ]). Intriguingly, adiponectin levels were also related to postpartum beta cell function (insulinogenic index/HOMA of insulin resistance; r=0.16, p=0.0009). Indeed, on multiple linear regression analyses, adiponectin levels during pregnancy independently predicted both postpartum insulin sensitivity (t=3.97, p<0.0001) and beta cell function (t=2.37, p=0.0181), even after adjustment for GDM. Furthermore, adiponectin emerged as a significant negative independent determinant of postpartum fasting glucose (t=−3.01, p=0.0027). Conclusions/interpretation Hypoadiponectinaemia during pregnancy predicts postpartum insulin resistance, beta cell dysfunction and fasting glycaemia, and hence may be relevant to the pathophysiology relating GDM with type 2 diabetes.

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Risk of development of diabetes mellitus after diagnosis of gestational diabetes

Cited by 377 publications

References 37 publications

Changes in serum adipocyte fatty acid‐binding protein in women with gestational diabetes mellitus and normal pregnant women during mid‐ and late pregnancy

Changes in serum adipocyte fatty acid‐binding protein in women with gestational diabetes mellitus and normal pregnant women during mid‐ and late pregnancy

Racial and ethnic disparities in diabetes risk after gestational diabetes mellitus

Low adiponectin concentration during pregnancy predicts postpartum insulin resistance, beta cell dysfunction and fasting glycaemia

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