Short stature in Korean women: a contribution to the multifactorial predisposition to gestational diabetes mellitus

Abstract

Gestational diabetes mellitus (GDM), which is defined as carbohydrate intolerance of variable severity with onset or first recognition during the present pregnancy [1], is associated with adverse outcomes of pregnancy including macrosomia, birth trauma and metabolic complications of the newborn [2±4]. Although most women with GDM have a normal glucose tolerance when tested several weeks postpartum, impairment of insulin secretory capacity or increased insulin resistance or both have been reported in these women [5,6], and a substantial proportion of the women with previous GDM will eventually develop Type II diabetes mellitus [7±9]. The reported prevalence of GDM has ranged widely from less than 1 % to more than 10 % [10]. To some extent, this wide variation is thought to reflect a lack of a standardization of screening test procedures and diagnostic criteria of GDM. However, it may also be attributed to the heterogeneous nature of GDM with respect to ethnic or racial influence or both, genetic factors, admixture Diabetologia (1998) Summary We examined the associations between demographic characteristics including short stature and the prevalence of gestational diabetes mellitus (GDM) in Korean women. In this study, a total of 9005 pregnant women underwent universal screening for GDM. Oral glucose tolerance tests (100 g OGTT) were performed in positive screenees (1 h plasma glucose ³ 7.2 mmol/l) and GDM was diagnosed using National Diabetes Data Group criteria. Women with GDM were older and heavier than those with a positive screen and normal OGTT, as well as those with a negative screen. However, height of women with GDM was significantly shorter than those with a positive screen and normal OGTT, and a negative screen. When the study subjects were stratified according to height quartiles, the plasma glucose at the screening test decreased as height increased. Furthermore, the prevalence of GDM was highest in the shortest quartile ( £ 157 cm) group; the odds ratio for GDM was two times greater compared with the highest quartile ( ³ 163 cm) group, even after controlling for age and body mass index (BMI). In addition, multiple logistic regression analysis revealed that greater prepregnancy BMI, age, weight gain, a parental history of diabetes mellitus, and shorter maternal height were directly and independently associated with the prevalence of GDM. We have found that short stature is an independent risk factor for GDM in the racially homogenous population of Seoul, Korea. It is suggested that this propensity may be conveyed primarily by environmental influences. However, genetic factors may also modify the response to the environmental insult. Our findings also emphasize the heterogeneity of factors which predispose to GDM. [Diabetologia (1998) 41: 778±783]

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 .…”

“…Jang et al 25 1998 and Di Cianni et al 33 2003 found greater ratio of women with gestational diabetes mellitus in the group with parity ≥ 2, in comparison to primiparas. After controlling for age, pre-pregnancy BMI, height, family history of diabetes mellitus and weight gain during pregnancy, both results were non statistically significant.…”

“…Jang et al 25 , in 1998, studying a cohort of Korean women, found that the height of pregnant women, divided into quartiles, was inversely associated with the gestational diabetes mellitus diagnosis. The association remained regardless of age, weight and pre-pregnancy BMI, family history of diabetes mellitus, parity and weight gain during pregnancy.…”

“…The authors showed that high concentrations of insulin were associated with a greater increase and retention of weight post-partum. Later, studies by Jang et al 25 , in 1998, Yang et al 29 , 2002 and Saldana et al 60 , 2006 controlling for age, weight and pre-pregnancy BMI, height, family history of diabetes mellitus and parity, have shown a significant association between weight gain and gestational diabetes mellitus, some studies have also adjusted for smoking habits and alcohol use.…”

Excessive gestational weight gain prior to glucose screening and the risk of gestational diabetes: a meta-analysis

“…Unfortunately, two authors could not provide the requested information, so these studies could not be included in the meta-analysis [20,21]. If papers reported associations between GWG and GDM but did not use IOM criteria for GWG, then the authors were contacted and asked to rerun their analysis [16,17,[22][23][24][25][26][27][28][29][30][31]. Additional analyses were provided by two authors [17,22].…”