A Prospective Study of Pregravid Determinants of Gestational Diabetes Mellitus

Department of Nutrition , Harvard University, Cambridge, Massachusetts, United States
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 10/1997; 278(13):1078-83. DOI: 10.1001/jama.278.13.1078
Source: PubMed


Gestational diabetes mellitus (GDM) affects 3% to 5% of pregnancies. Knowledge of risk factors for GDM is needed to identify possible preventive strategies.
To assess whether recognized determinants of noninsulin-dependent diabetes mellitus also may be markers for increased risk of GDM.
Prospective cohort study.
The Nurses' Health Study II, which involves female US nurses aged 25 to 42 years at entry.
The analyses included 14613 women without previous GDM or other known diabetes who reported a singleton pregnancy between 1990 and 1994. Of these women, 722 (4.9%) reported a new diagnosis of GDM.
Self-report of GDM, validated by medical record review in a subset.
In multivariate analyses including age, pregravid body mass index (BMI), and other GDM risk factors, the risk for GDM increased significantly with increasing maternal age (P for trend, <.01) and family history of diabetes mellitus (relative risk, 1.68; 95% confidence interval [CI], 1.39-2.04). Relative risks for GDM were 2.13 (95% CI, 1.65-2.74) for pregravid BMI of 25 to 29.9 kg/m2 and 2.90 (95% CI, 2.15-3.91) for BMI of 30 kg/m2 or more (vs BMI of <20 kg/m2). Risk for GDM increased with greater weight gain in early adulthood, and it also increased among nonwhite women. Pregravid current smokers had a relative risk for GDM of 1.43 (95% CI, 1.14-1.80), and pregravid vigorous exercise was associated with a nonsignificant reduction in GDM risk.
Advanced maternal age, family history of diabetes mellitus, nonwhite ethnicity, higher BMI, weight gain in early adulthood, and cigarette smoking predict increased GDM risk. These observations may facilitate the identification of women at particular risk for GDM and suggest potential strategies for reducing this risk even before a woman becomes pregnant, such as avoiding substantial weight gain and smoking.

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    • "The study population included offspring of participants in NHS II, a prospective cohort of 116,430 US female nurses aged 25-43 when recruited in 1989, followed biennially (Solomon et al. 1997). NHS II participants originally were recruited from 14 states in all regions of the continental US, but they now reside in all 50 states. "
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    ABSTRACT: Autism spectrum disorder (ASD) is a developmental disorder with increasing prevalence worldwide, yet with unclear etiology. To explore the association between maternal exposure to particulate matter (PM) air pollution and odds of ASD in her child. We conducted a nested case-control study of participants in the Nurses' Health Study II (NHS II), a prospective cohort of 116,430 US female nurses recruited in 1989, followed by biennial mailed questionnaires. Subjects were NHS II participants' children born 1990-2002 with ASD (n=245), and children without ASD (n=1522) randomly selected using frequency matching for birth years. ASD was based on maternal report, which was validated against the Autism Diagnostic Interview-Revised in a subset. Monthly averages of PM with diameters ≤2.5 µm (PM2.5) and 2.5-10 µm (PM10-2.5) were predicted from a spatiotemporal model for the continental US and linked to residential addresses. PM2.5 exposure during pregnancy was associated with increased odds of ASD, with an adjusted odds ratio (OR) for ASD per interquartile range higher PM2.5 (4.42 µg/m(3)) of 1.57 (95% CI: 1.22, 2.03) among women with the same address before and after pregnancy (160 cases, 986 controls). Associations with PM2.5 exposure 9 months before or after the pregnancy were weaker in independent models and null when all three time periods were included, while the association with the 9 months of pregnancy remained (OR=1.63; 95% CI: 1.08-2.47). The association between ASD and PM2.5 was stronger for exposure during the third trimester (OR=1.42 per inter-quartile range increase in PM2.5, 95% CI: 1.09, 1.86) than other trimesters (ORs 1.06 and 1.00) when mutually adjusted. There was little association between PM10-2.5 and ASD. Higher maternal exposure to PM2.5 during pregnancy, in particular the third trimester, was associated with greater odds of her child having ASD.
    Environmental Health Perspectives 12/2014; 123(3). DOI:10.1289/ehp.1408133 · 7.98 Impact Factor
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    • "The worldwide incidence of gestational diabetes mellitus (GDM) is rising [51], and although controversy continues regarding optimal diagnostic thresholds [52], there is clear evidence that its identification and treatment optimise perinatal outcomes [53]. Numerous risk factors for gestational diabetes are well established, including maternal BMI, advancing age, cultural background, history of polycystic ovarian syndrome, and family history of diabetes [54], although some develop impaired glucose tolerance in the absence of any identifiable risk factor. Accurate early prediction of those destined to develop gestational diabetes would allow for the early initiation of measures that may prevent or ameliorate the effects of this condition, such as exercise programs [55] and dietary modifications [56], although further research is required to confirm the specific benefits of these early interventions. "
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    ABSTRACT: Adverse obstetric outcomes, such as preeclampsia, preterm birth, gestational diabetes, and fetal growth restriction, are poorly predicted by maternal history and risk factors alone, especially in nulliparae. The ability to predict these outcomes from the first trimester would allow for the early initiation of prophylactic therapies, institution of an appropriate model and location of care, and recruitment of a truly "high risk" population to clinical trials of interventions to prevent or ameliorate these conditions. To this end, development of adequately sensitive and specific predictive tests for these outcomes has become a significant focus of perinatal research. This paper reviews the biomarkers involved in these multiparametric tests and also outlines the performance of these tests and issues regarding their introduction into clinical practice.
    03/2014; 2014:807196. DOI:10.1155/2014/807196
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    • "This result is consistent with several studies that have reported gestational weight gain, another modifiable exposure during gestation, to be associated with IGT but not GDM (Herring et al. 2009; Saldana et al. 2006; Tovar et al. 2009). Mothers predisposed to eventually develop GDM may enter pregnancy with an array of preexisting risk factors such as greater pregravid weight and family history of diabetes (Solomon et al. 1997) and may develop GDM regardless of additional behavioral or environmental risk factors during pregnancy. Thus, more severe degrees of hyperglycemia may be less sensitive to short-term exposures. "
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    ABSTRACT: Exposure to fine particulate matter (PM2.5) has been linked to type 2 diabetes mellitus, but associations with hyperglycemia in pregnancy have not been well studied. We studied Boston-area pregnant women without known diabetes. We identified impaired glucose tolerance (IGT) and gestational diabetes mellitus (GDM) during pregnancy from clinical glucose tolerance tests at median 28.1 weeks gestation. We used residential addresses to estimate second trimester PM2.5 and black carbon exposure via a central monitoring site and spatiotemporal models. We estimated residential traffic density and roadway proximity as surrogates for exposure to traffic-related air pollution. We performed multinomial logistic regression analyses adjusted for sociodemographic covariates and used multiple imputation to account for missing data. Of 2,093 women, 65 (3%) had IGT and 118 (6%) GDM. Second trimester spatiotemporal exposures ranged from 8.5 to 15.9 μg/m(3) for PM2.5 and from 0.1 to 1.7 μg/m(3) for black carbon. Traffic density was 0-30,860 vehicles/day x length of road (km) within 100 m; 281 (13%) women lived ≤ 200 m from a major road. The prevalence of IGT was elevated in the highest (vs. lowest) quartile of exposure to spatiotemporal PM2.5 (OR 2.63; 95% CI: 1.15, 6.01) and traffic density (OR 2.66; 95% CI: 1.24, 5.71). IGT also was positively associated with other exposure measures, though associations were not statistically significant. No pollutant exposures were positively associated with GDM. Greater exposure to PM2.5 and other traffic-related pollutants during pregnancy was associated with IGT but not GDM. Air pollution may contribute to abnormal glycemia in pregnancy.
    Environmental Health Perspectives 02/2014; 122(4). DOI:10.1289/ehp.1307065 · 7.98 Impact Factor
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