Relationship between the adoption of preventive practices and the metabolic profile of women with prior gestational diabetes mellitus

a Department of Food Science and Nutrition, Laval University, Quebec City, QC G1V 0A6, Canada.
Applied Physiology Nutrition and Metabolism (Impact Factor: 2.34). 12/2012; 37(6):1232-8. DOI: 10.1139/h2012-114
Source: PubMed


Women with prior gestational diabetes mellitus (GDM) are encouraged to adopt healthy lifestyle behaviours to prevent or delay type 2 diabetes. The objective was to examine the association between the adoption of preventive practices and the metabolic profile of women with prior GDM. Analyses included 181 women who had GDM between 2003 and 2010. The preventive practices examined included (i) regular physical activity (≥150 min·week(-1)) assessed with the International Physical Activity Questionnaire; (ii) a healthy diet (score derived from the Alternate Healthy Eating Index and associated with a lower metabolic risk) evaluated from a food frequency questionnaire; and (iii) exclusive breastfeeding (≥6 months). Women were classified according to the number of preventive practices adopted. Waist circumference, weight, and height were measured and body mass index (BMI) was calculated. Fasting insulinemia and glycemia were obtained and Matsuda index for insulin sensitivity was calculated. Nearly one-third of women adopted none of the listed preventive practices. For each increase of 1 preventive practice adopted, women were 30% less likely to have a BMI ≥ 25 kg·m(-2) (odds ratio (OR): 0.70, 95% confidence interval (CI) (0.50-0.98)), they were 34% less likely to have a waist circumference ≥ 88 cm (OR: 0.66, 95%CI (0.47-0.92)) and they were 33% less likely to have a Matsuda index for insulin sensitivity < 9.69 (OR: 0.67, 95%CI (0.48-0.94)). These results suggest that women with prior GDM who adopt the recommended preventive practices in the years following delivery are less likely to have lower insulin sensitivity, less likely to be overweight-obese, and less likely to be characterized by abdominal obesity.

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    ABSTRACT: Objective: Although their risk of type 2 diabetes is markedly increased, women with prior gestational diabetes mellitus (GDM) do not receive appropriate testing following their pregnancy. Identifying a less burdensome testing method might increase postpartum testing rates. Our objective was to examine the adequacy of glycated hemoglobin (A1C) and waist circumference (WC) measurements to detect impaired glucose metabolism among women with prior GDM. Methods: The analysis included 178 women who had GDM between 2003 and 2010. WC and A1C were measured, and a 75g 2h-OGTT was performed. Pre-diabetes was defined as a fasting plasma glucose (FPG) ≥ 5.6 and < 7.0 mmol/L or a 2-hour plasma glucose (2h-PG) ≥ 7.8 and < 11.0 mmol/L, and type 2 diabetes was defined as a FPG ≥ 7.0 mmol/L and/or a 2h-PG ≥ 11.1 mmol/L. Sensitivity and specificity analyses were performed. Results: The mean age of subjects was 36.4 ± 4.8 years, and testing occurred at a mean 3.5 ± 1.9 years following delivery. Combining A1C ≥ 5.7% and WC ≥ 88 cm to detect pre-diabetes had a sensitivity of 76% and specificity of 62%, and to detect type 2 diabetes it had a sensitivity of 91% and specificity of 34%. Compared with women who had A1C and WC within the normal range, women with A1C ≥ 5.7% and WC ≥ 88 cm were more likely to have type 2 diabetes (OR 4.4; 95% CI 2.0 to 9.9). Conclusion: These analyses suggest that the combination of A1C and WC could represent a sensitive test for pre-diabetes and type 2 diabetes in the years following a pregnancy complicated by GDM. Further validation of this testing method is required.
    Journal of obstetrics and gynaecology Canada: JOGC = Journal d'obstetrique et gynecologie du Canada: JOGC 09/2013; 35(9):810-815.
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    ABSTRACT: To examine (i) the prevalence of and associations between breast-feeding initiation and continuation by maternal diabetes status and (ii) the reasons for not initiating and/or continuing breast-feeding by maternal diabetes status. Secondary data analyses of a population-based cross-sectional study were conducting using data from the US Centers for Disease Control and Prevention's Pregnancy Risk Assessment Monitoring System (PRAMS), 2009-2011. Multivariable logistic regression was used to investigate the associations between breast-feeding initiation and continuation by diabetes status. Thirty states and New York City, USA. Mothers of recently live-born infants, selected by birth certificate sampling. Among 72755 women, 8·8 % had gestational diabetes mellitus (GDM) and 1·7 % had pregestational diabetes mellitus (PDM). Breast-feeding initiation was similar among GDM and no diabetes mellitus (NDM) women (80·8 % v. 82·2 %, respectively, P=0·2), but continuation was lower among GDM (65·7 % v. 68·8 %, respectively, P=0·01). PDM women had lower initiation and continuation compared with NDM (78·2 %, P=0·03 and 60·4 %, P<0·01, respectively). In adjusted analyses, current smoking status was a significant effect modifier for initiation, but not for continuation. Differences in breast-feeding initiation and continuation prevalence by maternal diabetes status may reflect differences in prenatal education, indicating the need for increased efforts among PDM women. Additionally, non-smoking women with PDM or GDM would benefit from additional breast-feeding education.
    Public Health Nutrition 05/2014; 18(04):1-9. DOI:10.1017/S1368980014000792 · 2.68 Impact Factor
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    ABSTRACT: Objective Although gestational diabetes mellitus (GDM) is associated with an increased risk of type 2 diabetes mellitus (T2DM) compared to normoglycemic pregnancies, the biochemical pathways underlying the progression of GDM to T2DM are not fully elucidated. The purpose of this exploratory study was to utilize metabolomics with an oral glucose tolerance test (OGTT) to examine the amino acid response in women with prior GDM to determine if a relationship between these metabolites and established risk factors for T2DM exists. Materials/methods Thirty-eight non-pregnant women without diabetes but with prior GDM within the previous 3 years were recruited from a community-based population. A 75 g-OGTT was administered; fasting and 2-h plasma samples were obtained. Metabolite profiles of 23 amino acids or amino acid derivatives were measured with gas chromatography-mass spectrometry. Measures of insulin resistance were derived from the OGTT and risk factors for T2DM were obtained by self-report. Results Twenty-two metabolite levels decreased significantly in response to the OGTT (p < 0.05). The clinical covariates most powerfully associated with metabolite level changes included race, body mass index (BMI), and duration of prior breastfeeding, (mean ± SD of standardized β-coefficients, β = −0.38 ± 0.05, 0.25 ± 0.08, and 0.44 ± 0.03, respectively, all p < 0.05). Notably, a prior history of breastfeeding was associated with the greatest number of metabolite changes. Conclusions Greater change in metabolite levels after a glucose challenge was significantly associated with a longer duration of breastfeeding and higher BMI. Further exploration of these preliminary observations and closer examination of the specific pathways implicated are warranted.
    Journal of Clinical and Translational Endocrinology 06/2014; 1(2):38–43. DOI:10.1016/j.jcte.2014.03.003
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