Life-course weight characteristics and the risk of gestational diabetes

Epidemiology Branch, Division of Epidemiology, Statistics, and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6100 Executive Blvd, 7B03, Bethesda, MD 20892, USA.
Diabetologia (Impact Factor: 6.67). 04/2010; 53(4):668-78. DOI: 10.1007/s00125-009-1634-y
Source: PubMed

ABSTRACT We prospectively determined the risk of gestational diabetes mellitus in association with life-course weight characteristics and adult abdominal adiposity.
We investigated the joint and independent impact of birthweight, childhood size by somatotypes, adolescent and adult BMI, and abdominal adiposity on gestational diabetes mellitus risk among the 21,647 women in the Nurses' Health Study II who reported a singleton pregnancy between 1989 and 2001. A total of 1,386 incident cases of gestational diabetes mellitus were reported. Relative risk was estimated by pooled logistic regression adjusting for age, prematurity, race, smoking status, parental history of diabetes, age of first birth, parity and physical activity.
Birthweight was inversely associated with gestational diabetes mellitus risk (p = 0.02 for trend). Childhood somatotypes at ages 5 and 10 years were not associated with risk. U-shaped associations were found for BMI at age 18 years and somatotype at age 20 years. Weight gain between adolescence and adulthood, pre-gravid BMI and abdominal adiposity were positively associated with risk (p < 0.01 for all trends). Multivariate adjusted RRs for gestational diabetes from lowest to highest quintile of WHR were 1.00, 1.50, 1.51, 2.03, 2.12 (p = 0.0003 for trend). Lower birthweight (<7 lb) without adulthood overweight (BMI > 25 kg/m(2)) was associated with a 20% increased risk (95% CI 1.02-1.41). However, adulthood overweight alone was related to a 2.36 times greater risk (95% CI 2.12-3.77).
Although lower birthweight is an independent risk factor for gestational diabetes mellitus, weight gain since early adulthood, and overall and central obesity in adulthood were more strongly associated with elevated risk of the condition independently of other known risk factors.

Download full-text


Available from: Germaine M. Buck Louis, Dec 30, 2013
16 Reads
  • Source
    • "Additional adjustment for income and year of birth was done in a sensitivity analysis. BMI is a known risk factor for hypertension, T2DM, and GDM (Li et al. 2007; Vazquez et al. 2007; Yeung et al. 2010); therefore we present the adjusted ORs before and after including BMI in the models. All analyses were done using Stata (release 10.1; StataCorp, College Station, TX, USA). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Environmental factors influencing the developmental origins of health and disease need to be identified and investigated. In utero exposure to tobacco smoke has been associated with obesity and a small increase in blood pressure in children; however, whether there is a corresponding increased risk of conditions such as diabetes and hypertension during adulthood remains unclear. Our goal was to assess the association of self-reported in utero exposure to tobacco smoke with the prevalence of obesity, hypertension, type 2 diabetes mellitus (T2DM), and gestational diabetes mellitus (GDM) in women 14-47 years of age. We conducted a cross-sectional analysis of the Norwegian Mother and Child Cohort Study, which enrolled pregnant women in Norway from 1999 thorough 2008. Exposure to tobacco smoke in utero (yes vs. no) was ascertained on the baseline questionnaire (obtained at ~ 17 weeks' gestation); the outcomes were ascertained from the Medical Birth Registry of Norway and the questionnaire. Our analysis included 74,023 women. Women exposed to tobacco smoke in utero had 1.53 times the odds of obesity [95% confidence interval (CI): 1.45, 1.61] relative to those unexposed, after adjusting for age, education, and personal smoking. After further adjustment for body mass index, the odds ratio for hypertension was 1.68 (95% CI: 1.19, 2.39); for T2DM 1.14 (95% CI: 0.79, 1.65); and for GDM 1.32 (95% CI: 1.10, 1.58) among exposed compared with unexposed. Exposure to tobacco smoke in utero was associated with obesity, hypertension, and GDM in adult women. The possibility that the associations were attributable to unmeasured confounding cannot be excluded.
    Environmental Health Perspectives 11/2011; 120(3):355-60. DOI:10.1289/ehp.1103789 · 7.98 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: We present here an approach we used for proving important properties of clopen topological spaces. We combine powerful theorem provers techniques (and implementations) with a graphical technique based on a graphical representation of a rough set, called rough diagrams. Rough diagrams are a generalization of a classical notion of Venn Diagrams for algebra of sets to clopen topological spaces. We use them as a powerful automated technique of constructing counter-models of properties the prover has a hard time proving and the user might suspect of being false. It means we propose to add a visual tool to a prover that after some fixed number of prover deductions would start constructing a visual counter-model for a property the prover is trying to prove. A prover with the visual tool is called a visual prover. The visual prover has a completeness property: for any rough set equality we can construct its proof or its counter-model
    Fuzzy Information Processing Society, 1999. NAFIPS. 18th International Conference of the North American; 08/1999
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The metabolic syndrome (MS) is a set of five cardiovascular and metabolic risk factors: elevated waist circumference, fasting plasma glucose, triglycerides and blood pressure; and reduced HDL-cholesterol. The prevalence of the MS is rising worldwide, and is linked to two diagnoses in young women: polycystic ovary syndrome (PCOS) and gestational diabetes mellitus (GDM). This narrative review focuses on hormonal contraceptive choices available for women in Europe with features of the MS. The levonorgestrel-intrauterine system and progestogen-only pills containing desogestrel or levonorgestrel have no significant effects on MS parameters. Combined oestrogen-progestogen methods do not appear to increase waist circumference or the incidence of glucose intolerance in women with PCOS or a history of GDM; their effect on HDL-cholesterol and triglycerides is comparable with that observed in women without the MS, while the effect on blood pressure remains inconclusive. The etonogestrel implant does not affect body weight, triglycerides and blood pressure but mildly reduces insulin sensitivity and HDL-cholesterol in healthy women. Depot medroxyprogesterone acetate increases body weight and truncal fat deposition, and lowers glucose tolerance in women with previous GDM. Low-dose hormonal contraception is safe for many women with the MS, but high-dose progestogens must be avoided.
    The European Journal of Contraception and Reproductive Health Care 10/2010; 15(5):305-13. DOI:10.3109/13625187.2010.502583 · 1.39 Impact Factor
Show more