Gestational Glucose Tolerance and Maternal Metabolic Profile at 3 Years Postpartum

Department of Nutrition , Harvard University, Cambridge, Massachusetts, United States
Obstetrics and Gynecology (Impact Factor: 5.18). 11/2011; 118(5):1065-73. DOI: 10.1097/AOG.0b013e3182325f5a
Source: PubMed


To estimate the independent effect of gestational impaired glucose tolerance, defined as a single abnormal oral glucose tolerance test value, on metabolic dysfunction at 3 years postpartum.
We used multiple linear regression to measure associations between glucose testing during pregnancy and metabolic markers at 3 years postpartum in Project Viva, a prospective cohort study of maternal and infant health. We compared metabolic measures at 3 years postpartum among four groups: normal glucose challenge test (less than 140 mg/dL, n=461); abnormal glucose challenge test but normal glucose tolerance test (n=39); impaired glucose tolerance (a single abnormal glucose tolerance test value, n=21); and gestational diabetes mellitus (n=16).
Adjusting for age, race, parity, parental history of diabetes, and maternal body mass index at 3 years postpartum, we found women with gestational diabetes mellitus had lower adiponectin (11.2 ng/mL compared with 20.7 ng/mL) and higher homeostatic model assessments of insulin resistance (3.1 compared with 1.3) and waist circumference (91.3 cm compared with 86.2 cm) compared with women with impaired glucose tolerance or normal glucose tolerance. Women in both the impaired glucose tolerance and gestational diabetes mellitus groups had lower high-density lipoprotein (gestational diabetes mellitus 44.7 mg/dL; impaired glucose tolerance 45.4/dL compared with normal glucose tolerance 55.8 mg/dL) and higher triglycerides (gestational diabetes mellitus 136.1 mg/dL; impaired glucose tolerance 140.1 mg/dL compared with normal glucose tolerance 78.3) compared with women in the normal glucose tolerance group. We found the highest values for hemoglobin A1c (gestational diabetes mellitus 5.1%, impaired glucose tolerance 5.3%, normal glucose tolerance 5.1%) and high-sensitivity C-reactive protein (gestational diabetes mellitus 1.4 mg/dL, impaired glucose tolerance 2.2 mg/dL, normal glucose tolerance 1.0 mg/dL) among women with impaired glucose tolerance.
Gestational diabetes mellitus and impaired glucose tolerance during pregnancy are associated with persistent metabolic dysfunction at 3 years postpartum, independent of other clinical risk factors.

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    • "The pathogenesis of GDM is very similar to that of type 2 diabetes (T2D), in which both pancreatic insulin release and chronic insulin resistance have roles. GDM and impaired glucose tolerance during pregnancy are shown to be associated with future metabolic dysfunction and diabetes separate from other clinical risk factors [3]. The GDM patients may also show early markers of vascular disease such as endothelial dysfunction [4] which may make them susceptible to premature atherosclerosis and coronary heart disease. "
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    • "Maternal glucose values from the screening and diagnostic tests were obtained from the KPNC regional laboratory database, which captures all laboratory tests and results performed at the KPNC regional laboratory. Women were classified as having GDM if two or more of the four plasma glucose values obtained during the diagnostic test were abnormal according to the American Diabetes Association criteria (20) used during the study period (plasma glucose thresholds: fasting 5.3 mmol/L [95 mg/dL], 1-h glucose 10.0 mmol/L [180 mg/dL], 2-h glucose 8.6 mmol/L [155 mg/dL], and 3-h glucose 7.8 mmol/L [140 mg/dL]; gestational IGT glucose challenge test ≥140 mg/dL; and OGTT with only one abnormal result) (7). "
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