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Patients with gestational diabetes mellitus may be treated in both early and late pregnancy, especially in patients with pre-pregnancy overweight: A cross-sectional study in Japan

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A Correction to this article was published on 18 December 2023

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Abstract

The significance of diagnosing gestational diabetes mellitus (GDM) in early pregnancy is controversial. We used the International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria to investigate whether clinical background and neonatal outcomes differ depending on when GDM is diagnosed in early or late pregnancy. This was a single-center, observational study conducted between November 2012 and March 2020 at St. Marianna University Hospital (Kawasaki, Japan). We compared the background and perinatal outcomes of patients with GDM depending on the time of diagnosis (at < 24 gestational weeks or ≥ 24 weeks). Insulin sensitivity index, homeostasis model assessment of insulin resistance, and β-cell function were calculated from a 75-g oral glucose tolerance test. Stratified analysis was performed by pre-pregnancy BMI in patients with early GDM. As a result, in the 507 patients, 89.9% gave birth at our hospital. The pre-pregnancy BMI was significantly higher in patients with early GDM than in those with late GDM (the median [interquartile range], 22.7 [20.3, 26.3] and 21.5 [19.3, 23.8] kg/m2, respectively; p = 0.001). Perinatal outcomes were not different between the two groups. However, in the subgroup analysis of patients with early GDM, the prevalence of large-for-gestational-age infants was significantly higher in the group with overweight (15.4% vs 2.1%, respectively; p = 0.008). In conclusion, patients with GDM using the IADPSG criteria in early pregnancy may be treated, especially in patients with pre-pregnancy overweight.

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Data availability

Data supporting the results of this study are available from the corresponding author, [Y, N], upon reasonable request.

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References

  1. Coustan DR. Gestational diabetes mellitus. Clin Chem. 2013;59:1310–21.

    Article  PubMed  CAS  Google Scholar 

  2. HAPO Study Cooperative Research Group, Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, Coustan DR, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358:1991–2002.

    Article  Google Scholar 

  3. Wilmot EG, Mansell P. Diabetes and pregnancy. Clin Med (Lond). 2014;14:677–80.

    Article  PubMed  Google Scholar 

  4. McIntyre HD. Discovery, Knowledge, and action-diabetes in pregnancy across the translational spectrum: The 2016 Norbert Freinkel Award Lecture. Diabetes Care. 2018;41:227–32.

    Article  PubMed  CAS  Google Scholar 

  5. Johns EC, Denison FC, Norman JE, Reynolds RM. Gestational diabetes mellitus: mechanisms, treatment, and complications. Trends Endocrinol Metab. 2018;29:743–54.

    Article  PubMed  CAS  Google Scholar 

  6. Murray SR, Reynolds RM. Short- and long-term outcomes of gestational diabetes and its treatment on fetal development. Prenat Diagn. 2020;40:1085–91.

    Article  PubMed  CAS  Google Scholar 

  7. Ngala RA, Fondjo LA, Gmagna P, Ghartey FN, Awe MA. Placental peptides metabolism and maternal factors as predictors of risk of gestational diabetes in pregnant women. A case-control study PLoS One. 2017;12: e0181613.

    Article  PubMed  Google Scholar 

  8. Beck P, Daughaday WH. Human placental lactogen: studies of its acute metabolic effects and disposition in normal man. J Clin Invest. 1967;46:103–10.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  9. Herrera E, Desoye G. Maternal and fetal lipid metabolism under normal and gestational diabetic conditions. Horm Mol Biol Clin Investig. 2016;26:109–27.

    Article  PubMed  CAS  Google Scholar 

  10. Sivan E, Homko CJ, Whittaker PG, Reece EA, Chen X, Boden G. Free fatty acids and insulin resistance during pregnancy. J Clin Endocrinol Metab. 1998;83:2338–42.

    PubMed  CAS  Google Scholar 

  11. Wada T, Hori S, Sugiyama M, Fujisawa E, Nakano T, Tsuneki H, et al. Progesterone inhibits glucose uptake by affecting diverse steps of insulin signaling in 3T3-L1 adipocytes. Am J Physiol Endocrinol Metab. 2010;298:E881–8.

    Article  PubMed  CAS  Google Scholar 

  12. Retnakaran R, Ye C, Kramer CK, Connelly PW, Hanley AJ, Sermer M, et al. Evaluation of circulating determinants of beta-cell function in women with and without gestational diabetes. J Clin Endocrinol Metab. 2016;101:2683–91.

    Article  PubMed  CAS  Google Scholar 

  13. Catalano PM, Tyzbir ED, Wolfe RR, Calles J, Roman NM, Amini SB, et al. Carbohydrate metabolism during pregnancy in control subjects and women with gestational diabetes. Am J Physiol. 1993;264:E60–7.

    PubMed  CAS  Google Scholar 

  14. Plows JF, Stanley JL, Baker PN, Reynolds CM, Vickers MH. The pathophysiology of gestational diabetes mellitus. Int J Mol Sci. 2018;19:3342.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Barbour LA, McCurdy CE, Hernandez TL, Kirwan JP, Catalano PM, Friedman JE. Cellular mechanisms for insulin resistance in normal pregnancy and gestational diabetes. Diabetes Care. 2007;30:S112–9.

    Article  PubMed  CAS  Google Scholar 

  16. Homko C, Sivan E, Chen X, Reece EA, Boden G. Insulin secretion during and after pregnancy in patients with gestational diabetes mellitus. J Clin Endocrinol Metab. 2001;86:568–73.

    PubMed  CAS  Google Scholar 

  17. Ferrara A. Increasing prevalence of gestational diabetes mellitus: a public health perspective. Diabetes Care. 2007;30:S141–6.

    Article  PubMed  Google Scholar 

  18. Coustan DR, Lowe LP, Metzger BE, Dyer AR, International Association of Diabetes and Pregnancy Study Groups. The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study: paving the way for new diagnostic criteria for gestational diabetes mellitus. Am J Obstet Gynecol. 2010;202:654.

    Article  PubMed Central  Google Scholar 

  19. Immanuel J, Simmons D. Screening and treatment for early-onset gestational diabetes mellitus: a systematic review and meta-analysis. Curr Diab Rep. 2017;17:115.

    Article  PubMed  Google Scholar 

  20. Jokelainen M, Stach-Lempinen B, Rönö K, Nenonen A, Kautiainen H, Teramo K, et al. Oral glucose tolerance test results in early pregnancy: A Finnish population-based cohort study. Diabetes Res Clin Pract. 2020;162: 108077.

    Article  PubMed  CAS  Google Scholar 

  21. Nakanishi S, Aoki S, Kasai J, Shindo R, Obata S, Hasegawa Y, et al. High probability of false-positive gestational diabetes mellitus diagnosis during early pregnancy. BMJ Open Diabetes Res Care. 2020;8: e001234.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Hagiwara Y, Kasai J, Nakanishi S, Saigusa Y, Miyagi E, Aoki S. Should the IADPSG criteria be applied when diagnosing early-onset gestational diabetes? Diabetes Res Clin Pract. 2018;140:154–61.

    Article  PubMed  Google Scholar 

  23. Clarke E, Cade TJ, Brennecke S. Early pregnancy screening for women at high-risk of GDM results in reduced neonatal morbidity and similar maternal outcomes to routine screening. J Pregnancy. 2020;2020:9083264.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Yasuda S, Inoue K, Iida S, Oikawa Y, Namba A, Isshiki M, et al. Differences in the birthweight of infants born to patients with early- or mid-to-late-detected gestational diabetes mellitus who underwent guideline-based glycemic control. J Diabetes Complications. 2021;35: 107850.

    Article  PubMed  CAS  Google Scholar 

  25. International Association of Diabetes and Pregnancy Study Groups Consensus Panel, Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P, et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010;33:676–82.

    Article  PubMed Central  Google Scholar 

  26. Committee of the Japan Diabetes Society on the Diagnostic Criteria of Diabetes Mellitus, Seino Y, Nanjo K, Tajima N, Kadowaki T, Kashiwagi A, Araki E, et al. Report of the committee on the classification and diagnostic criteria of diabetes mellitus. J Diabetes Investig. 2010;1:212–28.

    Article  Google Scholar 

  27. Kawanabe S, Nagai Y, Nakamura Y, Nishine A, Nakagawa T, Tanaka Y. Association of the muscle/fat mass ratio with insulin resistance in gestational diabetes mellitus. Endocr J. 2019;66:75–80.

    Article  PubMed  CAS  Google Scholar 

  28. Minakami H, Maeda T, Fujii T, Hamada H, Iitsuka Y, Itakura A, et al. Guidelines for obstetrical practice in Japan: Japan Society of Obstetrics and Gynecology (JSOG) and Japan Association of Obstetricians and Gynecologists (JAOG) 2014 edition. J Obstet Gynaecol Res. 2014;40:1469–99.

    Article  PubMed  Google Scholar 

  29. Araki E, Goto A, Kondo T, Noda M, Noto H, Origasa H, Osawa H, Taguchi A, Tanizawa Y, Tobe K, Yoshioka N. Japanese Clinical Practice Guideline for Diabetes. Diabetol Int. 2020;11:165–223.

    Article  PubMed  PubMed Central  Google Scholar 

  30. American Diabetes Association. (15) Management of diabetes in pregnancy. Diabetes Care. 2023;46:S260–1.

    Google Scholar 

  31. Matsuda M, DeFronzo RA. Insulin sensitivity indices obtained from oral glucose tolerance testing: comparison with the euglycemic insulin clamp. Diabetes Care. 1999;22:1462–70.

    Article  PubMed  CAS  Google Scholar 

  32. Kc K, Shakya S, Zhang H. Gestational diabetes mellitus and macrosomia: a literature review. Ann Nutr Metab. 2015;66:14–20.

    Article  PubMed  CAS  Google Scholar 

  33. Ikenoue S, Miyakoshi K, Saisho Y, Sakai K, Kasuga Y, Fukutake M, et al. Clinical impact of women with gestational diabetes mellitus by the new consensus criteria: two year experience in a single institution in Japan. Endocr J. 2014;61:353–8.

    Article  PubMed  Google Scholar 

  34. Horie I, Kawasaki E, Sakanaka A, Takashima M, Maeyama M, Ando T, et al. Efficacy of nutrition therapy for glucose intolerance in Japanese women diagnosed with gestational diabetes based on IADPSG criteria during early gestation. Diabetes Res Clin Pract. 2015;107:400–6.

    Article  PubMed  CAS  Google Scholar 

  35. Chen Y, Wan K, Gong Y, Zhang X, Liang Y, Wang X, et al. Assessing the relationship between pregravid body mass index and risk of adverse maternal pregnancy and neonatal outcomes: prospective data in Southwest China. Sci Rep. 2021;11:7591.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  36. McIntyre HD, Sacks DA, Barbour LA, Feig DS, Catalano PM, Damm P, et al. Issues with the diagnosis and classification of hyperglycemia in early pregnancy. Diabetes Care. 2016;39:53–4.

    Article  PubMed  CAS  Google Scholar 

  37. Diabetes in pregnancy: management from preconception to the postnatal period. London: National Institute for Health and Care Excellence (NICE); 2020

  38. ACOG Practice Bulletin No. 190 Summary: Gestational Diabetes Mellitus. Obstet Gynecol. 2018; 131:406-8

  39. Farrar D, Simmonds M, Bryant M, Sheldon TA, Tuffnell D, Golder S, et al. Hyperglycaemia and risk of adverse perinatal outcomes: systematic review and meta-analysis. BMJ. 2016;354: i4694.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors are indebted to Toshihiko Ohshige, Ami Nishine, Kana Igarashi, and Yukiko Yamanaka for their invaluable contributions to this research.

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Authors and Affiliations

  1. Division of Metabolism and Endocrinology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan

    Ayaka Takemoto, Yoshio Nagai, Shin Kawanabe, Tomoko Nakagawa & Masakatsu Sone

  2. Department of Diabetes and Endocrinology, Kanto Rosai Hospital, 1-1, Kizukisumiyoshicho, Nakahara-Ku, Kawasaki, Kanagawa, 211-8510, Japan

    Yoshio Nagai

  3. St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan

    Kaho Matsumoto

  4. Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan

    Jyunichi Hasegawa & Nao Suzuki

  5. Diabetes Center, Yokohama General Hospital, 2201-5, Kuroganecho, Aoba-Ku, Yokohama, Kanagawa, 225-0025, Japan

    Yasushi Tanaka

Authors
  1. Ayaka Takemoto
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  2. Yoshio Nagai
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  3. Shin Kawanabe
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  4. Tomoko Nakagawa
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  8. Yasushi Tanaka
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  9. Masakatsu Sone
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Correspondence to Yoshio Nagai.

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All authors declare no conflict of interest associated with this manuscript.

Ethical approval

This study was conducted with the Ethics Review Committee of St. Marianna University School of Medicine (The approval number 5424), which was which was approved on October. 8, 2021. Written informed consent was waived due to its retrospective nature. An opt-out procedure was conducted to allow patients to withdraw from the study by informing them of the study protocol on the hospital homepage website, as advised by the committee.

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Takemoto, A., Nagai, Y., Kawanabe, S. et al. Patients with gestational diabetes mellitus may be treated in both early and late pregnancy, especially in patients with pre-pregnancy overweight: A cross-sectional study in Japan. Diabetol Int 14, 381–389 (2023). https://doi.org/10.1007/s13340-023-00646-w

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