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Diabetologia

pp 1–11 | Cite as

Characteristics and pregnancy outcomes across gestational diabetes mellitus subtypes based on insulin resistance

  • Katrien BenhalimaEmail author
  • Paul Van Crombrugge
  • Carolien Moyson
  • Johan Verhaeghe
  • Sofie Vandeginste
  • Hilde Verlaenen
  • Chris Vercammen
  • Toon Maes
  • Els Dufraimont
  • Christophe De Block
  • Yves Jacquemyn
  • Farah Mekahli
  • Katrien De Clippel
  • Annick Van Den Bruel
  • Anne Loccufier
  • Annouschka Laenen
  • Caro Minschart
  • Roland Devlieger
  • Chantal Mathieu
Article

Abstract

Aims/hypothesis

This study aimed to determine the characteristics and pregnancy outcomes across different subtypes of gestational diabetes mellitus (GDM) based on insulin resistance.

Methods

GDM subtypes were defined in 1813 pregnant women from a multicentre prospective cohort study, stratified according to insulin resistance, based on Matsuda index below the 50th percentile of women with normal glucose tolerance (NGT), during a 75 g OGTT at 24–28 weeks’ gestation. GDM was diagnosed in 12.4% (n = 228) of all participants based on the 2013 WHO criteria.

Results

Compared with women with NGT (1113 [61.4%] of the total cohort) and insulin-sensitive women with GDM (39 [17.1%] women with GDM), women with GDM and high insulin resistance (189 [82.9%] women with GDM) had a significantly higher BMI, systolic BP, fasting plasma glucose (FPG), fasting total cholesterol, LDL-cholesterol and triacylglycerol levels in early pregnancy. Compared with women with NGT, insulin-sensitive women with GDM had a significantly lower BMI but similar BP, FPG and fasting lipid levels in early pregnancy. Compared with women with NGT, women with GDM and high insulin resistance had higher rates of preterm delivery (8.5% vs 4.7%, p = 0.030), labour induction (42.7% vs 28.1%, p < 0.001), Caesarean section (total Caesarean sections: 28.7% vs 19.4%, p = 0.004; emergency Caesarean sections: 16.0% vs 9.7%, p = 0.010), neonatal hypoglycaemia (15.4% vs 3.5%, p < 0.001) and neonatal intensive care unit admissions (16.0% vs 8.9%, p = 0.003). In multivariable logistic regression analyses using different models to adjust for demographics, BMI, FPG, HbA1c, lipid levels and gestational weight gain in early pregnancy, preterm delivery (OR 2.41 [95% CI 1.08, 5.38]) and neonatal hypoglycaemia (OR 4.86 [95% CI 2.04, 11.53]) remained significantly higher in women with GDM and high insulin resistance compared with women with NGT. Insulin-sensitive women with GDM had similar pregnancy outcomes as women with NGT. The need for insulin treatment during pregnancy and the rate of glucose intolerance in the early postpartum period were not significantly different among the GDM subtypes.

Conclusions/interpretation

GDM with high insulin resistance represents a more adverse metabolic profile with a greater risk of adverse pregnancy outcomes.

Keywords

Gestational diabetes mellitus Pregnancy outcomes Subtypes, insulin resistance, 2013 WHO criteria 

Abbreviations

BEDIP-N

Belgian Diabetes in Pregnancy Study

FPG

Fasting plasma glucose

GCT

50 g Glucose challenge test

GDM

Gestational diabetes mellitus

ISSI-2

Insulin secretion-sensitivity index-2

LGA

Large for gestational age

NGT

Normal glucose tolerance

NICU

Neonatal intensive care unit

Notes

Acknowledgements

KB and RD are the recipients of a ‘Fundamenteel Klinisch Navorserschap FWO Vlaanderen’. We thank I. Beckstedde (Department of Obstetrics, University Hospital of Antwerp, Belgium) and S. Van Imschoot (Department of Endocrinology, AZ St Jan Brugge, Belgium) for their help with participant recruitment and study assessments. We thank the research assistants, paramedics and physicians at all participating centres for their support, and we thank all of the women who participated in the study.

Contribution statement

KB, PVC and CMath conceived the project. CMoyso prepared the data and ALaen performed the statistical analysis. KB conducted the literature review. KB and CMath wrote the first draft of the manuscript. All authors contributed to the study design, including data collection, data interpretation and manuscript revision, and all authors have approved the final version. KB had full access to all of the data in the study and has final responsibility for the contents of the article and the decision to submit for publication.

Funding

This investigator-initiated study was funded by the Belgian National Lottery, the Fund of Academic studies of UZ Leuven and the Fund Yvonne and Jacques François – de Meurs of the King Boudewijn Foundation. The sponsors of the study had no role in the design of the study or in the collection, handling, analysis or interpretation of the data, or in the decision to write and submit the manuscript for publication.

Duality of interest

The authors declare that there is no duality of interest associated with this manuscript.

Supplementary material

125_2019_4961_MOESM1_ESM.pdf (249 kb)
ESM Tables (PDF 248 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Katrien Benhalima
    • 1
    Email author
  • Paul Van Crombrugge
    • 2
  • Carolien Moyson
    • 1
  • Johan Verhaeghe
    • 3
  • Sofie Vandeginste
    • 4
  • Hilde Verlaenen
    • 4
  • Chris Vercammen
    • 5
  • Toon Maes
    • 5
  • Els Dufraimont
    • 6
  • Christophe De Block
    • 7
  • Yves Jacquemyn
    • 8
  • Farah Mekahli
    • 9
  • Katrien De Clippel
    • 10
  • Annick Van Den Bruel
    • 11
  • Anne Loccufier
    • 12
  • Annouschka Laenen
    • 13
  • Caro Minschart
    • 1
  • Roland Devlieger
    • 3
  • Chantal Mathieu
    • 1
  1. 1.Department of Endocrinology, UZ GasthuisbergKU LeuvenLeuvenBelgium
  2. 2.Department of EndocrinologyOLV Ziekenhuis Aalst-Asse-NinoveAalstBelgium
  3. 3.Department of Obstetrics & Gynecology, University Hospital GasthuisbergKU LeuvenLeuvenBelgium
  4. 4.Department of Obstetrics & GynecologyOLV Ziekenhuis Aalst-Asse-NinoveAalstBelgium
  5. 5.Department of EndocrinologyImelda ZiekenhuisBonheidenBelgium
  6. 6.Department of Obstetrics & GynecologyImelda ZiekenhuisBonheidenBelgium
  7. 7.Department of Endocrinology-Diabetology-MetabolismAntwerp University HospitalEdegemBelgium
  8. 8.Department of Obstetrics & GynecologyAntwerp University HospitalEdegemBelgium
  9. 9.Department of EndocrinologyKliniek St-Jan BrusselBrusselsBelgium
  10. 10.Department of Obstetrics & GynecologyKliniek St-Jan BrusselBrusselsBelgium
  11. 11.Department of EndocrinologyAZ St-Jan BruggeBruggeBelgium
  12. 12.Department of Obstetrics & GynecologyAZ St-Jan BruggeBruggeBelgium
  13. 13.Center of Biostatics and Statistical BioinformaticsKU LeuvenLeuvenBelgium

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