Characteristics and pregnancy outcomes across gestational diabetes mellitus subtypes based on insulin resistance
This study aimed to determine the characteristics and pregnancy outcomes across different subtypes of gestational diabetes mellitus (GDM) based on insulin resistance.
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.
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.
GDM with high insulin resistance represents a more adverse metabolic profile with a greater risk of adverse pregnancy outcomes.
KeywordsGestational diabetes mellitus Pregnancy outcomes Subtypes, insulin resistance, 2013 WHO criteria
Belgian Diabetes in Pregnancy Study
Fasting plasma glucose
50 g Glucose challenge test
Gestational diabetes mellitus
Insulin secretion-sensitivity index-2
Large for gestational age
Normal glucose tolerance
Neonatal intensive care unit
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.
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.
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.
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