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Presence of diabetes-specific autoimmunity in women with gestational diabetes mellitus (GDM) predicts impaired glucose regulation at follow-up

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Abstract

Purpose

Gestational diabetes mellitus (GDM) is the most frequent complication of pregnancy; around 10% of GDM cases may be determined by autoimmunity, and our aims were to establish the role of autoimmunity in a population of Sardinian women affected by GDM, to find predictive factors for autoimmune GDM, and to determine type 1 diabetes (T1D) auto-antibodies (Aabs) together with glucose tolerance after a mean 21.2 months of follow-up.

Methods

We consecutively recruited 143 women affected by GDM and 60 without GDM; clinical data and pregnancy outcomes were obtained by outpatient visit or phone recall. T1D auto-antibodies GADA, IA2-A, IAA, ZnT8-A were measured in the whole population at baseline, and in the Aab-positive women at follow-up.

Results

The overall prevalence of autoimmunity was 6.4% (13/203). No significant difference was found in the prevalence of auto-antibodies between GDM (5.6%) and control (8.3%) women, neither in antibody titres. Highest titres for GADA and ZnT8-A were observed in the control group; no phenotypic factors were predictive for autoimmune GDM. Diabetes-related autoantibodies were still present in all the GDM women at follow-up, and their presence was associated with a 2.65 (p < 0.0016) relative risk (RR) of glucose impairment.

Conclusion

We observed a low prevalence (5.6%) of diabetes-related autoimmunity in our GDM cohort, consistent with the prevalence reported in previous studies. It was not possible to uncover features predictive of autoimmune GDM. However, given the significant risk of a persistent impaired glycemic regulation at follow-up, it is advisable to control for glucose tolerance in GDM women with diabetes-related autoimmunity.

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Acknowledgements

This work was funded by research Grants from the Regione Autonoma della Sardegna (Grant RAS 2007 n. CRP-59453), from Sapienza Ateneo Scientific Research (Research Projects 2016), and from the Foundation Banca d’Italia (Projects 2015) all awarded to Marco G. Baroni, and from the Foundation di Sardegna (Research Projects 2012-13) to Efisio Cossu.

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Authors and Affiliations

  1. Department of Experimental Medicine, Sapienza University of Rome, Policlinico Umberto I, 00161, Rome, Italy

    L. Bertoccini, F. A. Cimini, I. Barchetta, M. G. Cavallo & M. G. Baroni

  2. Endocrinology and Diabetes, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy

    E. Cossu, M. Incani, M. G. Pani, G. Gattu, C. Serafini, A. Strazzera & M. G. Baroni

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  1. E. Cossu
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  2. M. Incani
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Correspondence to M. G. Baroni.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

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The study was reviewed and approved by the Ethical Committee of Azienda Ospedaliero-Universitaria of Cagliari, Italy, and conducted in conformance with the Helsinki Declaration.

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Written consent was obtained from all subjects before the study.

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Cossu, E., Incani, M., Pani, M.G. et al. Presence of diabetes-specific autoimmunity in women with gestational diabetes mellitus (GDM) predicts impaired glucose regulation at follow-up. J Endocrinol Invest 41, 1061–1068 (2018). https://doi.org/10.1007/s40618-018-0830-3

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