Clinical Recommendations for the Use of Islet Cell Autoantibodies to Distinguish Autoimmune and Non-Autoimmune Gestational Diabetes

Abstract

Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance that begins or is first recognized during pregnancy. The prevalence of GDM is highly variable, depending on the population studied, and reflects the underlying pattern of diabetes in the population. GDM manifests by the second half of pregnancy and disappears following delivery in most cases, but is associated with the risk of subsequent diabetes development. Normal pregnancy induces carbohydrate intolerance to favor the availability of nutrients for the fetus, which is compensated by increased insulin secretion from the maternal pancreas. Pregnancy shares similarities with adiposity in metabolism to save energy, and both conditions favor the development of insulin resistance (IR) and low-grade inflammation. A highly complicated network of modified regulatory mechanisms may primarily affect carbohydrate metabolism by promoting autoimmune reactions to pancreatic β cells and affecting insulin function. As a result, diabetes development during pregnancy is facilitated. Depending on a pregnant woman's genetic susceptibility to diabetes, autoimmune mechanisms or IR are fundamental to the development autoimmune or non-autoimmune GDM, respectively. Pregnancy may facilitate the identification of women at risk of developing diabetes later in life; autoimmune and non-autoimmune GDM may be early markers of the risk of future type 1 and type 2 diabetes, respectively. The most convenient and efficient way to discriminate GDM types is to assess pancreatic β-cell autoantibodies along with diagnosing diabetes in pregnancy.

Intensive gestational glycemic management and childhood obesity: a systematic review and meta-analysis

“…[5][6][7] This differs from other types of diabetes such as monogenic or type 1 diabetes which have genetic and/or autoimmune origins. 8,9 Both pre-existing T2D and GDM are diagnosed through measurement of glycemia, and they are generally distinguished from each other by the timing of the diagnosis in reference to the gestational period, as GDM develops after the 20 th gestational week and usually resolves within six weeks post-partum. 10 Typically, GDM is diagnosed with an oral glucose tolerance test (OGTT) undergone between 24 and 28 weeks of gestation and during which the fasting pregnant woman drinks a solution containing 75g or 100 g of glucose.…”

Plasma Levels of the Interleukin-1-Receptor Antagonist Are Lower in Women with Gestational Diabetes Mellitus and Are Particularly Associated with Postpartum Development of Type 2 Diabetes

“…In most cases the body is able to compensate for this with increased insulin secretion and most cases resolves with delivery. [ 2 , 3 ]…”

Insulitis in Autoantibody-Positive Pancreatic Donor With History of Gestational Diabetes Mellitus

“…Indeed, this latter risk seems especially great when GDM is associated with type 1 diabetes autoantibodies (5,6). Nilsson et al (6) demonstrated that among 385 women with GDM, 24 (6%) had β-cell–specific autoantibodies characteristic of type 1 diabetes.…”

“…The residual β-cell mass was found to be 763 mg (methods as previously described by Campbell-Thompson et al [11]), with a pancreas weight of 82.83 g and a relative pancreas weight of 1.24 g/kg (calculated as previously described by Campbell-Thompson et al [14]). Approximately 5–10% of GDM cases may be associated with autoantibody positivity (5), and it is reasonable to suspect that the presence of autoantibodies reflects autoimmune destruction of pancreatic β-cells (2). However, direct histological evidence within the literature is lacking.…”