Dysglycemia and a History of Reproductive Risk Factors

Abstract

FOR THE DREAM TRIAL INVESTIGATORSOBJECTIVE -The purpose of this study was to identify reproductive risk factors associated with dysglycemia (diabetes, impaired glucose tolerance, and impaired fasting glucose) in a contemporary multiethnic population. CONCLUSIONS -Reproductive factors, particularly GDM, are associated with dysglycemia in middle-aged women from many ethnicities. Reproductive factors can be used to counsel young women about their future risk of dysglycemia, whereas in middle age they may help screen for dysglycemia. RESEARCH DESIGN AND METHODS Diabetes Care 31:1635-1638, 2008G estational diabetes mellitus (GDM) is a well-known reproductive risk factor for subsequent type 2 diabetes (1). Other reproductive factors such as preeclampsia are associated with insulin resistance during pregnancy and may also increase the subsequent risk for diabetes. Furthermore, some (2-4) but not all (5) studies suggest that pregnancy itself is a risk factor for future type 2 diabetes. For example, a population-based study of 1,186 elderly women showed that, even after accounting for age, obesity, and family history of diabetes, parity was associated with an increased risk of type 2 diabetes, with an odds ratio (OR) of 1.16 per pregnancy (95% CI 1.04 -1.20) (3). An even larger study comprising 2,310 women with type 2 diabetes reported that parity greater than six was associated with a relative risk (RR) of diabetes of 1.56 (95% CI 1.27-1.91); however, the estimate of the RR decreased to 1.19 (0.97-1.48) after adjustment for current age (2). The applicability of these results is limited by the homogeneity of the population (registered nurses with relatively high socioeconomic status and 98% Caucasian) and the use of the older fasting plasma glucose cutoff for diabetes of Ͼ7.8 mmol/l (Ͼ140 mg/dl) rather than the current, more sensitive value of 7.0 mmol/l (126 mg/dl) (6).The prevalence of dysglycemia (type 2 diabetes, impaired glucose tolerance [IGT], and impaired fasting glucose [IFG]) is increasing; however, reproductive risk factors are often underrecognized. In particular, their association with the more recently recognized forms of glucose dysregulation, IGT and IFG, have not yet been well studied. The detection of dysglycemia could be improved if risk factors were better known. Moreover, if reproductive factors such as parity and preeclampsia are risk factors for dysglycemia, they could be used to refine screening approaches. The goal of this research was to identify reproductive risk factors for dysglycemia in a contemporary, multiethnic group of women.

Epidemiology of abnormal glucose metabolism in a country facing its epidemic: SAUDI‐DM study

“…42 The risk factors for IFG were found to have a different order than what has been observed with the diabetes cases, where previous history of GDM had the highest OR as been reported by McDonald et al among women from many ethnicities. 43 As reported in the Chinese study, 19 obesity, high triglycerides, age ≥45 years, hypertension and being overweight were significant risk factors for IFG among the Saudi Arabian population. Although male gender was a risk factor for IFG among both populations, it was found to be significant only among the Saudi population, and not in the Chinese population.…”

Parity, Breastfeeding, and the Subsequent Risk of Maternal Type 2 Diabetes

“…There is less consistency among studies examining the association between parity and diabetes, with some suggesting either no effect (8) or a small (9) to moderate (10,11) increase in risk. This inconsistency may have arisen because none of these studies accounted for breastfeeding practices among parous women.…”

Pregnancy complications and later vascular ultrasound measures: A cohort study

“…Women who deliver a preterm or low birthweight infant have a higher risk of cardiovascular disease [1], elevated blood pressure, and insulin resistance later in life [2]. Women who develop pre-eclampsia have elevated blood pressure and lipids after pregnancy [3, 4] and are at higher risk of developing diabetes [4, 5], metabolic syndrome [6], and cardiovascular disease [7]. The pathways for these associations are less studied.…”