Gestational Diabetes Identifies Women at Risk for Permanent Type 1 and Type 2 Diabetes in Fertile Age

Abstract

OBJECTIVE -Our aim was to evaluate the predictive value of gestational diabetes mellitus (GDM), diabetes-associated autoantibodies, and other factors for development of clinical diabetes later in life.RESEARCH DESIGN AND METHODS -In this case-control study the presence of autoantibodies was studied in 435 women with GDM and in healthy matched control subjects. The need for exogenous insulin during GDM was recorded. In the GDM group, the mean follow-up period was 5.7 years and in the control group 6.1 years.RESULTS -Among the subjects with GDM, 20 (4.6%) developed type 1 diabetes and 23 (5.3%) developed type 2 diabetes, whereas none of the control subjects became diabetic. Twothirds of those who developed type 1 diabetes tested positive initially for islet cell antibodies (ICAs), whereas 56% of them had autoantibodies to GAD (GADAs) and 38% to the protein tyrosine phosphatase-related IA-2 molecule. Only 2 of the 23 women who presented later with type 2 diabetes tested positive for autoantibodies. According to multivariate analysis, initial age Յ30 years, the need for insulin treatment for GDM, and antibody positivity for ICAs and GADAs were associated with increased risk for clinical type 1 diabetes.CONCLUSIONS -Pregnancy seems to identify women who are at risk of developing diabetes later in life. About 10% of Finnish women with GDM will develop diabetes over the next 6 years; nearly half of them develop type 1 diabetes and the other half type 2 diabetes. Age Յ30 years, the need for insulin treatment during pregnancy, and positivity for ICAs and GADAs confer a high risk of subsequent progression to type 1 diabetes in women affected by GDM. Diabetes Care 29:607-612, 2006N ormal pregnancy induces insulin resistance (1), which may unmask diabetes or reduced insulin secretory capacity. The incidence of gestational diabetes mellitus (GDM) has been reported to be 2-5% during pregnancy (1). The condition is associated with both impaired insulin action and secretion, defects that are also characteristic of type 2 diabetes (2). Women with GDM have a considerable risk of developing type 2 diabetes later in life, but the risk of developing type 1 diabetes is also increased (3-5).The presence of circulating autoantibodies to various islet cell proteins is one of the most thoroughly characterized immune phenomena associated with type 1 diabetes (6). These autoantibodies are the detectable markers of an ongoing destructive process in the islets and thus provide a potential tool to identify individuals at risk of developing the disease in the future. Diabetesassociated autoantibodies have a high positive predictive value (PPV) for clinical type 1 diabetes among relatives of affected patients. The results of recent studies have implied that the PPV of autoantibodies associated with type 1 diabetes is also high in women with GDM (7). Although the antibody status of women with GDM may vary, depending on the phase of pregnancy and treatment mode for GDM, as well as on the methods used for antibody detection, most investigators hav...

Lifestyle Intervention in Prevention of Type 2 Diabetes in Women With a History of Gestational Diabetes Mellitus: One-Year Results of the FIN-D2D Project

“…Worsening insulin resistance and b cell dysfunction are wellknown reasons for glucose intolerance during gestation. 34 Because about one in ten Finnish women with a history of GDM will develop diabetes in the near future, and about half of them will develop type 1 diabetes, 4 our study may also include women, who were developing type 1 diabetes, which may also affect the current results. In our study, 5% of women 510 RAUTIO ET AL.…”

“…2,3 For example, about 10% of women with GDM in Finland will develop diabetes during the next 6 years; about half of them develop T2D. 4 GDM is also related to worse cardio-metabolic risk profile, 5,6 metabolic syndrome (MetS) 5,7 and risk for cardiovascular disease, which is partly due to the subsequent development of T2D. 8 Lifestyle interventions are a successful means of preventing T2D in high-risk individuals for T2D; 9,10 the effectiveness of lifestyle intervention in women with a history of GDM have also been examined to some extent.…”

Hyperemesis gravidarum and long‐term mortality: a population‐based cohort study

“…Gestational hypertension, pre‐eclampsia and placental abruption are all reported to increase the risk of cardiovascular disease (CVD) later in life 3, 4, 5, 6, 7. Moreover, it is well known that gestational diabetes increases the risk of developing type 2 diabetes 6, 8, 9, 10. According to the American Heart Association Guidelines for the prevention of Cardiovascular Disease in Women , taking a history of pregnancy complications is part of the CVD risk evaluation 11…”

Pre-pregnancy overweight overtakes gestational diabetes as a risk factor for subsequent metabolic syndrome

“…Another plausible explanation for the high proportion of MS in our study is that we only included GDM women who required insulin treatment during pregnancy. In previous studies, the requirement of insulin to achieve normoglycemia in GDM has been associated with an increased rate of subsequent morbidity, especially diabetes (22). The high prevalence of single components of MS (diabetes, hypertension, or dyslipidemia) that do not yet meet the full criteria of this disturbance suggests a further increased prevalence of MS.…”