Gestational Diabetes Prevalence at Moderate and High Altitude

Abstract

Background: High-altitude (HA) pregnancies have been associated with decreased glucose levels and increased insulin sensitivity versus sea level. Our objective was to determine if the prevalence of gestational diabetes mellitus (GDM) and the impact of demographic characteristics on GDM diagnosis differed at moderate altitude (MA) versus HA. Methods: Using a retrospective cohort design, we compared women living at HA (>8250 ft) and MA (4000-7000 ft) during pregnancy. Exclusion criteria were as follows: multiple gestation, preexisting diabetes, unavailable GDM results, or relocation from a different altitude during pregnancy. GDM diagnosis was determined using Carpenter and Coustan criteria. Data were compared by t-test (continuous variables) or chi-squared tests (categorical variables). Univariate, multivariate, and stepwise regression models were used to assess the impact of various factors on GDM prevalence. Results: There was no difference in GDM prevalence between altitudes in these populations; the relationship between altitude and GDM was nonsignificant in all regression analyses. At MA, maternal age, Hispanic ethnicity, body mass index (BMI), and gestational age (GA) at testing increased GDM incidence in univariate analyses. At HA, maternal age, Hispanic ethnicity, and multiparity increased GDM incidence in univariate analyses. Conclusion: While GDM prevalence did not differ between MA and HA, the impact of maternal demographic characteristics on GDM risk varied by altitude group. Higher BMI and greater GA at testing increased the incidence of GDM at MA, but not at HA. Multiparity had an effect at HA, but not MA. These differences may represent subtle differences in glucose metabolism at HA.

Pregnancy‐induced changes in β‐cell function: what are the key players?

“…Hypoxia. Hypoxia generated by living at high altitude (>2500 m) is a frequent cause of maternal physiological maladaptation during pregnancy (Moore et al 2004), but prevalence of GDM is not increased in high altitude populations (Euser et al 2018). Compared to women at sea level, pregnant women at high altitude present with decreased fasting plasma glucose concentrations and higher insulin sensitivity, although calculated β-cell function is similar and fasting insulin concentration is lower (Krampl et al 2001a,b).…”

Increased levels of glycosylated hemoglobin, microalbuminuria and serum cystatin C predict adverse outcomes in high‑risk pregnancies with gestational diabetes mellitus

“…Gestational diabetes mellitus (GDM) is clinically classified as a high-risk pregnancy condition (1). In recent years, the incidence of GDM is increasing with continuous changes in living standards and eating habits (2). It has been estimated that 1 out of 15 pregnant females is susceptible to GDM, and in developed countries, including the US and the UK, the incidence of GDM exceeds 10%.…”

Association between VDR genetic polymorphisms and risk of gestational diabetes mellitus in the Chinese population

“…The prevalence of diabetes mellitus (DM) and impaired glucose tolerance (IGT) has increased in this area, although previous studies have shown that high altitude residents had lower fasting glucose levels, improved glucose tolerance 5,6 . Altitude has a certain effect on glucose metabolism and has been studied in Bolivia and Peru who have lived at high altitude for thousands of years, 7 but genetic characteristics and other environmental factors still play an influential role 8 . It is necessary to study the influencing factors of GDM in areas with hypoxia, high altitude, strong ultraviolet radiation, and a relatively stable genetic background.…”

“…5,6 Altitude has a certain effect on glucose metabolism and has been studied in Bolivia and Peru who have lived at high altitude for thousands of years, 7 but genetic characteristics and other environmental factors still play an influential role. 8 It is necessary to study the influencing factors of GDM in areas with hypoxia, high altitude, strong ultraviolet radiation, and a relatively stable genetic background.…”