Metabolic Characteristics of Gestational Diabetes Mellitus and the Effects on Pregnancy Outcomes

Abstract

Objective To describe the metabolic characteristics of gestational diabetes mellitus (GDM) and assess their effects on perinatal outcomes. Methods A two-center nested case‒control study was designed, including 192 pregnant women with GDM and 191 pregnant women with normal glucose tolerance (NGT). Serum glucose and insulin concentrations based upon the 75 g oral glucose tolerance test (OGTT) were measured. Several indices were calculated to describe the metabolic characteristics of the subjects. The relationship between glucose metabolism parameters and pregnancy outcomes was evaluated using stepwise linear regression and binary logistic regression. Results Compared with the NGT group, the GDM group showed significantly higher fasting and postprandial glucose parameters but significantly lower fasting and postprandial insulin responses. Meanwhile, the GDM group had significantly lower HOMA-β, DI and ISI Matsuda but comparable HOMA-IR. The IFG subgroup showed significantly lower FINS/FPG only, while the IGT and IFSG subgroups showed deficiency in both fasting and postprandial insulin response. The IFSG subgroup had the highest glucose parameters and the lowest insulin parameters, as well as significantly lower ISI Matsuda and HOMA-β than the NGT group. FPG had a significant effect on infants’ birth weight, and 1hPG and FINS/FPG had a significant effect on delivery gestational age. AUC-INS, IGI 60 and DI were related to premature delivery risk after adjusting for confounders. The IFG subgroup of GDM was 2.319 times more likely to be subject to cesarean section than the NGT group. FPG, FINS/FPG, AUC-GLU, AUC-INS/AUC-GLU and HOMA-β were related to macrosomia risk. Conclusion Beta cell dysfunction rather than insulin resistance determines the occurrence of GDM in the central Chinese population. Women with predominant insulin secretion defects had a similar risk of adverse perinatal outcomes to women with NGT. Our study provided a basis for the selection of glucose metabolism monitoring indicators useful for the prevention of adverse perinatal outcomes.

Management of gestational diabetes mellitus via nutritional interventions: The relevance of gastric emptying

“…A study by Luo et al [ 8 ] in a recent issue reported that individualised nutrition interventions, including calorie restriction, adoption of smaller and more frequent meals, and guidance on exercise, were effective at lowering pregnant weight gain, fasting plasma glucose, haemoglobin A1c and the incidence of neonatal adverse events, such as premature birth, macrosomia and respiratory distress syndrome, in Chinese women with GDM. However, Luo et al [ 9 ] did not specifically document how adequately post-prandial glycaemia was controlled by the nutritional intervention. The latter is of major importance, as the majority of Han Chinese women with GDM exhibit elevated plasma glucose at the 1 and 2-h time points of an oral glucose tolerance test, with normal or modestly high fasting glucose.…”

Diabetes Mellitus and Pregnancy: An Insight into the Effects on the Epigenome

“…It can evolve into type 2 diabetes mellitus (T2DM) in the mother after pregnancy, especially when maternal obesity is present, although it usually disappears after childbirth [1]. In most pregnancies in which it occurs, it appears to be caused by a pancreatic response due to an inability to compensate for insulin resistance in the gestational stage [3].…”