Postpartum Metabolic Function in Women Delivering a Macrosomic Infant in the Absence of Gestational Diabetes Mellitus

Abstract

OBJECTIVEGestational diabetes mellitus (GDM) is associated with fetal macrosomia and maternal postpartum dysglycemia, insulin resistance, and β-cell dysfunction. Indeed, in practice, a prior pregnancy that resulted in a large-for-gestational-age (LGA) delivery is often considered presumptive evidence of GDM, whether or not it was diagnosed at the time. If this clinical assumption is correct, however, we would expect these women to exhibit postpartum metabolic dysfunction. Thus, to test this hypothesis, we assessed metabolic function during and after pregnancy in a cohort of women stratified according to the presence/absence of GDM and LGA delivery, respectively.RESEARCH DESIGN AND METHODSA total of 562 women underwent metabolic characterization, including oral glucose tolerance test (OGTT), in late pregnancy and at 3 months’ postpartum. The women were stratified into three groups: those with neither GDM nor LGA delivery (nonGDM, n = 364), those without GDM but with LGA delivery (nonGDM–LGA, n = 46), and those with GDM (n = 152).RESULTSOn logistic regression, GDM predicted postpartum glucose intolerance (OR 4.1 [95% CI 2.5–6.8]; P < 0.0001), whereas nonGDM–LGA did not (P = 0.65). At 3 months’ postpartum, the mean adjusted levels of fasting glucose and area under the glucose curve on the OGTT were significantly higher in the GDM women compared with either nonGDM or nonGDM–LGA (all P < 0.05), with no differences between the latter two groups. In a similar manner, mean adjusted insulin sensitivity (Matsuda index) and β-cell function (Insulin Secretion-Sensitivity Index-2) were lower in GDM women compared with either nonGDM or nonGDM–LGA (all P < 0.05), again with no differences between the latter two groups.CONCLUSIONSWomen with nonGDM–LGA do not exhibit postpartum metabolic dysfunction, arguing against the assumption of undiagnosed GDM in these patients.

Delivery of an LGA infant and the maternal risk of diabetes: A prospective cohort study

“…In fact, these two studies [15,16] along with the Larsson et al's study [7] were the only studies suggesting significantly increased T2DM risk after an LGA delivery. The remaining previous studies [8,10], and our findings did not demonstrate significantly increased risk of later T2DM. In addition, a study of 18 women with LGA compared to 18 women with appropriate-for-gestational-age (AGA) infants did not find significant differences in glucose, insulin or HbA1c levels between the groups two years after pregnancy [9].…”

“…In clinical practice, a woman who delivers a large-for-gestational-age (LGA, birth weight above the 90th percentile for gestational age) infant is more likely to have GDM and this combination is considered a risk factor for GDM in a subsequent pregnancy. However, studies focusing on T2DM risk in women with a history of LGA birth (but without GDM) have given conflicting results, probably due to the variation of the follow-up time, ascertainment of the cases and controls and women's overall T2DM risk profile [7][8][9][10].…”

The effect of DASH diet on pregnancy outcomes in gestational diabetes: a randomized controlled clinical trial

“…Several studies have shown higher mean birth weight, greater number of large for gestational age birth and macrosomic babies as pregnancy outcomes in pregnant women with GDM. 45,46 In a study by Moses et al, 17 consumption of low-GI diet, as compared with high-GI diet, in pregnant women with GDM resulted in birth of lighter infants (P ¼ 0.05), lower birth centile (P ¼ 0.005) and lower prevalence of large for gestational age (P ¼ 0.01). The difference in mean birth weight between the two groups in the current study was almost 600 g. This is much lower than that obtained in another study that did the intervention with a low-GI diet.…”

Circulating LncRNA Serve as Fingerprint for Gestational Diabetes Mellitus Associated with Risk of Macrosomia

“…Insulin treatment was administrated when dietary control could not achieve this goal. The babies of GDM group were diagnosed as macrosomia when their birth-weight was equal to or exceeded 4000 g [14,15]. Controls were from healthy volunteers without any health problems during their health checkups at the at the Obstetrics and Gynecology Department in Wuxi Maternity and Child Health Hospital.…”