Risk factors for hyperglycemia in pregnancy in the DALI study differ by period of pregnancy and OGTT time point

Mendoza, Lilian; Harreiter, Jürgen; Simmons, David; Desoyé, Gernot; Adelantado, Juan M.; Juarez, Fabiola; Chico, Ana; Devlieger, Roland; Assche, Ado Van; Galjaard, Sander; Damm, Peter; Mathiesen, Elisabeth R.; Jensen, Dorte Møller; Andersen, Lise Lotte Torvin; Tanvig, Mette; Lapolla, Annunziata; Dalfrà, Maria Grazia; Bertolotto, Alessandra; Mantaj, Urszula; Wender-Ożegowska, Ewa; Zawiejska, Agnieszka; Hill, David J.; Jelsma, Judith G. M.; Snoek, Frank J.; Poppel, Mireille N. M. van; Worda, Christof; Bancher‐Todesca, Dagmar; Kautzky‐Willer, Alexandra; Dunne, Fidelma; Corcoy, Rosa

doi:10.1530/eje-18-0003

Cited by 20 publications

(21 citation statements)

References 36 publications

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“…In contrast, a study of 1635 women from Hungary reported no significant association between height and risk of GDM according to the 1998 WHO criteria [ 16 ]. The DALI study including 971 women found that decreased height was associated with significantly decreased risk of GDM using the IADPSG criteria [ 17 ]. These discrepancies across these studies may be due to the differences in height among ethnic groups, diagnostic criteria for GDM, race/ethnicity, and sample size.…”

Section: Discussionmentioning

confidence: 99%

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Height and Risk of Gestational Diabetes Mellitus: Results from the Healthy Baby Cohort Study

Song

Shen

et al. 2018

Journal of Diabetes Research

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Background The aim of this study was to examine the association between height and plasma glucose level, as well as risk of GDM among Chinese women. Methods A total of 6941 pregnant Chinese women were recruited from the Healthy Baby Cohort study in Hubei Province, China, in 2012–2014. Measured height was categorized into four groups according to the quartile distribution (≤158.0 cm, 158.1–161.0 cm, 161.1–164.0 cm, and >164.0 cm). GDM was defined based on the International Association of the Diabetes in Pregnancy Study Group criteria. Linear regression was used to estimate the association between height and plasma glucose levels. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between height and GDM. Results The prevalence of GDM was 14.7% in our study. Height was inversely associated with the 1 h and 2h plasma glucose levels (all P value for trend < 0.05), but not with fasting plasma glucose levels. A significant negative trend was found between height and risk of GDM (P value for trend < 0.05), and each centimeter increase in height was associated with 2% (OR: 0.98; 95% CI: 0.96, 0.99) lower risk of GDM. Women in the highest quartile of height (>164.0 cm) had 23% (OR: 0.77; 95% CI: 0.64, 0.94) lower risk of developing GDM than those in the shortest quartile of height (≤158.0 cm), after adjusting for potential confounders. Conclusions Our findings suggested that height was negatively associated with risk of GDM among Chinese women. The difference in plasma glucose levels is present in the 1 h and 2 h plasma glucose, but not with fasting plasma glucose.

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Section: Discussionmentioning

confidence: 99%

“…Previous studies have shown an inverse relationship between height and risk of GDM in several countries [ 7 , 12 – 15 ], but not all [ 16 , 17 ]. However, due to the variations in height among different ethnic and socioeconomic groups [ 14 ], their results might not generalize to Chinese women.…”

Section: Introductionmentioning

confidence: 99%

Height and Risk of Gestational Diabetes Mellitus: Results from the Healthy Baby Cohort Study

Song

Shen

et al. 2018

Journal of Diabetes Research

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“…All samples were stored immediately at − 20°C or below and centrally analysed in the ISO-certified laboratory of the Medical University of Graz. Nonmodifiable risk factors for the development of GDM (women developing GDM vs. those maintaining a normal OGTT respectively) [ [31]. Pregnancy outcomes did not differ overall between women with normal glucose tolerance and women with GDM developing mid-late pregnancy.…”

Section: Epidemiology Of Gdmmentioning

confidence: 99%

The Effects of Lifestyle and/or Vitamin D Supplementation Interventions on Pregnancy Outcomes: What Have We Learned from the DALI Studies?

et al. 2019

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Purpose of Review The DALI (vitamin D and lifestyle intervention in the prevention of gestational diabetes mellitus (GDM)) study aimed to prevent GDM with lifestyle interventions or Vitamin D supplementation (1600 IU/day). This review summarizes the learnings from the DALI studies among pregnant women with a BMI ≥ 29 kg/m 2. Recent Findings Women diagnosed with GDM earlier in pregnancy had a worse metabolic profile than those diagnosed later. A combined physical activity (PA) and healthy eating (HE) lifestyle intervention improved both behaviours, limited gestational weight gain (GWG) and was cost-effective. Although GDM risk was unchanged, neonatal adiposity was reduced due to less sedentary time. Neither PA nor HE alone limited GWG or GDM risk. Fasting glucose was higher with HE only intervention, and lower with Vitamin D supplementation. Summary Our combined intervention did not prevent GDM, but was cost-effective, limited GWG and reduced neonatal adiposity.

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“…Most of the analyzed studies examined GDM that was diagnosed after 24 gestational weeks, and type 2 diabetes rate was assessed later than 12 weeks post delivery. Time of GDM diagnosis is important as it was shown that different risk factors affect GDM development depending on the time when OGTT was conducted . Three studies included women with GDM that were diagnosed prior to 24 gestational weeks, and the rate of type 2 diabetes was analyzed between 1 and 4 months post pregnancy.…”

Section: Discussionmentioning

confidence: 99%

“…Time of GDM diagnosis is important as it was shown that different risk factors affect GDM development depending on the time when OGTT was conducted. 30 Three studies included women with GDM that were diagnosed prior to 24 gestational weeks, and the rate of type 2 diabetes was analyzed between 1 and 4 months post pregnancy. None of these studies performed subgroup analysis of the early GDM group, and there are no data regarding its size or the rate of type 2 diabetes in this population.…”

Section: Discussionmentioning

confidence: 99%

Markers for undiagnosed type 2 diabetes mellitus during pregnancy—A population‐based retrospective cohort study

Yefet

Jeda

Tzur

et al. 2019

Journal of Diabetes

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Background To examine possible markers for undiagnosed type 2 diabetes in early‐onset gestational diabetes mellitus (GDM). Methods A population‐based retrospective cohort study of women with GDM diagnosed prior to the 24th week, who delivered between 2005 and 2018, was conducted. The results of the 50‐g glucose challenge test, 100‐g oral glucose tolerance test, and the first available glycosylated hemoglobin (HbA1c) were examined as markers for type 2 diabetes diagnosed 6 to 12 weeks post pregnancy, which is suggestive of pregestational diabetes. This was done by calculating the area under the curve (AUC) of the receiver operating characteristic (ROC) curve for each marker. These markers and additional ones were evaluated for independency by stepwise multivariate logistic regression. Results Of 69 417 pregnancies, 3321 (5%) pregnancies were with GDM. Of them, in 261 (8%) women GDM was diagnosed prior to the 24th week, and 219 (84%) women had available data for analysis. Among them, 11 (5%) women had type 2 diabetes post pregnancy. Elevated HbA1c was the most accurate marker for undiagnosed type 2 diabetes (AUC 91% with 95% CI [81%‐100%]) and the only independent marker for undiagnosed type 2 diabetes in multivariate analysis (odds ratio [OR] 19; 95% CI [3.2‐109], C statistic = 88%). Using the ROC curve, a cutoff of 5.8% predicted type 2 diabetes with 89% sensitivity, 86% specificity, 99.4% negative predictive value, and 23% positive predictive value. Conclusions Early‐onset GDM with HbA1c ≥ 5.8% should be managed as type 2 diabetes. Definitive diagnosis should be done after delivery.

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Risk factors for hyperglycemia in pregnancy in the DALI study differ by period of pregnancy and OGTT time point

Abstract: In this population, most clinical characteristics associated with GDM/overt diabetes were non-modifiable and differed by pregnancy period and OGTT time point. The identified risk factors can help define the target population for future intervention trials.

Cited by 20 publications

References 36 publications

Height and Risk of Gestational Diabetes Mellitus: Results from the Healthy Baby Cohort Study

Height and Risk of Gestational Diabetes Mellitus: Results from the Healthy Baby Cohort Study

The Effects of Lifestyle and/or Vitamin D Supplementation Interventions on Pregnancy Outcomes: What Have We Learned from the DALI Studies?

Markers for undiagnosed type 2 diabetes mellitus during pregnancy—A population‐based retrospective cohort study

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