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23.07.2019 | Article

Characteristics and pregnancy outcomes across gestational diabetes mellitus subtypes based on insulin resistance

verfasst von: Katrien Benhalima, Paul Van Crombrugge, Carolien Moyson, Johan Verhaeghe, Sofie Vandeginste, Hilde Verlaenen, Chris Vercammen, Toon Maes, Els Dufraimont, Christophe De Block, Yves Jacquemyn, Farah Mekahli, Katrien De Clippel, Annick Van Den Bruel, Anne Loccufier, Annouschka Laenen, Caro Minschart, Roland Devlieger, Chantal Mathieu

Erschienen in: Diabetologia | Ausgabe 11/2019

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Abstract

Aims/hypothesis

This study aimed to determine the characteristics and pregnancy outcomes across different subtypes of gestational diabetes mellitus (GDM) based on insulin resistance.

Methods

GDM subtypes were defined in 1813 pregnant women from a multicentre prospective cohort study, stratified according to insulin resistance, based on Matsuda index below the 50th percentile of women with normal glucose tolerance (NGT), during a 75 g OGTT at 24–28 weeks’ gestation. GDM was diagnosed in 12.4% (n = 228) of all participants based on the 2013 WHO criteria.

Results

Compared with women with NGT (1113 [61.4%] of the total cohort) and insulin-sensitive women with GDM (39 [17.1%] women with GDM), women with GDM and high insulin resistance (189 [82.9%] women with GDM) had a significantly higher BMI, systolic BP, fasting plasma glucose (FPG), fasting total cholesterol, LDL-cholesterol and triacylglycerol levels in early pregnancy. Compared with women with NGT, insulin-sensitive women with GDM had a significantly lower BMI but similar BP, FPG and fasting lipid levels in early pregnancy. Compared with women with NGT, women with GDM and high insulin resistance had higher rates of preterm delivery (8.5% vs 4.7%, p = 0.030), labour induction (42.7% vs 28.1%, p < 0.001), Caesarean section (total Caesarean sections: 28.7% vs 19.4%, p = 0.004; emergency Caesarean sections: 16.0% vs 9.7%, p = 0.010), neonatal hypoglycaemia (15.4% vs 3.5%, p < 0.001) and neonatal intensive care unit admissions (16.0% vs 8.9%, p = 0.003). In multivariable logistic regression analyses using different models to adjust for demographics, BMI, FPG, HbA_1c, lipid levels and gestational weight gain in early pregnancy, preterm delivery (OR 2.41 [95% CI 1.08, 5.38]) and neonatal hypoglycaemia (OR 4.86 [95% CI 2.04, 11.53]) remained significantly higher in women with GDM and high insulin resistance compared with women with NGT. Insulin-sensitive women with GDM had similar pregnancy outcomes as women with NGT. The need for insulin treatment during pregnancy and the rate of glucose intolerance in the early postpartum period were not significantly different among the GDM subtypes.

Conclusions/interpretation

GDM with high insulin resistance represents a more adverse metabolic profile with a greater risk of adverse pregnancy outcomes.

Nur mit Berechtigung zugänglich

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Titel: Characteristics and pregnancy outcomes across gestational diabetes mellitus subtypes based on insulin resistance
verfasst von: Katrien Benhalima
Paul Van Crombrugge
Carolien Moyson
Johan Verhaeghe
Sofie Vandeginste
Hilde Verlaenen
Chris Vercammen
Toon Maes
Els Dufraimont
Christophe De Block
Yves Jacquemyn
Farah Mekahli
Katrien De Clippel
Annick Van Den Bruel
Anne Loccufier
Annouschka Laenen
Caro Minschart
Roland Devlieger
Chantal Mathieu
Publikationsdatum: 23.07.2019
Verlag: Springer Berlin Heidelberg
Erschienen in: Diabetologia / Ausgabe 11/2019
Print ISSN: 0012-186X
Elektronische ISSN: 1432-0428
DOI: https://doi.org/10.1007/s00125-019-4961-7

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