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09.12.2019 | Article

Longitudinal changes in glucose metabolism in women with gestational diabetes, from late pregnancy to the postpartum period

verfasst von: Thaddeus P. Waters, Shin Y. Kim, Andrea J. Sharma, Pamela Schnellinger, Janet K. Bobo, Robert T. Woodruff, Lisa A. Cubbins, Mary Haghiac, Judi Minium, Larraine Presley, Honor Wolfe, Sylvie Hauguel-de Mouzon, William Adams, Patrick M. Catalano

Erschienen in: Diabetologia | Ausgabe 2/2020

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Abstract

Aims/hypothesis

This study aimed to determine, in women with gestational diabetes (GDM), the changes in insulin sensitivity (Matsuda Insulin Sensitivity Index; IS_OGTT), insulin response and disposition index (DI) from late pregnancy (34–37 weeks gestation, T1), to early postpartum (1–5 days, T2) and late postpartum (6–12 weeks, T3). A secondary aim was to correlate the longitudinal changes in maternal lipids, adipokines, cytokines and weight in relation to the changes in IS_OGTT, insulin response and DI.

Methods

IS_OGTT, insulin response and DI were calculated at the three time points (T1, T2 and T3) using the results of a 75 g OGTT. Adipokines, cytokines and lipids were measured prior to each OGTT. Linear mixed-effects models were used to compare changes across each time point. Changes in IS_OGTT, insulin response and DI were correlated with changes in maternal adipokines, cytokines and lipids at each time point.

Results

A total of 27 women completed all assessments. Compared with T1, IS_OGTT was 11.20 (95% CI 8.09, 14.31) units higher at 1–5 days postpartum (p < 0.001) and was 5.49 (95% CI 2.38, 8.60) units higher at 6–12 weeks postpartum (p < 0.001). Compared with T1, insulin response values were 699.6 (95% CI 957.5, 441.6) units lower at T2 (p < 0.001) and were 356.3 (95% CI 614.3, 98.3) units lower at T3 (p = 0.004). Compared with T1, the DI was 6434.1 (95% CI 2486.2, 10,381.0) units higher at T2 (p = 0.001) and was 4262.0 (95% CI 314.6, 8209.3) units higher at T3 (p = 0.03). There was a decrease in mean cholesterol, triacylglycerol, LDL-cholesterol and VLDL-cholesterol from T1 to T2 (all p < 0.001), and an increase in mean C-reactive protein, IL-6 and IL-8 from T1 to T2 (all p < 0.001). Mean leptin decreased from T1 to T2 (p = 0.001). There was no significant change in mean adiponectin (p = 0.99) or TNF-α (p = 0.81) from T1 to T2. The mean maternal BMI decreased from T1 to T2 (p = 0.001) and T3 (p < 0.001). There were no significant correlations between any measure of change in IS_OGTT, insulin response and DI and change in maternal cytokines, adipokines, lipids or weight from T1 to T2.

Conclusions/interpretation

In women with GDM, delivery was associated with improvement in both insulin sensitivity and insulin production within the first few days. Improvement in insulin production persisted for 6–12 weeks, but insulin sensitivity deteriorated slightly. These changes in glucose metabolism were not associated to changes in lipids, leptin, inflammation markers or body weight.

Trial registration

ClinicalTrials.gov NCT02082301

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Titel: Longitudinal changes in glucose metabolism in women with gestational diabetes, from late pregnancy to the postpartum period
verfasst von: Thaddeus P. Waters
Shin Y. Kim
Andrea J. Sharma
Pamela Schnellinger
Janet K. Bobo
Robert T. Woodruff
Lisa A. Cubbins
Mary Haghiac
Judi Minium
Larraine Presley
Honor Wolfe
Sylvie Hauguel-de Mouzon
William Adams
Patrick M. Catalano
Publikationsdatum: 09.12.2019
Verlag: Springer Berlin Heidelberg
Erschienen in: Diabetologia / Ausgabe 2/2020
Print ISSN: 0012-186X
Elektronische ISSN: 1432-0428
DOI: https://doi.org/10.1007/s00125-019-05051-0

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