Oral Presentation Australasian Diabetes in Pregnancy Society Annual Scientific Meeting 2019

The metabolic phenotypes of early onset gestational diabetes mellitus (GDM) and their association with adverse pregnancy outcomes (#13)

Jincy Immanuel 1 , David Simmons 1 , Jürgen Harreiter 2 , Gernot Desoye 3 , Juan M Adelantado 4 , Rosa Corcoy 4 , Roland Devlieger 5 , Sander Galjaard 5 , Annunziata Lapolla 6 , Maria G Dalfra 6 , Alessandra Bertolotto 7 , Ewa Wender-Ozegowska 8 , Agnieszka Zawiejska 8 , Alexandra Kautzky-Willer 2 , Fidelma P Dunne 9 , Peter Damm 10 , Elisabeth R Mathiesen 10 , Dorte M Jensen 11 , Lise Lotte T Andersen 12 , David J Hill 13 , Judith GM Jelsma 14 , Frank J Snoek 15 , Mireille NM van Poppel 14
  1. School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
  2. Department of Medicine III, Division of Endocrinology, Gender Medicine Unit Medical University of Vienna , Vienna, Austria
  3. Department of Obstetrics and Gynecology, Medizinische Universitaet Graz, Graz, Austria
  4. Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
  5. KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Leuven, Belgium
  6. Universita Degli Studi di Padova, Padua, Italy
  7. Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
  8. Division of Reproduction, Medical Faculty I, Poznan University of Medical Sciences, Poznan, Poland
  9. National University of Ireland, Galway, Ireland
  10. Center for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, Copenhagen, Denmark
  11. Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
  12. Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
  13. Recherche en Santé Lawson SA, St. Gallen, Switzerland
  14. Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands
  15. Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Psychology, Amsterdam, The Netherlands

Objective: We described the metabolic phenotypes of early-onset gestational diabetes mellitus (GDM) and their association with adverse pregnancy outcomes.

Methods: This study is a secondary analysis of the vitamin D and lifestyle intervention for GDM prevention (DALI) trial. In pregnant women (BMI ≥29kg/m2) with early GDM (<20 weeks), insulin sensitivity and secretion were estimated using the homeostasis model assessment for insulin resistance (HOMA-IR) and Stumvoll first phase indices, respectively. Dichotomizing the median values in women with normal glucose tolerance (NGT), GDM women were classified into 3 groups: GDM-R (insulin resistance alone), GDM-S (secretion impairment alone), and GDM-B (a combination of both). GDM was treated according to local protocols.

Results: In the 902 women included, the GDM rate was 27.7% before 20 weeks. Compared with women in the NGT group (n = 652), women in the GDM-R group (n = 145) had higher BMI and fasting and post-load glucose values and insulin levels. Women in this group were at greater risk of having large for gestational age babies (adjusted odds ratio [aOR] = 2.98 [1.47–6.07]) and cesarean section (aOR = 2.59 [1.39–4.81]) than those in the NGT group. Women in the GDM-B group (n = 62) experienced the highest fasting and 2-hour glucose values, and their neonates were more likely to develop small for gestational age (aOR = 3.44 [1.19–9.98]) and hyperbilirubinemia (aOR = 4.97 [1.69–14.63]) than those of women in the NGT group. Pregnancy outcomes were similar in both GDM-S (n = 37) and NGT groups.

Conclusion: Pregnancy outcomes among women with an early diagnosis of GDM differed dependent upon their underlying pathophysiology.