Risk Factors Screening for Gestational Diabetes Mellitus Heterogeneity in Chinese Pregnant Women: A Case–Control Study

Abstract

Ning Wang,1,* Yanqi Peng,1,* Lu Wang,1 Lin Song,2 Bo Sun,2 Junxiang Wei,3 Ting Wang,4 Yang Mi,3 Wei Cui1 1Department of Endocrinology and Second Department of Geriatrics, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China; 2Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an, People’s Republic of China; 3The Second Department of Obstetrics, Northwest Women and Children’s Hospital, Xi’an, People’s Republic of China; 4Department of Respiratory Medicine, Xi’an No.4 Hospital, Xi’an, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yang MiThe Second Department of Obstetrics, Northwest Women and Children’s Hospital, 1616 Yanxiang Road, Xi’an, Shaanxi, 710065, People’s Republic of ChinaTel [phone]Email [email protected] CuiDepartment of Endocrinology and Second Department of Geriatrics, The First Affiliated Hospital of Xi’an Jiaotong University, 277 West Yanta Road, Xi’an, Shaanxi, 710061, People’s Republic of ChinaTel [phone]Email [email protected]: To study the risk factors of gestational diabetes mellitus (GDM) heterogeneity, and to evaluate the correlation between the risk factors and obesity.Methods: We performed a case–control study of 452 women with GDM and 516 women with normal glucose tolerance (NGT) at the first and second trimester. We defined GDM women as GDM-resistance subtype, GDM-dysfunction subtype, and GDM-mixed subtype, according to their simultaneous insulin-release test with predominant insulin-sensitivity defect, insulin-secretion defect, or both defects.Results: We found that higher maternal age, family history of diabetes, the elevated level of fasting blood glucose in the first trimester (≥ 5.1 mmol/L) were risk factors of all GDM subtypes. Pre-pregnancy overweight/obesity and the increased gestational weight gain (GWG) in the first-trimester are risk factors of the GDM-resistance subtype. Indicators including younger age at first menstruation, the elevated levels of alanine aminotransferase (ALT), total bile acid (TBA), triglyceride (TG), and the decreased level of high-density lipoprotein cholesterol (HDL-C) are risk factors of the GDM-resistance subtype. However, the associations between those risk factors and GDM-resistance subtype attenuated after adjusted by pre-pregnancy body mass index (pre-BMI) and gestational weight gain (GWG) in the first trimester. Nonalcoholic fatty liver disease (NAFLD) and the improved level of TG are independent risk factors for the GDM-resistance subtype and the GDM-mixed subtype, respectively.Conclusion: Women with GDM exhibited heterogeneity based on glycemic physiology and their risk factors are not all the same. Some obesity-related risk factors are specific to the GDM-resistance subtype, which are mediated by pre-pregnancy overweight/obesity and the elevated GWG the first-trimester.Keywords: pregnancy, pre-pregnancy BMI, gestational weight gain, obesity, insulin resistance, insulin secretion

Keywords

• pregnancy
• pre-pregnancy bmi
• gestational weight gain
• obesity
• insulin resistance
• insulin secretion