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

Ning Wang; Yanqi Peng; Lu Wang; Lin Song; Bo Sun; Junxiang Wei; Ting Wang; Yang Mi; Wei Cui

doi:10.2147/DMSO.S295071

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

Diabetes Metab Syndr Obes. 2021 Mar 2:14:951-961. doi: 10.2147/DMSO.S295071. eCollection 2021.

Authors

Ning Wang^#¹, Yanqi Peng^#¹, Lu Wang¹, Lin Song², Bo Sun², Junxiang Wei³, Ting Wang⁴, Yang Mi³, Wei Cui¹

Affiliations

¹ Department of Endocrinology and Second Department of Geriatrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China.
² Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, People's Republic of China.
³ The Second Department of Obstetrics, Northwest Women and Children's Hospital, Xi'an, People's Republic of China.
⁴ Department of Respiratory Medicine, Xi'an No.4 Hospital, Xi'an, People's Republic of China.

^# Contributed equally.

Abstract

Purpose: 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: gestational weight gain; insulin resistance; insulin secretion; obesity; pre-pregnancy BMI; pregnancy.

Grants and funding

This work was supported by the Natural Science Foundation of Shaanxi Province (No. 2020GXLH-Y-029, 2019JQ069, 2019JM262), the Bethune-Merck Diabetes Research Foundation (No. G-X-2019-056), the Clinical Research Award of the First Affiliated Hospital of Xi’an Jiaotong University, China (No. XJTU1AF-CRF-2019-007), the Natural Science Foundation of China (No. 81801459; No. 81741079; No. 82071732), the Natural Science Foundation for Postdoctoral Scientists of China (No. 2018M641001, No. 2016M600799), the Fundamental Research Funds for the Central University (No. Z20186124, Z201704129).