Combined analysis of gestational diabetes and maternal weight status from pre-pregnancy through post-delivery in future development of type 2 diabetes

Ling-Wei Chen,Keith M Godfrey,Johan G Eriksson,Peter D Gluckman,See Ling Loy,Kok Hian Tan,Mya-Thway Tint,Lynette Pei-Chi Shek,Fabian Yap,Yap-Seng Chong,Yung Seng Lee,Shiao-Yng Chan,Shu E Soh

doi:10.1038/s41598-021-82789-x

Abstract

We examined the associations of gestational diabetes mellitus (GDM) and women’s weight status from pre-pregnancy through post-delivery with the risk of developing dysglycaemia [impaired fasting glucose, impaired glucose tolerance, and type 2 diabetes (T2D)] 4–6 years post-delivery. Using Poisson regression with confounder adjustments, we assessed associations of standard categorisations of prospectively ascertained pre-pregnancy overweight and obesity (OWOB), gestational weight gain (GWG) and substantial post-delivery weight retention (PDWR) with post-delivery dysglycaemia (n = 692). Women with GDM had a higher risk of later T2D [relative risk (95% CI) 12.07 (4.55, 32.02)] and dysglycaemia [3.02 (2.19, 4.16)] compared with non-GDM women. Independent of GDM, women with pre-pregnancy OWOB also had a higher risk of post-delivery dysglycaemia. Women with GDM who were OWOB pre-pregnancy and had subsequent PDWR (≥ 5 kg) had 2.38 times (1.29, 4.41) the risk of post-delivery dysglycaemia compared with pre-pregnancy lean GDM women without PDWR. No consistent associations were observed between GWG and later dysglycaemia risk. In conclusion, women with GDM have a higher risk of T2D 4–6 years after the index pregnancy. Pre-pregnancy OWOB and PDWR exacerbate the risk of post-delivery dysglycaemia. Weight management during preconception and post-delivery represent early windows of opportunity for improving long-term health, especially in those with GDM.

Highlights

We examined the associations of gestational diabetes mellitus (GDM) and women’s weight status from pre-pregnancy through post-delivery with the risk of developing dysglycaemia [impaired fasting glucose, impaired glucose tolerance, and type 2 diabetes (T2D)] 4–6 years post-delivery
We aimed to describe, for the first time in a general multi-ethnic Asian population who were universally screened for GDM, the incidence of new onset pre-diabetes and T2D within 4–6 years of an index pregnancy complicated by GDM, compared to those who had normal glucose tolerance in pregnancy
Family history of diabetes, smoking status, breastfeeding duration and peri-pregnancy body mass index (BMI) were comparable between the groups (Supplemental Table 3)

Summary

Introduction

We examined the associations of gestational diabetes mellitus (GDM) and women’s weight status from pre-pregnancy through post-delivery with the risk of developing dysglycaemia [impaired fasting glucose, impaired glucose tolerance, and type 2 diabetes (T2D)] 4–6 years post-delivery. Previous meta-analyses involving mostly studies in European and North American populations suggested that maternal overweight/obesity and increased gestational weight gain are associated with a higher risk of GDM10,11 It was unclear if an elevated weight acts as a confounder or adds additional risk to the development of future T2D following a GDM-complicated pregnancy. One study showed that among Chinese women with a history of GDM, pre-pregnancy obesity and substantial post-delivery weight gain elevated the risk for developing T2D and prediabetes at 1–5 years after d elivery[12]; this study did not investigate gestational weight gain nor quantify the additive risks of all these factors (GDM and weight status) combined. Weight status and weight-change of women from pre-conception, through pregnancy and to years after delivery should be considered in combination to identify critical window periods to target for most cost-effective intervention

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