Abstract
Despite the importance of pre-pregnancy body mass index (BMI) and a history of gestational diabetes mellitus (GDM) in the progression of GDM to type 2 diabetes, few studies have evaluated the combined effect of high pre-pregnancy BMI and GDM status on the future development of type 2 diabetes in Korean women. This study aimed to examine the relationship of pre-pregnancy BMI and GDM history with the risk of type 2 diabetes among Korean women. In addition, the effects of pre-pregnancy BMI and current BMI on the risk of type 2 diabetes were evaluated. Women who gave birth in the Health Examinees Study of the Korean Genome and Epidemiology Study from 2004 to 2013 (n = 59,258) were included in this study. Multivariable logistic regression was used to examine the association of pre-pregnancy BMI categories (underweight: <18.5 kg/m2; normal: 18.5–22.9 kg/m2; overweight: 23.0–24.9 kg/m2; obese: ≥25.0 kg/m2) and GDM history with the risk of type 2 diabetes after controlling for the following covariates: age, education, income, smoking status before the first pregnancy, alcohol consumption, regular exercise, menarche age, first pregnancy age, and first pregnancy outcome. Compared to women with normal pre-pregnancy BMIs, women with overweight and obese pre-pregnancy BMIs had higher odds of developing type 2 diabetes (adjusted odds ratio [AOR]: 1.13, 95% confidence interval [CI]: 1.02–1.25 and AOR: 1.29, 95% CI: 1.10–1.50, respectively) after controlling for covariates. Women with pre-pregnancy BMIs <23 kg/m2 and current BMIs ≥23 kg/m2 had increased odds of developing type 2 diabetes (AOR: 1.64, 95% CI: 1.51–1.78) compared to those with pre-pregnancy BMIs <23 kg/m2 and current BMIs <23 kg/m2. Among women without a history of GDM, those with overweight and obese pre-pregnancy BMIs had increased odds of developing type 2 diabetes compared to those with normal pre-pregnancy BMIs (AOR: 1.12, 95% CI: 1.01–1.24 and AOR: 1.23, 95% CI: 1.05–1.44, respectively). Among women with GDM, those with obese pre-pregnancy BMIs had increased odds of developing type 2 diabetes (AOR: 3.84, 95% CI: 1.52–9.87). This study showed that there was a higher likelihood of developing type 2 diabetes in women who were overweight or obese before pregnancy with a history of GDM compared to their counterparts without a history of GDM. Furthermore, high pre-pregnancy BMI or high current BMI increased the risk of type 2 diabetes in Korean women, regardless of GDM history. This emphasizes the importance of maintaining a healthy weight status before and after pregnancy to prevent the future risk of type 2 diabetes.
Highlights
Gestational diabetes mellitus (GDM) is defined as glucose intolerance that is first identified during pregnancy [1], and its prevalence has increased globally over the past 10–20 years [2, 3]
Compared to women with normal pre-pregnancy body mass index (BMI), those with obese pre-pregnancy BMIs had higher odds of GDM (AOR: 1.63, 95% Confidence interval (CI): 1.05–2.55) after controlling for the following covariates: age, education, income, smoking status before the first pregnancy, alcohol consumption, physical activity, menarche age, first pregnancy age, and first pregnancy outcome
Compared to women with normal pre-pregnancy BMIs, those with overweight and obese prepregnancy BMIs had higher odds of developing type 2 diabetes (AOR: 1.13, 95%: 1.02–1.25 and Adjusted odds ratio (AOR): 1.29, 95% CI: 1.10–1.50, respectively) after controlling for the same covariates
Summary
Gestational diabetes mellitus (GDM) is defined as glucose intolerance that is first identified during pregnancy [1], and its prevalence has increased globally over the past 10–20 years [2, 3]. The most important modifiable risk factor for GDM is pre-pregnancy body mass index (BMI) [17, 18]. A previous study showed that every unit increase in pre-pregnancy BMI was associated with significantly shorter cord blood telomere length and placental telomere length in a large birth cohort [19]. This indicated that pre-pregnancy weight might influence longevity in the offspring. Pre-pregnancy BMI may be one of the most important modifiable environmental factors that may dictate the life expectancy of and brain development in newborns, and their later health status and risk of chronic diseases [19, 20]
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