Abstract
Gestational diabetes mellitus (GDM) is associated with a high risk of developing type 2 diabetes (T2DM) and cardiovascular disease (CVD). Identifying among GDM women those who are at high risk may help prevent T2DM and, possibly CVD. Several studies have shown that in women with GDM, hyperglycemia at 1 h during an oral glucose tolerance test (OGTT) (1-h PG) is not only associated with an increase in adverse maternal and perinatal outcomes but is also an independent predictor of T2DM. Interestingly, also in pregnant women who did not meet the criteria for a GDM diagnosis, 1-h PG was an independent predictor of postpartum impaired insulin sensitivity and beta-cell dysfunction. Moreover, maternal 1- and 2-h PG levels have been found to be independently associated with insulin resistance and impaired insulin secretion also during childhood. There is evidence that hyperglycemia at 1h PG during pregnancy may identify women at high risk of future CVD, due to its association with an unfavorable CV risk profile, inflammation, arterial stiffness and endothelial dysfunction. Overall, hyperglycemia at 1h during an OGTT in pregnancy may be a valuable prediction tool for identifying women at a high risk of future T2DM, who may then benefit from therapeutic strategies aimed at preventing cardiovascular outcomes.
Highlights
2-h PG levels were not found significant predictors of postpartum impaired glucose tolerance (IGT) (2 h: OR, 1.001; 95% CI, 0.980–1.023; P = 0.9) [16]. These results suggest that elevated 1-h post-load glucose concentration (1-h PG) levels in women with Gestational diabetes mellitus (GDM) may be a valuable prediction tool for identifying women at risk for future T2DM
Taken together with the data reported in pregnancy and in women with previous GDM (p-GDM), it is tempting to suggest that hyperglycemia at 1 h during an oral glucose tolerance test (OGTT) may identify a sizable proportion of subjects, who are at increased risk to develop T2DM, and its related cardiovascular complications
Several studies have observed the relationship between GDM and future risk of cardiovascular disease (CVD), highlighting the importance of early preventive intervention, as well as the promotion of a healthy lifestyle [4, 9, 61]
Summary
Gestational diabetes mellitus (GDM) is a clinical condition characterized by a pancreatic beta-cell dysfunction responsible for an insufficient insulin secretion that is unable to compensate for the progressive insulin resistance that characterizes the latter half of gestation [1, 2]. Numerous studies have provided evidence for an independent association between PG levels during an OGTT in pregnancy and adverse maternal and neonatal outcomes [10, 28,29,30,31]. In this scenario, the glucose value at 1 h during an OGTT may represent a useful early biomarker to recognize women with worse adverse outcomes. The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study, a clinical trial conducted on a large cohort of pregnant women, showed a highly significant association between maternal fasting and post-load glucose values and increased birth weight as well as higher cord-blood serum Cpeptide levels [28]. In the HAPO cohort, it has been shown that in addition to glucose levels maternal metabolome was associated with
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