Absence Of Gestational Diabetes Mellitus Research Articles

Maternal glucose homeostasis during pregnancy in women with overweight or obesity and offspring metabolic health

Gestational diabetes mellitus (GDM) adversely affects offspring glucose homeostasis and risk of developing obesity. Here, we examined the association between glycemia in pregnant women with overweight or obesity without GDM and offspring metabolic health. Maternal fasting glucose concentrations and glucose 2-h after an oral glucose tolerance test (OGTT) were measured in 208 women with a pre-pregnancy body mass index (BMI) of 28–45 kg/m2 without GDM. Offspring outcomes were collected at birth, 3, and 5 years of age. Linear mixed models with time as fixed factor and subject ID as random effects were used for analysis. No associations were found between maternal fasting or 2-h glucose concentrations with offspring glucose and insulin concentrations from birth to 5 years of age. However, maternal fasting glucose in GW 28 and 36, and 2-h OGTT glucose in GW 28 were positively associated with C-peptide concentration at birth. Maternal fasting glucose concentrations in GW 28 and 36 were positively associated with weight-for-length, and maternal fasting glucose in GW 36 was associated with BMI z-score at birth. In summary, blood glucose in pregnant women with overweight or obesity is positively associated with offspring C-peptide concentration, weight-for-length, and BMI z-score at birth, even in the absence of GDM.

Time to Move Beyond a Binary Criterion for Gestational Diabetes?

Over the years, several international guidelines have been developed by specialist organizations for the diagnosis of gestational diabetes mellitus (GDM). However, these guidelines vary and lack consensus on what level of glycemia defines GDM and worryingly, there is now evidence of over- or- under-diagnosis of women with GDM by current criteria. Towards this end, the National Priorities Research Program (NPRP) funded a program of research aimed at elucidating the problem with GDM diagnosis. It was determined, on completion of the project, that the solution required diagnosis of graded levels of dysglycemia in pregnancy and not just a diagnosis of presence or absence of GDM. A new diagnostic criterion (called the NPRP criterion) was created based on a single numerical summary of the three readings from the oral glucose tolerance test (GTT) that diagnosed women in pregnancy into four levels: normal, impaired, GDM and high risk GDM. This paper now examines existing GDM criteria vis-à-vis the NPRP criterion. It is noted that no significant change has happened over the years for existing criteria except for a gradual reduction in the threshold values of individual time-points or the number of time points, bringing us towards over-diagnosis of GDM in pregnancy. The new criterion unifies all readings from the GTT into one numerical value and, because it results in four levels of glycemia, represents a new way forwards for GDM diagnosis and can potentially reduce the rates of under diagnosis and over diagnosis of GDM.

Prevalance of impaired glucose tolerance and its association with adverse perinatal outcomes in non-gestational diabetes pregnancies

Objective: Gestational diabetes mellitus (GDM) is characterized by glucose intolerance with onset during pregnancy and is one of the most common metabolic disorders complicating pregnancy. The aim of this study was to evaluate the risk of maternal and neonatal outcomes in non-gestational diabetes pregnancies with abnormal glucose challenge test (GCT) and abnormal glucose tolerance test (GTT) results.
 
 Methods: In this retrospective cohort study of 2982 singleton pregnancies, all patients underwent a non-fasting 50 g GCT at 24 to 28 weeks of gestation. A GCT cutoff of ≥ 140 mg/dl was selected. Women with an elevated GCT underwent prompt diagnostic testing with a 3-hour GTT. Subjects were divided into four groups according to GCT and GTT results.
 
 Results: There was an impaired glucose tolerance in 19.2 % of patients and 14.7 % of them had mild glucose intolerance and 4.5 % of them had moderate glucose intolerance. As expected, there was statistically significant difference in fetal macrosomia, neonatal hypoglicemia, PE, primary CS, and preterm birth between secreening negative and GDM patients (p < 0.0001). We also observed statistically significant difference in neonatal hypoglicemia (p = 0.0001) and PE (p = 0.0277) between screning negative and mild glucose intolerance group. Moreover, there was a significant difference in fetal macrosomia (p=0.0480) between mild glucose intolerance and moderate glucose intolerance groups.
 
 Conclusion: Compared with screening negative group, mild and moderate glucose intolerance are associated with increased adverse maternal and neonatal outcomes even in the absence of GDM.

Maternal overweight and obesity and its association with metabolic changes and fetal overgrowth in the absence of gestational diabetes mellitus: A prospective cohort study.

Previous studies indicated an association between fetal overgrowth and maternal obesity independent of gestational diabetes mellitus (GDM). However, the underlying mechanisms beyond this possible association are not completely understood. This study investigates metabolic changes and their association with fetal and neonatal biometry in overweight and obese mothers who remained normal glucose-tolerant during gestation. In this prospective cohort study 893 women who did not develop GDM were categorized according to their pregestational body mass index (BMI): 570 were normal weight, 220 overweight and 103 obese. Study participants received a broad metabolic evaluation before 16 weeks and were followed up until delivery to assess glucose levels during the oral glucose tolerance test (OGTT) at mid-gestation as well as fetal biometry in ultrasound and pregnancy outcome data. Increased maternal BMI was associated with an adverse metabolic profile at the beginning of pregnancy, including a lower degree of insulin sensitivity (as assessed by the quantitative insulin sensitivity check index) in overweight (mean difference: -2.4, 95% CI -2.9 to -1.9, p < 0.001) and obese (mean difference: -4.3, 95% CI -5.0 to -3.7, p < 0.001) vs normal weight women. Despite not fulfilling diagnosis criteria for GDM, overweight and obese mothers showed higher glucose levels at fasting and during the OGTT. Finally, we observed increased measures of fetal subcutaneous tissue thickness in ultrasound as well as higher proportions of large-for-gestational-age infants in overweight (18.9%, odds ratio [OR] 1.74, 95% CI 1.08-2.78, p = 0.021) and obese mothers (21.0%, OR 1.99, 95% CI 1.06-3.59, p = 0.027) vs normal weight controls (11.8%). The risk for large for gestational age was further determined by OGTT glucose (60 min: OR 1.11, 95% CI 1.02-1.21, p = 0.013; 120 min: OR 1.13, 95% CI 1.02-1.27, P = 0.025, for the increase of 10 mg/dL) and maternal triglyceride concentrations (OR 1.11, 95% CI 1.01-1.22, p = 0.036, for the increase of 20 mg/dL). Mothers affected by overweight or obesity but not GDM had a higher risk for fetal overgrowth. An impaired metabolic milieu related to increased maternal BMI as well as higher glucose levels at mid-gestation may impact fetal overgrowth in women still in the range of normal glucose tolerance.

Growth differentiation factor‑15 in patients with gestational diabetes mellitus and its relationship with microalbuminuria.

Gestational diabetes mellitus (GDM) is a common pregnancy-related complication and growth differentiation factor-15 (GDF-15) is involved in a number of diseases; therefore, the aim of the present study was to investigate the level and clinical significance of serum GDF-15 levels in patients with GDM. A total of 237 pregnant women at 20-24 weeks of gestation were selected and assigned to a normal pregnancy group (70 patients) and a GDM group (167 patients) according to the presence or absence of GDM. The general clinical data of the two groups were collected. Fasting plasma glucose, 1-h plasma glucose, 2-h plasma glucose, glycated hemoglobin, fasting insulin, 24-h urinary albumin and serum GDF-15 levels were measured. The results showed that the body mass index (BMI) of the GDM group was higher than that of the normal pregnancy group. Fasting plasma glucose, 1-h plasma glucose, 2-h plasma glucose, fasting insulin, glycated hemoglobin and GDF-15 levels and the positive rate of microalbuminuria were significantly higher in the GDM group compared with the normal pregnancy group. GDF-15 levels were positively correlated with BMI, fasting plasma glucose, glycated hemoglobin, homeostasis model assessment-insulin resistance and fasting insulin levels. Logistic regression analysis suggested that elevated GDF-15 levels are an independent risk factor for microalbuminuria. In conclusion, serum GDF-15 levels are strongly associated with GDM and elevated GDF-15 levels are an independent risk factor for microalbuminuria. Serum GDF-15 may act as a novel biomarker for predicting microalbuminuria in GDM patients.

MATERNAL DYSLIPIDEMIA AND OBESITY/GESTATIONAL DIABETES MELLITUS ARE ASSOCIATED AN UPCOMING INVESTIGATION

Background: Maternal dyslipidemia and gestational diabetes are known to be associated, however it is unknownhow obesity plays a role in this interaction. We examined the relationship between fasting lipids at the oral glucosetolerance test (OGTT) in women diagnosed with GDM and maternal obesity at the first prenatal visit.Objectives: The study aims to investigate the relationship between maternal dyslipidemia and gestational diabetesmellitus (GDM), pinpoint risk factors, elucidate procedures, and provide guidance for therapeutic treatments aimedat improving the health of expectant mothers.Study design: A prospective studyDuration and place of study: from jan 2022 to jan 2023 at Dow University Karachi, PakistanMethods: This prospective study was undertaken at Dow University Karachi, which has an annual delivery rateexceeding 150 pupils. At their first prenatal hospital visit, participants who were between the ages of 20 and 45 andhad at least one maternal risk factor for GDM were enlisted. Pregnant women with diabetes mellitus or those whohave had several pregnancies were excluded. To investigate maternal risk factors and GDM outcomes, laboratorytests were carried out, interviews were done, and medical records were examined. In the statistical analysis, logisticregression and descriptive statistics were used to find relationships between risk factors and the development of GDM.The purpose of this study at Dow University Karachi was to ascertain the impact of risk factors on the incidence ofGDM in young women.Results: The features of the research population were classified according to the presence or absence of GDM. 150women consented to participate in the research during their first prenatal visit. The study’s findings demonstrated astrong correlation between maternal traits and the prevalence of gestational diabetes mellitus (GDM). An average oflate adolescence and a younger mother age indicated a greater risk of GDM. It was noted that maternal obesity wasprevalent among individuals who had GDM and that it posed a significant risk. GDM risk was linked to specificrisk factors like a family history of diabetes mellitus, a prior diagnosis of GDM, and a high body mass index.Additionally, elevated fasting cholesterol, particularly triglycerides, and total cholesterol were particularly high in theGDM group, highlighting the importance of maternal cholesterol. These results emphasise the complexity of GDMdevelopment and the need of focused preventive measures.Conclusion: The study looked at the link between maternal dyslipidemia and gestational diabetes mellitus (GDM),emphasizing the impact obesity plays in this interaction. Although the study’s goals and methods are explained inthe abstract, the findings are regrettably not shared. However, the study has the potential to further our knowledgeof the intricate interactions among maternal Obesity, dyslipidemia, and GDM. These results may have significantramifications for identifying pregnant women who are at risk and creating focused treatments to enhance the health ofpregnant moms and their unborn children. The study’s benefits to maternal healthcare must be fully appreciated bymore Study and a comprehensive presentation of the findings.Keywords: maternal dyslipidemia, gestational diabetes mellitus (GDM), and pregnancy complications

Factores de riesgo asociados a diabetes mellitus gestacional en la región norte de México

ObjectiveTo determine the risk factors associated with gestational diabetes mellitus in northern México. DiseñoObservational, analytical case-control study. SiteFamily Medicine Unit No. 33 in Reynosa, Tamaulipas, México. ParticipantsPregnant women between 24 to 28 gestational weeks. Interventions363 cases and 587 controls underwent a one-step test with an oral intake of 75 grams of glucose with basal determination, at one hour and 2 hours to determine the presence or absence of gestational diabetes. From the electronic medical record; sociodemographic, anthropometric, gynecologic, obstetric, pathological and non-pathological variables were collected. Main measurementsA univariate exploratory analysis was performed using the sample mean and standard deviation to find out the centrality and dispersion. Subsequently, a bivariate analysis was performed to determine association and correlation of the variables of interest with the presence or absence of gestational diabetes mellitus. Lastly, an integral logistic model was performed with the independent variables to determine its effects and statistical significance. ResultsAge of the cases was 30.46 years, 4 years older than the controls; weight of 78.82 kilograms, 10 kilograms more than controls. Obstetric risk of 6.34 in cases and 4.69 in controls. Age older than 30 years had an OR 5.15 (CI 1.77-15) for gestational diabetes. Overweight OR 4.53 (CI 2.56-8.03), obesity class I OR 10.03 (CI 5.59-18), obesity class II OR 16.11 (CI 8.36-31.04) and obesity class III OR 16.91 (CI 6.86-41.68). ConclusionsWomen with gestational diabetes have a higher age, weight and obstetric risk. The main risk factors associated with gestational diabetes were age and obesity.

Don't sugar coat it: The independent and synergistic impacts of obesity and gestational diabetes on placental parameters.

Don't sugar coat it: The independent and synergistic impacts of obesity and gestational diabetes on placental parameters.

Risk factors for gestational diabetes mellitus in pregnant women with chronic HBV infection and its influence on maternal and fetal outcomes

Objective To investigate the factors for gestational diabetes mellitus (GDM) in pregnant women with chronic hepatitis B virus (HBV) infection, their pregnancy outcome, and related influence on neonates. Methods A retrospective analysis was performed for 317 pregnant women with chronic HBV infection who were treated, gave birth, and were followed up in Beijing YouAn Hospital, Capital Medical University, from January to December 2017, and according to the presence or absence of GDM, they were divided into chronic HBV+GDM group and chronic HBV control group. Related data were recorded, including HBV serology, liver function, HBV DNA quantification, pregnancy comorbidities, mode of delivery, and the condition of neonates at birth. The t-test or t′-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test or the Fisher's exact test was used for comparison of categorical data between two groups; a binary logistic regression analysis was used to investigate the risk factors for GDM in mothers with chronic HBV infection. Results Among the 317 mothers, 64 (20.19%) had chronic HBV infection and GDM, and there were 253 mothers (79.81%) in the control group. Compared with the control group, the chronic HBV+GDM group had significantly higher age (Z=-2.652, P Conclusion HBV DNA quantification and old age are risk factors for GDM in mothers with chronic HBV infection, and GDM in pregnant women with chronic HBV infection may increase the incidence rate of premature rupture of membranes, fetal intrauterine distress, and premature delivery.

Improvement of glucose metabolism in pregnant women through probiotic supplementation depends on gestational diabetes status: meta-analysis

The aim of this study was to assess the effects of probiotic and synbiotic supplementation on glucose metabolism in pregnant women using data from randomized controlled trials. Furthermore, this meta-analysis examines whether the observed effects depend on the presence or absence of gestational diabetes mellitus (GDM), and if the effect is dependent on the type of supplement used (probiotic or synbiotic). We performed a literature search of databases (Medline, Scopus, Web of Knowledge, and Cochrane Library) and identified all relevant randomized controlled trials (RCTs) published prior to May 2019. We compared the effects of probiotic supplementation with the administration of placebos in pregnant women with and without GDM. The systematic review and meta-analysis protocol were registered in the International Prospective Register of Systematic Reviews as number CRD 42019111467. 1119 study participants from 15 selected studies were included. The participants in four studies did not have GDM (being recruited to the study before week 20 of pregnancy) and the participants in the rest of the studies were diagnosed with GDM between weeks 24 and 28 of gestation. The meta-analysis showed that supplementation lowers serum glucose, insulin levels, and HOMA-IR index, but only in pregnant women with GDM. Moreover, both probiotics and synbiotics lower serum insulin level and HOMA-IR index, but the glucose lowering effect is specific only to probiotics and not synbiotics. Probiotic supplementation may improve glucose metabolism in pregnant women with GDM. There is a need for more RCT studies with larger groups to better estimate this effect.

Relationship between 50-g glucose challenge test and large for gestational age infants among pregnant women without gestational diabetes

The study aimed to compare the incidence of large for gestational age (LGA) infants between women with a false positive and normal glucose challenge test (GCT), and to evaluate the factors associated with LGA. A total of 480 pregnant women at risk for gestational diabetes mellitus (GDM); 160 with a false positive GCT and 320 with normal GCT results were included. The incidence of LGA and other pregnancy outcomes were compared between the two groups. Possible associated factors for LGA were also evaluated. Women with a false positive GCT were significantly older and more likely to be multiparous. The incidence of LGA was comparable between the false positive and normal GCT groups (15.6% vs. 13.1%, p = .456). Other pregnancy outcomes were also comparable. Logistic regression analysis showed that pre-pregnancy underweight significantly reduced the risk of LGA (adjusted OR 0.25, 95% CI 0.07–0.87, p = .029) while a second trimester weight gain >7 kg significantly increased the risk of LGA (adjusted OR 3.13, 95% CI 1.67–5.89, p < .001).Impact StatementWhat is already known on this subject? Women with a false-positive GCT (abnormal GCT but normal OGTT) can be considered as having an early form of glucose intolerance which similar adverse outcomes to GDM could develop. Previous studies have reported that a mild maternal hyperglycaemia in the absence of GDM is associated with LGA, macrosomia, shoulder dystocia and a caesarean delivery. There is no current recommendation for any intervention or treatment among women with a false positive GCT.What the results of this study add? The results of this study showed that an incidence of LGA was not significantly increased in the false positive GCT groups and that other pregnancy outcomes were comparable. A pre-pregnancy underweight significantly reduced the risk of LGA while a second trimester weight gain >7 kg significantly increased the risk of LGA.What the implications are of these findings for clinical practice and/or further research? As a gestational weight gain is modifiable, behavioural and a dietary intervention as well as a close monitoring of the weight gain could help in lowering the risk of LGA, even in the absence of GDM. Further studies which are more widely generalisable are needed to elucidate the relationship between 50 g GCT and the adverse outcomes and to investigate the benefits of a specific intervention among this specific group of women.

Salivary Adiponectin and Leptin Levels are Increased in Women with Gestational Diabetes Mellitus and Gingival Inflammation.

Gestational diabetes mellitus (GDM) is defined as glucose intolerance with first onset or diagnosis in pregnancy. This study evaluated clinical and biochemical parameters in a possible association between GDM and gingival inflammation. A total of 87 pregnant women - 44 with GDM and 43 without (NGDM) - were included. Subgroups were created according to gingival inflammation. Plaque index (PI), bleeding on probing (BOP), and probing depth (PD) were recorded. Age, anthropometric variables and baby weight (g) were all statistically significantly higher in the GDM group (p < 0.0001). Systolic and diastolic blood pressure (mmHg), saliva, serum leptin and adiponectin levels were similar in the GDM and NGDM groups (p = 0.605, p = 0.662, p = 0.737, and p = 0.596, respectively). Salivary adiponectin levels were statistically significantly higher in the two subgroups with gingivitis compared to those with clinically healthy periodontium (p < 0.01). Serum adiponectin levels were statistically significantly higher in the NGDM subgroup with gingivitis than the NGDM group with clinically healthy periodontium (p < 0.05). Statistically significant positive correlations were found between PD, PI, BOP and saliva adiponectin levels in the GDM group (p < 0.05). Positive correlations were also found between clinical periodontal parameters and saliva, serum levels of adiponectin in the control group without GDM (p < 0.05). The higher salivary adiponectin levels in the gingivitis groups suggest that gingival inflammation is more likely to influence local inflammatory parameters both in the presence and absence of GDM. Further larger-scale studies are required to better clarify the possible interactions between gingival inflammation and GDM.

Delivery outcomes of large-for-gestational-age newborns stratified by the presence or absence of gestational diabetes mellitus.

To evaluate separate and combined contributions of gestational diabetes mellitus (GDM) and large-for-gestational age (LGA) on delivery outcomes. In a retrospective cohort study of term singleton deliveries between 2007 and 2014 in Tel Aviv, Israel, outcomes were compared between non-GDM/AGA pregnancies (reference) and three study groups: non-GDM/LGA, GDM/appropriate for gestational age (AGA) and GDM/LGA. Overall, there were 62102 deliveries, of which 53201 (85.7%) were eligible for inclusion. Of these, 43775 (82.3%) were non-GDM/AGA, 6441 (12.1%) non-GDM/LGA, 2351 (4.4%) GDM/AGA, and 634 (1.2%) GDM/LGA. Compared with the reference group, the study groups had higher mean maternal age and higher rates of previous cesarean delivery, polyhydramnios, induction of labor, and cesarean delivery. Considering only women attempting vaginal delivery, the three groups were independently associated with adverse outcomes including cesarean delivery (adjusted odds ratio [aOR], 1.5, 1.6, and 2.6 for non-GDM/LGA, GDM/AGA, and GDM/LGA, respectively), mainly for prolonged first stage of labor, and hypoglycemia (aOR, 1.9, 2.5, and 4.6, respectively). LGA with and without GDM was associated with shoulder dystocia (aOR, 14.5 and 6.9, respectively), prolonged second stage, and jaundice. GDM and LGA share similarities in pregnancy complications. The presence of both has a cumulative impact.

The Effects of Mild Gestational Hyperglycemia on Exclusive Breastfeeding Cessation.

Gestational diabetes increases the risk of a range of adverse perinatal outcomes, including breastfeeding failure, but the best cut-off point for gestational diabetes is unknown. The purpose of this study was to evaluate the association between mild gestational glucose tolerance impairment and the early cessation of exclusive breastfeeding (EBF). This is an observational study of 768 women with full term pregnancies that were screened for gestational diabetes at 24–28 weeks gestation. Subjects were divided into two groups: those with a normal 1-h glucose challenge test and those with an elevated 1-h glucose challenge test but still did not qualify for gestational diabetes. We constructed multivariable logistic regression models using data from 616 women with normal gestational glucose tolerance and 152 women with an isolated positive 1-h glucose challenge test. The risk of early exclusive breastfeeding cessation was found to increase in women with mildly impaired glucose tolerance during pregnancy (adjusted OR, 1.65; 95% CI: 1.11, 2.45). Risks of early EBF cessation were also independently associated with the amount of neonatal weight loss and admission to the neonatal ward. Instead, parity was associated with a decreased risk for shorter EBF duration. Insulin resistance—even in the absence of gestational diabetes mellitus—may be an impeding factor for EBF.

Maternal and Perinatal Outcomes in Women with Insulin Resistance.

Objective This study aims to estimate the risks of adverse maternal and perinatal outcomes in women with insulin resistance below the threshold of gestational diabetes mellitus (GDM). Methods This was a retrospective cohort study of 5,983 women with singleton pregnancies undergoing universal GDM screening between 24 and 28 weeks gestation. Subjects were divided into those with a normal 1-hour glucose challenge test (GCT), those with an elevated GCT with all normal values on a 3-hour glucose tolerance test (GTT), and those with an elevated GCT with one abnormal value on GTT. Outcomes included macrosomia, pregnancy-induced hypertension (PIH), cesarean section and operative delivery, shoulder dystocia, indicated-preterm birth, and other neonatal outcomes. Logistic regression was performed to compare outcomes among groups. Results The risk of macrosomia was increased for those with an elevated GCT and all normal values on GTT (adjusted odds ratio [aOR], 1.71; 95% confidence interval [CI]: 1.12, 1.97), and for those with an elevated GCT and one abnormal value (aOR, 2.69; 95% CI: 1.49, 4.83). Risks of PIH, cesarean section, and indicated-preterm birth were also increased in those with an elevated 1-hour GCT and no GDM. Conclusion There are increased risks of macrosomia, PIH, indicated-preterm birth, and cesarean section among those with insulin resistance even in the absence of GDM.

Insights from the Growing Up in Singapore Towards Healthy Outcomes (GUSTO) Cohort Study

Background: The dramatic emergence of noncommunicable diseases (NCD) in Asia, albeit with ethnic variation, has coincided with the rapid socioeconomic and nutritional transition taking place in the region, with the prevalence of diabetes rising 5-fold in Singapore in less than 4 decades. The Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort study recruited 1,247 expectant mothers of Chinese, Malay, or Indian ethnicity in their first trimester, with detailed longitudinal tracking - through the antenatal period, birth, and the child's first 4 years of life - to examine the potential roles of fetal, developmental, and epigenetic factors in early pathways to metabolic and neurodevelopmental outcomes. Key Messages: A number of findings with a translational and clinical focus have already emerged. In the mothers, we found that changes and differences in food consumption varied across ethnic groups, with persistence of traditional beliefs, during pregnancy and the postpartum period. During pregnancy, higher maternal glucose levels, even in the absence of gestational diabetes mellitus, had graded relations with infant adiposity. Relations between maternal emotional health and birth outcomes and neurodevelopment have been identified. Genotype (25%) and in particular gene × environment interactions (75%) shape interindividual variations in the DNA methylome at birth. The complex effects of fixed genetic variations and different in utero environments can influence the epigenetic status at birth and the later-life phenotype. Conclusions: The richness of the clinical data in 3 ethnicities, the extent of the biospecimen collection, and the extensive infancy and preschool follow-up have allowed us to study the biological pathways that link fetal development to health outcomes. In the coming years, more sophisticated analyses of epigenotype-phenotype relationships will become possible as the children grow and develop. Our studies will lead to the development of clinical and population-based interventions to reduce the burden of NCD.

The Relative Contribution of Prepregnancy Overweight and Obesity, Gestational Weight Gain, and IADPSG-Defined Gestational Diabetes Mellitus to Fetal Overgrowth

OBJECTIVEThe International Association of Diabetes in Pregnancy Study Groups (IADPSG) criteria for diagnosis of gestational diabetes mellitus (GDM) identifies women and infants at risk for adverse outcomes, which are also strongly associated with maternal overweight, obesity, and excess gestational weight gain.RESEARCH DESIGN AND METHODSWe conducted a retrospective study of 9,835 women who delivered at ≥20 weeks’ gestation; had a prenatal, 2-h, 75-g oral glucose tolerance test; and were not treated with diet, exercise, or antidiabetic medications during pregnancy. Women were classified as having GDM based on IADPSG criteria and were categorized into six mutually exclusive prepregnancy BMI/GDM groups: normal weight ± GDM, overweight ± GDM, and obese ± GDM.RESULTSOverall, 5,851 (59.5%) women were overweight or obese and 1,892 (19.2%) had GDM. Of those with GDM, 1,443 (76.3%) were overweight or obese. The prevalence of large-for-gestational-age (LGA) infants was significantly higher for overweight and obese women without GDM compared with their normal-weight counterparts. Among women without GDM, 21.6% of LGA infants were attributable to maternal overweight and obesity, and the combination of being overweight or obese and having GDM accounted for 23.3% of LGA infants. Increasing gestational weight gain was associated with a higher prevalence of LGA in all groups.CONCLUSIONSPrepregnancy overweight and obesity account for a high proportion of LGA, even in the absence of GDM. Interventions that focus on maternal overweight/obesity and gestational weight gain, regardless of GDM status, have the potential to reach far more women at risk for having an LGA infant.

Postpartum Metabolic Function in Women Delivering a Macrosomic Infant in the Absence of Gestational Diabetes Mellitus

OBJECTIVEGestational diabetes mellitus (GDM) is associated with fetal macrosomia and maternal postpartum dysglycemia, insulin resistance, and β-cell dysfunction. Indeed, in practice, a prior pregnancy that resulted in a large-for-gestational-age (LGA) delivery is often considered presumptive evidence of GDM, whether or not it was diagnosed at the time. If this clinical assumption is correct, however, we would expect these women to exhibit postpartum metabolic dysfunction. Thus, to test this hypothesis, we assessed metabolic function during and after pregnancy in a cohort of women stratified according to the presence/absence of GDM and LGA delivery, respectively.RESEARCH DESIGN AND METHODSA total of 562 women underwent metabolic characterization, including oral glucose tolerance test (OGTT), in late pregnancy and at 3 months’ postpartum. The women were stratified into three groups: those with neither GDM nor LGA delivery (nonGDM, n = 364), those without GDM but with LGA delivery (nonGDM–LGA, n = 46), and those with GDM (n = 152).RESULTSOn logistic regression, GDM predicted postpartum glucose intolerance (OR 4.1 [95% CI 2.5–6.8]; P < 0.0001), whereas nonGDM–LGA did not (P = 0.65). At 3 months’ postpartum, the mean adjusted levels of fasting glucose and area under the glucose curve on the OGTT were significantly higher in the GDM women compared with either nonGDM or nonGDM–LGA (all P < 0.05), with no differences between the latter two groups. In a similar manner, mean adjusted insulin sensitivity (Matsuda index) and β-cell function (Insulin Secretion-Sensitivity Index-2) were lower in GDM women compared with either nonGDM or nonGDM–LGA (all P < 0.05), again with no differences between the latter two groups.CONCLUSIONSWomen with nonGDM–LGA do not exhibit postpartum metabolic dysfunction, arguing against the assumption of undiagnosed GDM in these patients.

Retinol-binding protein 4: a novel adipokine implicated in the genesis of LGA in the absence of gestational diabetes mellitus

Adipokines (cytokines produced by adipose tissue) play a major role in the control of body weight and energy distribution. Retinol-binding protein 4 (RBP4), only recently recognized as an adipokine, has been proposed to modulate systemic insulin sensitivity. The goal of this study was to determine whether there is an association between maternal plasma RBP4 concentration and the birth of a large-for-gestational-age (LGA) newborn in women with and without gestational diabetes mellitus (GDM). This cross-sectional study included pregnant women at term in the following groups: 1) normal pregnancy with an appropriate-for-gestational-age (AGA) neonate (n=64); 2) normal pregnancy with an LGA neonate (n=44); 3) GDM with an AGA neonate (n=55); and 4) GDM with an LGA neonate (n=42). Maternal plasma RBP4 concentration was determined by ELISA. Parametric and non-parametric statistics were used for analyses. 1) Patients with GDM, either with AGA or LGA neonates, had a higher median plasma concentration of RBP4 than normal pregnant women who delivered an AGA neonate (P=0.01 and P=0.008, respectively); 2) mothers without GDM but with LGA neonates had a higher median plasma concentration of RBP4 than those with normal pregnancy and AGA newborns (P=0.001); 3) these findings remained significant after adjusting for maternal age, body mass index and gestational age at blood sampling. GDM is characterized by alterations in maternal circulating RBP4 concentrations akin to those of Type 2 diabetes mellitus. RBP4 concentrations in maternal plasma may play a role in accelerated fetal growth in the absence of overt carbohydrate intolerance.

272: Retinol-binding protein-4: a novel adipokine implicated in the genesis of LGA in the absence of gestational diabetes mellitus

272: Retinol-binding protein-4: a novel adipokine implicated in the genesis of LGA in the absence of gestational diabetes mellitus