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Insulin sensitivity, beta-cell function parameters could help characterize gestational diabetes
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In pregnant women, higher degree of obesity could partially explain the insulin resistance affecting early manifestation of gestational diabetes, according to research published the Journal of Clinical Endocrinology & Metabolism.
Beta-cell dysfunction was also detectable in pregnant women with later manifestation of gestational diabetes, pointing to defective compensatory mechanisms developing early in pregnancy, according to researchers.
“We observed significant differences in parameters of insulin sensitivity and beta-cell function, which were partly explained by the degree of overweight or obesity, allowing characterization of women with early and later manifestation of gestational diabetes,” the researchers wrote.
In a prospective study of 211 pregnant women, Latife Bozkurt, MD, of the Medical University of Vienna, Austria, and colleagues from other institutions evaluated clinical and pathophysiologic characteristics before the 21st gestational week (GW) in three cohorts: early (≤21stGW) and late (≥24thGW) gestational diabetes (GDM) onset and normal glucose tolerance (NGT).
The researchers used the International Association of Diabetes and Pregnancy Study Groups criteria as a reference standard.
At an average of 16 gestational weeks, participants underwent detailed obstetrical risk assessment and oral glucose tolerance test (OGTT) with multiple measurements of glucose, insulin and C-peptide taken to evaluate insulin sensitivity and beta-cell function. Clinical follow-ups were conducted through the end of pregnancy.
Normal glucose tolerance was maintained by 130 (62%) women. GDM occurred in 81 women; 49 (23%) exhibited early GDM and 32 (15%) late GDM. Compared with late GDM, women with early GDM were affected by decreased insulin sensitivity (early GDM vs. NGT, P < .0001; early GDM vs. late GDM, P < .001). Women with early and late GDM onset showed impairments in beta-cell function.
Women with early GDM demonstrated the highest levels of preconceptional and actual BMI, which was associated with fasting glucose (r = 0.42, P < .001) and insulin sensitivity (r = –0.51, P < .001).
In multivariable analysis including the strongest GDM risk factors (age, history of GDM and BMI in the study population), the between-subgroup differences observed in glucose disposal remained constant.
“Identification of pathophysiological peculiarities associated with time of onset of GDM could contribute to efforts in improvement of screening for metabolic disorders during pregnancy and performance of an appropriate risk categorization,” the researchers wrote.
Disclosure: The researchers report no relevant financial disclosures.
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