medwireNews: Less stringent criteria for gestational diabetes remain predictive of risk for later prediabetes or type 2 diabetes despite identifying a larger number of women, the HAPO FUS investigators report in JAMA.
The criteria for gestational diabetes proposed by the International Association of Diabetes and Pregnancy Study Groups (IADPSG) require just one abnormal glucose value during a 2-hour 75 g oral glucose tolerance test.
On this basis, 14.3% of the 4697 pregnant women in the HAPO study had gestational diabetes, and during follow-up 52.2% of these women developed dysglycemia (prediabetes or type 2 diabetes), compared with 20.1% of those who did not have gestational diabetes.
When adjusted for baseline and follow-up factors including age, BMI, family history of diabetes, and blood pressure, women with gestational diabetes had a significant 25.7% absolute risk increase for later dysglycemia, or a 3.44-fold relative risk increase. The risk increases were also significant for prediabetes and type 2 diabetes individually.
In an exploratory analysis, Boyd Metzger (Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA) and co-researchers looked at the Carpenter-Coustan gestational diabetes criteria, routinely used in the USA, which require two abnormal glucose values and therefore identify substantially fewer women than the IADPSG criteria.
They found that diagnosis by these criteria conferred a higher risk for later dysglycemia, which occurred 68.4% of women in this analysis, compared with 47.2% if diagnosed by the IADPSG criteria.
“However, the risks for the large group of women meeting the IADPSG-defined criteria for gestational diabetes were substantial and cannot be ignored from a public health perspective,” the team stresses.
Maternal gestational diabetes according to the IADPSG criteria was associated with an increased rate of overweight or obesity in their children, at 39.5% compared with 28.6% in its absence. This association lost significance after accounting for maternal BMI; however, associations with secondary adiposity endpoints persisted.
For example, children had an absolute 4.2% increased risk for having percentage body fat greater than the 85th percentile for their age and sex, after accounting for study center.
“These associations were stronger than the associations with BMI, likely reflecting contributions of both fat and lean body mass to BMI,” observe the researchers.
And they stress: “In this study, adjusting for maternal BMI attenuated observed associations of gestational diabetes with measures of childhood adiposity, but multiple associations remained significant, demonstrating that gestational diabetes was associated with these measures independent of maternal BMI.”
By Eleanor McDermid
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