Australia: Study on Gestational Diabetes Mellitus

Pre-pregnancy insulin, fasting blood glucose (FBG), and insulin resistance may be used as early markers for predicting the incidence of gestational diabetes mellitus (GDM), a recent study has shown. The study was featured online in The Journal of Maternal-Fetal & Neonatal Medicine on 31 Mar 2023.

"The measurement of pre-pregnancy biomarkers might be more beneficial for predicting gestational diabetes than early pregnancy values," the researchers wrote. "Therefore, such analyses should be included in the routine health checks before pregnancy to identify women at high GDM risk in subsequent pregnancies."

Gestational diabetes is a state of glucose intolerance detected anytime during pregnancy, which does not meet the criteria for diabetes diagnosis in non-pregnant women. It is a common pregnancy complication, potentially causing short- and long-term adverse health outcomes for the mother and child. Besides, GDM is linked with an increased risk of macrosomia, operative delivery, and hypertensive disorders during pregnancy. It increases postnatal and antenatal expenses. In the long term, it increases the risk of CVDs (cardiovascular diseases) and metabolic disorders in the mother and her baby. Therefore, early prevention of gestational diabetes is critical to lower the risk of adverse pregnancy outcomes and post-pregnancy cardiometabolic risk in women and children over the life course.

Against the above background, Sura Alwash, The University of Queensland, Brisbane, Australia, and colleagues aimed to determine some blood biomarkers before pregnancy to predict gestational diabetes.

For this purpose, the researchers used the Mater-University of Queensland Study of Pregnancy (MUSP) cohort to investigate the prospective association of blood biomarkers before pregnancy and GDM risk in women. A multiple logistic regression model estimated the odds of experiencing GDM by blood biomarkers.

Findings

• Out of 525 women included in this study, GDM prevalence was 7.43%.
• There was an elevated risk of experiencing GDM among women who experienced obesity (Odds ratio = OR 2.4), had high fasting blood glucose (OR = 2.2), high insulin (OR = 1.1), increased insulin resistance (OR = 1.2) and low high-density lipoprotein (OR = 0.2) before pregnancy.
• Adjustments for potential confounders, such as age, marital status, and BMI, did not attenuate these associations substantially.

The findings showed that insulin resistance, insulin, and fasting blood glucose were independent predictions of gestational diabetes. Therefore, the authors suggest that women with insulin resistance and fasting blood glucose before pregnancy should be monitored and paid more attention to GDM prevention.

"Our results suggest that pathophysiological changes related to glucose regulation, which may lead to gestational diabetes, are present before pregnancy and are not simply induced by pregnancy in women who develop GDM," the authors explained.

"Future longitudinal studies must examine the association between these biomarkers before and during pregnancy and GDM," they concluded. "Furthermore, further studies are needed to determine the most appropriate risk-benefit use of pre-pregnancy blood biomarkers."

Reference

Alwash, Sura, et al. "The Pre-pregnancy Fasting Blood Glucose, Glycated Hemoglobin and Lipid Profiles as Blood Biomarkers for Gestational Diabetes Mellitus: Evidence From a Multigenerational Cohort Study." The Journal of Maternal-fetal & Neonatal Medicine: the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, vol. 36, no. 1, 2023, p. 2195524.