Clinical characteristics and outcome of pregnancy in women with gestational hyperglycaemia with and without antibodies to beta-cell antigens.
OBJECTIVE
To evaluate the prevalence of beta-cell autoantibodies in women with gestational diabetes and impaired glucose tolerance, and identify clinical characteristics differentiating hyperglycaemic patients with and without autoantibodies.


METHODS
One hundred and twenty-three pregnant patients with gestational diabetes, 84 with impaired glucose tolerance and 290 with normoglycaemia were evaluated for anti-islet cell antibodies, glutamic acid decarboxylase (GAD) autoantibodies, and the components of the metabolic syndrome.


RESULTS
Autoantibody positivity was 8.9%, 17.9% and 0.3% in patients with diabetes, impaired tolerance and normoglycaemia, respectively. Hyperglycaemic patients with autoantibodies had lower body mass index, waist, weight gain at the time of the screening test and a lower percentage of previous pregnancies than those without autoantibodies. In addition, their fasting insulin values were significantly lower and inversely related to the presence of autoantibodies (odds ratio (OR) = 0.64; 95% confidence interval (CI) 0.42-0.96), the lowest values being found in anti-GAD+ patients. Autoantibody-positive women with diabetes were more frequently treated with insulin than negative patients (OR = 7.21; 95% CI 1.85-28.08).


CONCLUSIONS
Autoantibody-positive women with gestational hyperglycaemia displayed fewer features of insulin resistance and required more frequent insulin therapy than negative women and presumably had presymptomatic Type 1 diabetes. If this conclusion is corroborated by the follow-up of larger series, clinical and immunological distinction of types of gestational hyperglycaemia would be useful.
Bo
S
S
Department of Internal Medicine, University of Turin, Turin, Italy.
Menato
G
G
Pinach
S
S
Signorile
A
A
Bardelli
C
C
Lezo
A
A
Marchisio
B
B
Gentile
L
L
Cassader
M
M
Massobrio
M
M
Pagano
G
G
D000328:Adult; D000941:Antigens / Q000032:analysis; D001323:Autoantibodies / Q000032:analysis / Q000276:immunology*; D016640:Diabetes, Gestational / Q000276:immunology*; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D006943:Hyperglycemia / Q000276:immunology*; D007515:Islets of Langerhans / Q000276:immunology*; D011247:Pregnancy; D011256:Pregnancy Outcome
D000941:Antigens; D001323:Autoantibodies; C024211:islet cell antibody