Gestational glucose tolerance and maternal metabolic profile at 3 years postpartum.
OBJECTIVE
To estimate the independent effect of gestational impaired glucose tolerance, defined as a single abnormal oral glucose tolerance test value, on metabolic dysfunction at 3 years postpartum.


METHODS
We used multiple linear regression to measure associations between glucose testing during pregnancy and metabolic markers at 3 years postpartum in Project Viva, a prospective cohort study of maternal and infant health. We compared metabolic measures at 3 years postpartum among four groups: normal glucose challenge test (less than 140 mg/dL, n=461); abnormal glucose challenge test but normal glucose tolerance test (n=39); impaired glucose tolerance (a single abnormal glucose tolerance test value, n=21); and gestational diabetes mellitus (n=16).


RESULTS
Adjusting for age, race, parity, parental history of diabetes, and maternal body mass index at 3 years postpartum, we found women with gestational diabetes mellitus had lower adiponectin (11.2 ng/mL compared with 20.7 ng/mL) and higher homeostatic model assessments of insulin resistance (3.1 compared with 1.3) and waist circumference (91.3 cm compared with 86.2 cm) compared with women with impaired glucose tolerance or normal glucose tolerance. Women in both the impaired glucose tolerance and gestational diabetes mellitus groups had lower high-density lipoprotein (gestational diabetes mellitus 44.7 mg/dL; impaired glucose tolerance 45.4/dL compared with normal glucose tolerance 55.8 mg/dL) and higher triglycerides (gestational diabetes mellitus 136.1 mg/dL; impaired glucose tolerance 140.1 mg/dL compared with normal glucose tolerance 78.3) compared with women in the normal glucose tolerance group. We found the highest values for hemoglobin A1c (gestational diabetes mellitus 5.1%, impaired glucose tolerance 5.3%, normal glucose tolerance 5.1%) and high-sensitivity C-reactive protein (gestational diabetes mellitus 1.4 mg/dL, impaired glucose tolerance 2.2 mg/dL, normal glucose tolerance 1.0 mg/dL) among women with impaired glucose tolerance.


CONCLUSIONS
Gestational diabetes mellitus and impaired glucose tolerance during pregnancy are associated with persistent metabolic dysfunction at 3 years postpartum, independent of other clinical risk factors.
From the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, School of Medicine, and the Department of Maternal and Child Health, Gillings Global School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and the Department of Endocrinology, Diabetes and Metabolism, Beth Israel Deaconess Medical Center, the Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, the Departments of Nutrition and Epidemiology, Harvard School of Public Health, the Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, and the Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Brigham Circle, Boston, Massachusetts.
Alison M
AM
Stuebe
Christos
C
Mantzoros
Ken
K
Kleinman
Matthew W
MW
Gillman
Sheryl
S
Rifas-Shiman
Ellen W
EW
Seely
Janet
J
Rich-Edwards
D000328:Adult; D016640:Diabetes, Gestational / Q000097:blood*; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D016014:Linear Models; D049590:Postpartum Period / Q000097:blood*; D011247:Pregnancy; D013997:Time Factors