title: Pathophysiological characteristics and effects of obesity in women with early and late manifestation of gestational diabetes diagnosed by the International Association of Diabetes and Pregnancy Study Groups criteria.
abstract: BACKGROUND
  Appropriate risk stratification is essential in gestational diabetes (GDM) diagnosis to optimize therapeutic strategies during pregnancy. However, there are sparse data related to the newly recommended International Association of Diabetes and Pregnancy Study Groups criteria and their use in early pregnancy.
  
  
  OBJECTIVE
  This study sought to evaluate clinical and pathophysiological characteristics less up to gestational week (GW) 21 in women with early and late GDM onset.
  
  
  METHODS
  This was a prospective study conducted at the Medical University of Vienna.
  
  
  METHODS
  Pregnant women (n = 211) underwent an oral glucose tolerance test at 16 GW (interquartile range, 14-18 wk) with multiple measurements of glucose, insulin, and C-peptide for evaluation of insulin sensitivity and ß-cell function in addition to detailed obstetrical risk assessment. Clinical followups were performed until end of pregnancy.
  
  
  METHODS
  We performed a metabolic characterization of early-onset GDM.
  
  
  RESULTS
  Of 81 women, 49 (23%) showed early (GDMEarly ≤ 21 GW) and 32 (15%) later manifestation (GDMLate ≥ 24 GW) whereas 130 (62%) remained normal-glucose-tolerant (NGT). In contrast with GDMLate, GDMEarly were affected by decreased insulin sensitivity (GDMEarly vs NGT, P < .001; GDMEarlyvs GDMLate, P < .001; GDMLate vs NGT, P = .410). However, both early and late manifested subjects showed impairments in ß-cell function. GDMEarly showed highest levels of preconceptional and actual body mass index (BMI), which was related to fasting glucose (r = 0.42, P < .001) and particularly insulin sensitivity (r = -0.51, P < .001). Differences in glucose disposal between the subgroups remained constant in multivariable analysis including the strongest risk factors for GDM, ie, age, history of GDM, and BMI in our population.
  
  
  CONCLUSIONS
  Early manifestation of GDM is affected by insulin resistance that is partly explained by higher degree in obesity. However, ß-cell dysfunction was also detectable in GDMLate, indicating defective compensatory mechanisms emerging already in early pregnancy.
authors.affiliation: Department of Internal Medicine III, Division of Endocrinology and Metabolism, Unit of Gender Medicine (L.B., L.P., K.L., A.L., S.B.-P., A.K.-W.), Department of Obstetrics and Gynecology, Division of Feto-Maternal Medicine (C.S.G., D.B.-T.), Medical University of Vienna, A-1090 Vienna, Austria; and Metabolic Unit (G.P.), Institute of Biomedical Engineering, National Research Council, I-35127 Padova, Italy.
authors.forename: Latife
authors.initials: L
authors.lastname: Bozkurt
authors.forename: Christian S
authors.initials: CS
authors.lastname: Göbl
authors.forename: Lisa
authors.initials: L
authors.lastname: Pfligl
authors.forename: Karoline
authors.initials: K
authors.lastname: Leitner
authors.forename: Dagmar
authors.initials: D
authors.lastname: Bancher-Todesca
authors.forename: Anton
authors.initials: A
authors.lastname: Luger
authors.forename: Sabina
authors.initials: S
authors.lastname: Baumgartner-Parzer
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pacini
authors.forename: Alexandra
authors.initials: A
authors.lastname: Kautzky-Willer
mesh_terms: D000328:Adult; D017668:Age of Onset; D015992:Body Mass Index; D016640:Diabetes, Gestational / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005865:Gestational Age; D005951:Glucose Tolerance Test / Q000592:standards; D006801:Humans; D007333:Insulin Resistance; D050417:Insulin-Secreting Cells / Q000502:physiology; D009765:Obesity / Q000150:complications*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis*; D012015:Reference Standards; D012307:Risk Factors