title: Heterogeneous Contribution of Insulin Sensitivity and Secretion Defects to Gestational Diabetes Mellitus.
abstract: To characterize physiologic subtypes of gestational diabetes mellitus (GDM).
  
  
  
  Insulin sensitivity and secretion were estimated in 809 women at 24-30 weeks' gestation, using oral glucose tolerance test-based indices. In women with GDM (8.3%), defects in insulin sensitivity or secretion were defined below the 25th percentile in women with normal glucose tolerance (NGT). GDM subtypes were defined based on the defect(s) present.
  
  
  
  Relative to women with NGT, women with predominant insulin sensitivity defects (51% of GDM) had higher BMI and fasting glucose, larger infants (birth weight z score 0.57 [-0.01 to 1.37] vs. 0.03 [-0.53 to 0.52], P = 0.001), and greater risk of GDM-associated adverse outcomes (57.6 vs. 28.2%, P = 0.003); differences were independent of BMI. Women with predominant insulin secretion defects (30% of GDM) had BMI, fasting glucose, infant birth weights, and risk of adverse outcomes similar to those in women with NGT.
  
  
  
  Heterogeneity of physiologic processes underlying hyperglycemia exists among women with GDM. GDM with impaired insulin sensitivity confers a greater risk of adverse outcomes.
authors.affiliation: Diabetes Unit, Massachusetts General Hospital, Boston, MA Harvard Medical School, Boston, MA.
authors.forename: Camille E
authors.initials: CE
authors.lastname: Powe
authors.affiliation: Université de Sherbrooke, Québec, Canada Centre de Recherché Clinique Étienne-Le Bel of the Centre Hospitalier Universitaire de Sherbrooke, Québec, Canada.
authors.forename: Catherine
authors.initials: C
authors.lastname: Allard
authors.affiliation: Université de Sherbrooke, Québec, Canada Centre de Recherché Clinique Étienne-Le Bel of the Centre Hospitalier Universitaire de Sherbrooke, Québec, Canada.
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Battista
authors.affiliation: Université de Sherbrooke, Québec, Canada Centre de Recherché Clinique Étienne-Le Bel of the Centre Hospitalier Universitaire de Sherbrooke, Québec, Canada.
authors.forename: Myriam
authors.initials: M
authors.lastname: Doyon
authors.affiliation: Université de Sherbrooke, Québec, Canada Centre de Recherché Clinique Étienne-Le Bel of the Centre Hospitalier Universitaire de Sherbrooke, Québec, Canada.
authors.forename: Luigi
authors.initials: L
authors.lastname: Bouchard
authors.affiliation: Harvard Medical School, Boston, MA Division of Maternal-Fetal Medicine, Massachusetts General Hospital, Boston, MA.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Ecker
authors.affiliation: Université de Sherbrooke, Québec, Canada Centre de Recherché Clinique Étienne-Le Bel of the Centre Hospitalier Universitaire de Sherbrooke, Québec, Canada.
authors.forename: Patrice
authors.initials: P
authors.lastname: Perron
authors.affiliation: Diabetes Unit, Massachusetts General Hospital, Boston, MA Harvard Medical School, Boston, MA Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA.
authors.forename: Jose C
authors.initials: JC
authors.lastname: Florez
authors.affiliation: Harvard Medical School, Boston, MA Division of Nephrology, Massachusetts General Hospital, Boston, MA.
authors.forename: Ravi
authors.initials: R
authors.lastname: Thadhani
authors.affiliation: Diabetes Unit, Massachusetts General Hospital, Boston, MA Harvard Medical School, Boston, MA Université de Sherbrooke, Québec, Canada Centre de Recherché Clinique Étienne-Le Bel of the Centre Hospitalier Universitaire de Sherbrooke, Québec, Canada Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA mhivert@partners.org.
authors.forename: Marie-France
authors.initials: MF
authors.lastname: Hivert
mesh_terms: D000328:Adult; D001724:Birth Weight; D001786:Blood Glucose / Q000378:metabolism*; D015992:Body Mass Index; D016022:Case-Control Studies; D016640:Diabetes, Gestational / Q000378:metabolism*; D005215:Fasting; D005260:Female; D005865:Gestational Age; D005951:Glucose Tolerance Test; D006801:Humans; D007328:Insulin / Q000378:metabolism*; D007333:Insulin Resistance; D000078790:Insulin Secretion; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011263:Pregnancy Trimester, Third; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D007328:Insulin