Risk Factors for Progression to Postpartum Diabetes Mellitus and Perinatal Complications in Women with Gestational Diabetes Mellitus

Su jeong Kim; Hyunji Chun; Eun-Hee Jang; Joune Seup Lee; MeeKyoung Kim; Ki-Hyun Baek; Ki-Ho Song; Hyuk-Sang Kwon

doi:10.4093/jkd.2014.15.2.116

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Kim, Chun, Jang, Lee, Kim, Baek, Song, and Kwon: Risk Factors for Progression to Postpartum Diabetes Mellitus and Perinatal Complications in Women with Gestational Diabetes Mellitus

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J Korean Diabetes 2014;15(2):116-123.

Published online: 20 January 2014

DOI: https://doi.org/10.4093/jkd.2014.15.2.116

Risk Factors for Progression to Postpartum Diabetes Mellitus and Perinatal Complications in Women with Gestational Diabetes Mellitus

Su jeong Kim¹, Hyunji Chun¹, Eun-Hee Jang², Joune Seup Lee¹, MeeKyoung Kim¹, Ki-Hyun Baek¹, Ki-Ho Song¹, Hyuk-Sang Kwon¹

¹Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul

²Department of Internal Medicine, Hando Hospital, Ansan, Korea

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Gestational diabetes mellitus (GDM) is a hyperglycemic condition caused by increased insulin resistance and impaired insulin secretion during pregnancy. It is known to be temporary, but it can cause perinatal complications in the mother and baby. Additionally, it may progress to type 2 diabetes mellitus (T2DM). In the present study, we evaluated the risk factors for complications and progression to T2DM in patients with GDM.

Methods

The study included 130 pregnant women who were diagnosed with GDM at gestational weeks 24–28 in 2011. Body mass index and the levels of glucose, total cholesterol, lipoproteins, and coagulation factors (von Willebrand factor and plasminogen activator inhibitor-1) were assessed in all patients.

Results

The level of high-density lipoprotein (HDL) was significantly lower and the triglyceride/HDL ratio and coagulation factor levels were significantly higher in the group of patients with perinatal complications compared to those in the group of patients without complications. After delivery, the level of HDL was lower and the value of homeostasis model assessment of insulin resistance (HOMA–IR) was higher in women with impaired glucose metabolism compared to those in women with normal glucose metabolism. In logistic regression analysis, perinatal complications were independently associated with HDL and PAI-1 levels (OR = 0.929 and 1.101, respectively).

Conclusion

The findings of our study show that the levels of HDL and coagulation factors are notable risk factors of perinatal complications. Additionally, we showed that lower HDL level may influence the progression to T2DM. Large-scale population studies are needed to verify our findings.

Keywords: Gestational diabetes mellitus, Risk factors, High-density lipoproteins, von Willebrand factor, Plasminogen activator inhibitor 1

References

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Table 1.

Background characteristics of women at diagnosis of gestational diabetes mellitus

Variables		Total n = 130
Age (yr)		32.8 ± 3.9
Gestational age (wk) at the time of 100 g OGTT		27.9 ± 2
Height (cm)		161.1 ± 5.5
²) Pre-preganancy BMI (kg/m		22.2 ± 4.8
Pre-pregnancy weight (kg)		58.3 ± 11.2
²) BMI during pregnancy (kg/m		25.0 ± 3.9
Weight during pregnancy (kg)		64.9 ± 10.8
Parity, no. (%)
Primigravida		58 (43)
Multigravida		50 (37)
History of GDMpresent/absent, n (%)		8 (5.9) / 41 (30)
Familial history of DMpresent/absent, n (%)		57 (42) / 46 (34)
50 g OGTT (mg/dL)		176.1 ± 26.1
100 g OGTT (mg/dL),	fasting	92.4 ± 15.9
	1 hr	207.4 ± 33.5
	2 hr	191.9 ± 30.6
	3 hr	154.3 ± 32.3
HbA1C (%)		5.3 ± 0.5
Glycoalbumin (%)		12.7 ± 1.9
Total cholesterol (mg/dL)		243.6 ± 47.5
Triglyceride (mg/dL)		250.8 ± 109.5
HDL (mg/dL)		70.0 ± 14.3
LDL (mg/dL)		134.9 ± 37.4

OGTT: Oral glucose tolerance test, BMI: Body mass index

Table 2.

Comparison of variables by criteria of perinatal complications

Variables		Poor outcome(−) n = 55	Poor outcome(+) n = 9	P value
Age (yr)		33.1 ± 3.8	34.4 ± 4.5	0.326
History of GDM, (yes/no)		4/18	1/4	0.925
Familial history of diabetes (yes/no)		25/17	5/4	0.826
Birth weight for gestational age (SGA/AGA/LGA)		2/35/4	4/2/1	0.0004
Parity (0/1/2)		24/21/5	4/4/1	0.98
Gestational age (wk) at the time of 100 g OGTT		27.9 ± 2.9	28.0 ± 2.2	0.970
BMIPrepregnancy (kg/m 2)		23.1 ± 3.9	24.0 ± 3.5	0.501
²) BMI at diagnosis (kg/m		25.7 ± 4.2	25.2 ± 2.6	0.777
50 g OGTT (mg/dL)		180.3 ± 27.6	187.3 ± 33.1	0.570
100 g OGTT (mg/dL)	fasting	93.8 ± 17.1	94.4 ± 21.5	0.933
	1 hr	211.8 ± 40.3	198.9 ± 36.6	0.398
	2 hr	192.5 ± 31.4	212.8 ± 37.9	0.103
	3 hr	152.2 ± 28.6	186.3 ± 46.0	0.077
C-peptide (ng/ml)	fasting	2.41 ± 1.2	4.95 ± 5.4	0.304
	PP2hr	13.9 ± 8.8	27.4 ± 39.7	0.442
Insulin (uIU/mL)	fasting	11.7 ± 9.4	64.7 ± 39.1	0.338
	PP2hr	8.6 ± 3.6	44.9 ± 24.3	0.235
Fasting glucose (mg/dL)		88.0 ± 13.6	95.6 ± 17.4	0.792
PP2hr glucose (mg/dL)		123.5 ± 27.3	133.8 ± 35.8	0.405
HbA1c (%)		5.4 ± 0.5	5.5 ± 0.6	0.387
Glycoalbumin (%)		13.1 ± 1.6	12.0 ± 3.4	0.226
Total cholesterol (mg/dL)		243.5 ± 49.9	224.7 ± 48.6	0.384
Triglyceride (mg/dL)		244.8 ± 108.6	320.5 ± 92.1	0.108
HDL (mg/dL)		69.8 ± 13.9	56.5 ± 12.2	0.029
LDL (mg/dL)		136.6 ± 35.8	115.5 ± 33.8	0.176
Fatty acid (uEq/L)		731.6 ± 235.4	667.8 ± 160.3	0.525
vWF (%)		171.7 ± 62.7	228.5 ± 38.9	0.037
PAI –1 (ng/mL)		69.1 ± 21.9	88.6 ± 6.3	0.0007
hsCRP (mg/L)		3.63 ± 3.9	8.20 ± 10.2	0.248

GDM, gestational diabetes mellitus; SGA, small for gestational age; AGA, appropriate for gestational age; LGA, large for gestational age; BMI, body mass index; OGTT, oral glucose tolerance test; PP2hr, 2-hour postprandial; HbA1c, glycated hemoglobin; HDL, high density lipoprotein; LDL, low density lipoprotein; vWF, von willebrant factor; PAI–1, plasminogen activator inhibitor–1; hsCRP, high sensitivity CRP.

Table 3.

Comparison of variables by criteria of 75 g oral glucose tolerance test after 2 months from delivery

Variable		NGT (n = 34, 47.2%)	Prediabetes + DM (n = 36 (50%) + 2 (2.8%))	P value
Age (yr)		33.3 ± 3.8	32.6 ± 3.8	0.447
History of GDM (yes/no) (n)		1/8	2/11	0.774
Familial history of DM, (yes/no)		14/10	19/12	0.824
Birth weight for gestational age (SGA/AGA/LGA)		4/14/0	0/18/4	0.017
Parity (0/1/2)		13/9/2	17/14/2	0.903
BMIPrepregnancy (kg/m ²)		20.6 ± 4.9	23.9	0.004
BMI at diagnosis (kg/m ²)		23.4 ± 2.6	26.6 ± 4.4	0.0004
50 g OGTT (mg/dL)		167.0 ± 21.3	178.9 ± 28.7	0.107
100 g OGTT (mg/dL)	fasting	87.4 ± 7.8	93.3 ± 14.7	0.04
	1 hr	203.1 ± 22.8	205.8 ± 36.1	0.704
	2 hr	188.2 ± 26.1	191.5 ± 20.4	0.547
	3 hr	149.6 ± 28.8	159.1 ± 25.4	0.148
C-peptide (ng/mL)	fasting	1.79 ± 0.7	2.61 ± 1.3	0.002
	PP2hr	11.6 ± 8.4	14.5 ± 8.2	0.178
insulin (uIU/mL)	fasting	8.6 ± 3.7	12.6 ± 8.6	0.022
	PP2hr	54.4 ± 27.5	69.8 ± 42.6	0.103
Fasting glucose (mg/dL)		82.8 ± 9.4	91.7 ± 12.2	0.003
PP2hr glucose (mg/dL)		118.4 ± 18.0	129.6 ± 23.7	0.047
HbA1C (%)		5.1 ± 0.3	5.4 ± 0.5	0.019
Glycoalbumin (%)		12.4 ± 1.6	12.5 ± 1.8	0.783
Total cholesterol (mg/dL)		250.3 ± 37.2	225.5 ± 53.7	0.036
Triglyceride (mg/dL)		209.3 ± 86.3	247.9 ± 113.2	0.139
HDL (mg/dL)		73.8 ± 13.1	66.1 ± 14.9	0.034
LDL (mg/dL)		147.2 ± 29.3	122.9 ± 34.9	0.005
Fatty acid (uEq/L)		675.4 ± 242.4	780.7 ± 214.5	0.098

Table 4–1.

Independent risk factors for perinatal complications according to logistic regression analysis (Penalized likelihood estimation)

	OR	95% CI
HDL	0.929	0.847	0.995
TG/HDL	1.564	1.082	2.569
vWF	1.014	0.998	1.037
PAI	1.101	1.009	1.323

BMI, body mass index; OR, odds Ratio; CI, confidence interval; HOMA-IR, homoeostasis model assessment estimate of insulin resistance; HDL, high density lipoprotein; vWF, von willebrant factor; PAI–1, plasminogen activator inhibitor-1.

Table 4–2.

Independent risk factors for for postdelivery glucose intolerance according to logistic regression analysis

	OR	95% CI
Fasting C-peptide	2.535	1.347	4.772
HOMA – IR	1.318	0.818	2.123
TG/HDL	1.196	0.91	1.655

BMI, body mass index; OR, odds ratio; CI, confidence interval; HOMA-IR, homoeostasis model assessment estimate of insulin resistance; HDL, high density lipoprotein; vWF, von willebrant factor; PA–1, plasminogen activator inhibitor-1.

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