Gestational diabetes (GDM) is a type of diabetes that develops during pregnancy, and although it generally resolves after delivery, it has been associated with long-term health issues for both mothers and their babies. Rates of GDM are rising globally. Current professional guidelines differ on how to best diagnose and treat GDM, which is in part due to conflicting evidence surrounding pathophysiological heterogeneity (i.e., the multiple root causes) of this condition. New research published in Diabetic Medicine uses two cohorts of pregnant women to examine obstetrical and neonatal outcomes and explore potential pathophysiologic explanations.
The research team identified women with GDM in a population-based cohort of all pregnancies in Alberta, Canada during a 10-year period. These pregnancies were then categorized into seven different maternal glucose profiles based on their laboratory results. The investigators used similar maternal glucose profiles to examine a second smaller independent cohort of 1,451 women from an earlier Toronto-based study, which provided detailed biomarker information that was not available in the Alberta cohort. The primary outcomes from the study were large for gestational age (LGA) infants and neonatal intensive care unit (NICU) admissions.
The study findings demonstrate that mothers who had combined elevated fasting and elevated post-load glucose were at the highest risk of having LGA babies and babies that needed NICU admission; and had the lowest beta-cell function and insulin sensitivity.
In an accompanying editorial, Professor Nick Oliver from Imperial College London, said “These data not only have important implications for pathophysiology, they also suggest that risk stratification of women with gestational diabetes may be partly feasible at the time of diagnosis, enabling a more aggressive, personalised approach for some.”
This study was co-authored by the CVC’s Drs. Padma Kaul and Anamaria Savu, along with Dr. Rose Yeung (University of Alberta), Dr. Ravi Retnakaran (University of Toronto), and Dr. Sonia Butalia (University of Calgary).
