Heterogeneity of Gestational Diabetes and Risk for Adverse Pregnancy Outcome: A Cohort Study

作者：Yixin Gong, Qunhua Wang, Suyu Chen, Yujie Liu, Chenghua Li, Rong Kang, Jing Wang, Wei Tian, Q. Wang, Xianming Li, Sihui Luo, Jianping Weng, Xueying Zheng, Yu Ding · 发表于：The Journal of Clinical Endocrinology & Metabolism · 年份：2024 · DOI：10.1210/clinem/dgae754 · 被引用次数：10 · 研究领域：Gestational Diabetes Research and Management、Pregnancy and preeclampsia studies、Pancreatic function and diabetes

CONTEXT: Diabetes is increasingly recognized as a heterogeneous disease, with clinical characteristics and outcome risks varying across different phenotypes. Evidence on heterogeneity of gestational diabetes (GDM) is yet to be provided. OBJECTIVE: To investigate the insulin physiology and pregnancy outcomes of GDM phenotypes characterized by fasting hyperglycemia or postload hyperglycemia. METHODS: A total of 2050 women who underwent a 75-g oral glucose tolerance test were prospectively recruited and followed until delivery. Women were categorized into normoglycemia (NGT, n = 936), isolated impaired fasting glucose (gestational-IFG, n = 378), and isolated impaired postload glucose tolerance (gestational-IGT, n = 736) groups. Fasting blood samples at mid-pregnancy were collected to measure C-peptide and insulin concentrations. Homeostasis model assessment (HOMA) and quantitative insulin sensitivity check index (QUICKI) were used to evaluate insulin physiology. Maternal and neonatal outcomes were recorded. RESULTS: Gestational-IFG had greater insulin resistance (HOMA-IR 3.11 vs 2.25, QUICKI-C-peptide 0.94 vs 1.03, both P < .01), and gestational-IGT had worse β-cell function (C-peptide 2.00 vs 2.26 ng/mL, P < .05), when compared to one another. Gestational-IFG was more strongly associated with excessive gestational weight gain (risk ratio [RR] 1.62; 95% CI, 1.18-2.23) and large-for-gestational-age infants (RR 1.45; 95% CI, 1.03-2.03) than gestational-IGT. The risk for neonatal b...