Gestational diabetes & diabetes in pregnancy
Towards Precision Medicine in Gestational Diabetes: Pathophysiology and Glycemic Patterns in Pregnant Women With Obesity
Authors' conclusion
Patterns of glycemia during the OGTT may contribute to a precision approach to GDM as assessed by differences in insulin resistance/secretion. Further research is indicated to determine if isolated postload hyperglycemia reflects a different mechanistic pathway for targeted management.
Study context
- Population
- Pregnant women with obesity (BMI ≥ 30 kg/m²) from the UPBEAT trial, assessed for gestational diabetes mellitus (GDM) at 28 weeks' gestation (75 g oral glucose tolerance test (OGTT); WHO criteria)241 developed GDM
- Participants
- 867 women
- Comparison
- Patterns of glycaemia (fasting, 1 h, 2 h) during the OGTT in women with GDM vs euglycemic women
Methodological detailsFasting plasma lipid profiling by direct infusion mass spectrometry; logistic/linear regression with and without adjustment for confounders, Insulin secretion and sensitivity by homeostatic model assessment 2b and 2s
- Fasting plasma lipid profiling by direct infusion mass spectrometry; logistic/linear regression with and without adjustment for confounders
- Insulin secretion and sensitivity by homeostatic model assessment 2b and 2s
Primary result
As reported in the abstract
Pathophysiological subtypes of GDM by OGTT glycaemia pattern · 28 weeks' gestation
- In women with GDM, patterns of glycaemia were associated with distinct clinical and biochemical characteristics and changes to lipid abundance in the circulation
- Severity of glucose derangement, rather than pattern of postload glycaemia, was most strongly related to insulin action and lipid abundance/profile
- Isolated postload hyperglycemia: insulin secretion and sensitivity comparable to euglycemic women
Original publication
Towards Precision Medicine in Gestational Diabetes: Pathophysiology and Glycemic Patterns in Pregnant Women With Obesity. J Clin Endocrinol Metab. Published 23 March 2023. doi:10.
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