Combined analysis of gestational diabetes and maternal weight status from pre-pregnancy through post-delivery in future development of type 2 diabetes

Ling-Wei Chen, Shu E Soh, Mya-Thway Tint, See Ling Loy, Fabian Yap, Kok Hian Tan, Yung Seng Lee, Lynette Pei-Chi Shek, Keith M Godfrey, Peter D Gluckman, Johan G Eriksson, Yap-Seng Chong, Shiao-Yng Chan, Ling-Wei Chen, Shu E Soh, Mya-Thway Tint, See Ling Loy, Fabian Yap, Kok Hian Tan, Yung Seng Lee, Lynette Pei-Chi Shek, Keith M Godfrey, Peter D Gluckman, Johan G Eriksson, Yap-Seng Chong, Shiao-Yng Chan

Abstract

We examined the associations of gestational diabetes mellitus (GDM) and women's weight status from pre-pregnancy through post-delivery with the risk of developing dysglycaemia [impaired fasting glucose, impaired glucose tolerance, and type 2 diabetes (T2D)] 4-6 years post-delivery. Using Poisson regression with confounder adjustments, we assessed associations of standard categorisations of prospectively ascertained pre-pregnancy overweight and obesity (OWOB), gestational weight gain (GWG) and substantial post-delivery weight retention (PDWR) with post-delivery dysglycaemia (n = 692). Women with GDM had a higher risk of later T2D [relative risk (95% CI) 12.07 (4.55, 32.02)] and dysglycaemia [3.02 (2.19, 4.16)] compared with non-GDM women. Independent of GDM, women with pre-pregnancy OWOB also had a higher risk of post-delivery dysglycaemia. Women with GDM who were OWOB pre-pregnancy and had subsequent PDWR (≥ 5 kg) had 2.38 times (1.29, 4.41) the risk of post-delivery dysglycaemia compared with pre-pregnancy lean GDM women without PDWR. No consistent associations were observed between GWG and later dysglycaemia risk. In conclusion, women with GDM have a higher risk of T2D 4-6 years after the index pregnancy. Pre-pregnancy OWOB and PDWR exacerbate the risk of post-delivery dysglycaemia. Weight management during preconception and post-delivery represent early windows of opportunity for improving long-term health, especially in those with GDM.

Conflict of interest statement

K.M.G., Y.S.C. and S.Y.C. are part of an academic consortium that has received research funding from Société Des Produits Nestlé S.A., Abbott Nutrition, Danone and BenevolentAI Bio Ltd, and are co-inventors on patents filed on nutritional factors and metabolic risk outside the submitted work. K.M.G. has received reimbursement for speaking at a Nestle Nutrition Institute conference. S.Y.C. has received reimbursement and honoraria into her research funds from Nestlé S.A. for a half-day consultancy and for speaking at a conference. All other authors declare no competing interest.

Figures

Figure 1
Figure 1
Relative risk of dysglycaemia at 4–6 years post-delivery according to combinations of peri-pregnancy risk factors. The diamonds and capped lines represent point estimates and 95% confidence intervals, respectively, of relative risk of having dysglycaemia at 4–6 years post-delivery according to combinations of peri-pregnancy risk factors. Reference group comprised participants without any of the risk factor. Estimates are adjusted for ethnicity, age at delivery, education, parity, family history of diabetes, insulin treatment during pregnancy and pregnancy induced hypertension. GDM gestational diabetes mellitus, PDWR post-delivery weight retention (≥ 5 kg) at 4 years, ppLean pre-pregnancy lean (BMI < 23 kg/m2), ppOWOB pre-pregnancy overweight or obese (BMI ≥ 23 kg/m2).

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