Routinely Assessed Measures of Blood Sugar and Body Weight may be Good Indicators of Risk for Developing Diabetes During Pregnancy
OAKLAND, Calif. — A woman’s risk of developing diabetes during pregnancy can be identified up to seven years before she becomes pregnant based on routinely assessed measures of blood sugar and body weight, according to a Kaiser Permanente study published in the online issue of the American Journal of Obstetrics and Gynecology.
Researchers at the Kaiser Permanente Division of Research in Oakland, Calif., studied 580 ethnically diverse women who took part in a multiphasic health checkup at Kaiser Permanente Northern California between1984 and 1996. The researchers looked at women who had a subsequent pregnancy and compared those who developed gestational diabetes mellitus during pregnancy to women who did not have GDM.
The study found that the risk of GDM increased directly with the number of adverse risk factors commonly associated with diabetes and heart disease (high blood sugar, hypertension and being overweight) present before pregnancy. In addition, the authors found that adverse levels of blood sugar and body weight were associated with a 4.6-fold increased risk of GDM, compared to women with normal levels.
The study is among the first to look at routinely measured cardio-metabolic risk factors before pregnancy in women who later became pregnant and developed GDM. The research provides evidence to support pre-conception care for healthy pregnancies as noted in a 2006 report by the Centers for Disease Control and Prevention. That report suggested that risk factors for adverse outcomes among women and infants can be identified prior to conception and are characterized by the need to start, and sometimes finish, interventions before conception occurs.
Women who develop GDM during pregnancy are more likely to develop Type 2 diabetes after pregnancy, previous research has shown. GDM is defined as glucose intolerance that typically occurs during the second or third trimester and causes complications in as much as 7 percent of pregnancies in the United States. It can lead to early delivery and Cesarean sections, and increases the baby’s risk of developing diabetes, obesity and metabolic disease later in life.
“Our study indicates that a woman’s cardio-metabolic risk profile for factors routinely assessed at medical visits such as blood sugar, high blood pressure, cholesterol and body weight can help clinicians identify high-risk women to target for primary prevention or early management of GDM,” said lead author Monique Hedderson, PhD, a research scientist at the Kaiser Permanente Division of Research.
Although the established risk factors for GDM are older maternal age, obesity, non-white race/ethnicity, giving birth previously to a very large baby and a family history of diabetes, these risk factors are absent in up to half of women who develop GDM. This study is significant because it gives a better understanding of pre-pregnancy predictors of GDM that may help identify women at risk and get them into intervention programs before pregnancy to prevent GDM and its associated risks, researchers said.
This study is part of ongoing research at Kaiser Permanente to understand, prevent and treat gestational diabetes. Recent Kaiser Permanente research includes:
*A study in the American Journal of Epidemiology found that cardio-metabolic risk factors such as high blood sugar and insulin, and low high-density lipoprotein cholesterol that are present before pregnancy, predict whether a woman will develop diabetes during a future pregnancy.
*A study in The American Journal of Obstetrics and Gynecology found there is an increased risk of recurring gestational diabetes in pregnant women who developed gestational diabetes during their first and second pregnancies.
*A study in Diabetes Care of 10,000 mother-child pairs showed that treating gestational diabetes during pregnancy can break the link between gestational diabetes and childhood obesity. That study showed, for the first time, that by treating women with gestational diabetes, the child’s risk of becoming obese years later is significantly reduced.
*A study in Obstetrics & Gynecology of 1,145 pregnant women found that women who gain excessive weight during pregnancy, especially in the first trimester, may increase their risk of developing diabetes later in their pregnancy.
*A study in Ethnicity & Disease of 16,000 women in Hawaii found that more than 10 percent of women of Chinese and Korean heritage may be at risk for developing gestational diabetes.
Co-authors of the current study include Jeanne A. Darbinian, MA, Charles P. Quesenberry, PhD, and Assiamira Ferrara, MD, all from the Kaiser Permanente Division of Research.
About Kaiser Permanente Division of Research
The Kaiser Permanente Division of Research conducts, publishes, and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and the society at large. It seeks to understand the determinants of illness and well-being and to improve the quality and cost-effectiveness of health care. Currently, DOR’s 500-plus staff is working on more than 250 epidemiological and health services research projects. For more information, visit http://www.dor.kaiser.org.
About Kaiser Permanente
Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve 8.8 million members in nine states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health.
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