Heterogeneity of gestational diabetes (GDM) and long-term risk of diabetes and metabolic syndrome: findings from the RADIEL study follow-up
To assess the metabolic health of obese and non-obese women at high GDM risk 5 years postpartum.
This is a secondary analysis of the 5-year follow-up of the RADIEL GDM prevention study including 333 women at high GDM risk (BMI ≥ 30 kg/m2 and/or previous GDM). Five years postpartum metabolic health was assessed including anthropometric measurements, oral glucose tolerance test, lipid metabolism, and body composition as well as medical history questionnaires. For the analysis, we divided the women into four groups based on parity, BMI, and previous history of GDM.
Five years postpartum impaired glucose regulation (IFG, IGT, or diabetes) was diagnosed in 15% of the women; 3.6% had type 2 diabetes. The highest prevalence was observed among obese women with a history of GDM (26%), and the lowest prevalence (8%) among primiparous obese women (p = 0.021). At follow-up 25–39% of the obese women fulfilled the diagnostic criteria for the metabolic syndrome, in the non-obese group 11% (p < 0.001). This was associated with body fat percentage. The non-obese group, however, faced metabolic disturbances (IFG, IGT, diabetes, or metabolic syndrome) at a significantly lower BMI (p < 0.001). Among women who were non-obese before pregnancy, 5 years postpartum, the obesity prevalence based on BMI was 14% and based on body fat percentage 58%.
The prevalence of impaired glucose regulation and metabolic syndrome is high 5 years postpartum among women at high risk of GDM. There are high-risk women also among the non-obese, who develop metabolic derangements already at a lower BMI.
Clinical trial registration
ClinicalTrials.gov, www.clinicaltrials.com, NCT01698385.
KeywordsGestational diabetes Type 2 diabetes Metabolic syndrome Heterogeneity Normal weight obesity Body composition
The study was funded by Ahokas Foundation, the Finnish Foundation for Cardiovascular Disease, Academy of Finland, Special state subsidy for health science research of Helsinki University Hospital (HUH), Samfundet Folkhälsan, Finska Läkaresällskapet, Juho Vainio Foundation, Viipuri Tuberculosis Foundation, The Finnish Diabetes Research Foundation, State Provincial Office of Southern Finland, Health Promotion Grant (Ministry of Social Affairs and Health) EU H2020-PHC-2014-DynaHealth Grant No. 633595, and The Social Insurance Institution of Finland. The funders have not had any role in designing or conducting the study; nor in collection, management, analysis, or interpretation of the data; nor in preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
EH participated in the design and implementation of the study, literature search, data interpretation, and the drafting and editing of the article. JGE is the principal investigator of the study, participated in the implementation of the study, analysis of the results, and advised on drafting and editing the article. SBK initiated, participated in the design of the study, coordinated the study, and helped in the editing of the article. NG participated in the design of the study and helped with the editing of the article. AT participated in the design of the study and helped with the editing of the article. BS-L participated in the design of the study, coordinated the study in Lappeenranta, and helped with editing the article. KR participated in the design of the study and helped in the statistical analysis and drafting and editing of the article. All authors have read and approved the final version of the manuscript. EH is the guarantor of this work and, as such, had full access to all the data in the study and takes full responsibility for the integrity of the data and the accuracy of the data analysis.
Compliance with ethical standards
Conflict of interest
The authors declare that there is no conflict of interest associated with this manuscript.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the Ethics Committees of HUH and SKCH and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed written consent was obtained from all individual participants included in the study.
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
- 1.National Institute for Health and Welfare (2016) Official Statistics of Finland; Health; 2014Google Scholar
- 4.Freinkel N, Metzger BE, Phelps RL et al (1985) Gestational diabetes mellitus. Heterogeneity of maternal age, weight, insulin secretion, HLA antigens, and islet cell antibodies and the impact of maternal metabolism on pancreatic B-cell and somatic development in the offspring. Diabetes 34(Suppl 2):1–7CrossRefPubMedGoogle Scholar
- 11.Lauenborg J, Mathiesen E, Hansen T et al (2005) The prevalence of the metabolic syndrome in a danish population of women with previous gestational diabetes mellitus is three-fold higher than in the general population. J Clin Endocrinol Metab 90(7):4004–4010. https://doi.org/10.1210/jc.2004-1713 CrossRefPubMedGoogle Scholar
- 15.Rono K, Stach-Lempinen B, Klemetti MM et al (2014) Prevention of gestational diabetes through lifestyle intervention: study design and methods of a Finnish randomized controlled multicenter trial (RADIEL). BMC Pregnancy Childbirth 14:70. https://doi.org/10.1186/1471-2393-14-70 CrossRefPubMedPubMedCentralGoogle Scholar
- 16.Koivusalo SB, Rono K, Klemetti MM et al (2016) gestational diabetes mellitus can be prevented by lifestyle intervention: the Finnish Gestational Diabetes Prevention Study (RADIEL): a randomized controlled trial. Diabetes Care 39(1):24–30. https://doi.org/10.2337/dc15-0511 CrossRefPubMedGoogle Scholar
- 17.Alberti KGMM, Eckel RH, Grundy SM et al (2009) Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 120(16):1640–1645. https://doi.org/10.1161/CIRCULATIONAHA.109.192644 CrossRefPubMedGoogle Scholar
- 18.Malavolti M, Mussi C, Poli M et al (2003) Cross-calibration of eight-polar bioelectrical impedance analysis versus dual-energy X-ray absorptiometry for the assessment of total and appendicular body composition in healthy subjects aged 21–82 years. Ann Hum Biol 30(4):380–391. https://doi.org/10.1080/0301446031000095211 CrossRefPubMedGoogle Scholar
- 19.USA: The American council on exercise (2016) What are the guidelines for percentage of body fat loss? http://www.acefitness.org/acefit/healthy-living-article/60/112/what-are-the-guidelines-for-percentage-of-body-fat. Accessed 22 Aug 2016
- 22.Rayanagoudar G, Hashi AA, Zamora J, Khan KS, Hitman GA, Thangaratinam S (2016) Quantification of the type 2 diabetes risk in women with gestational diabetes: a systematic review and meta-analysis of 95,750 women. Diabetologia 59(7):1403–1411. https://doi.org/10.1007/s00125-016-3927-2 CrossRefPubMedPubMedCentralGoogle Scholar
- 24.Hakkarainen H, Huopio H, Cederberg H, Paakkonen M, Voutilainen R, Heinonen S (2015) Post-challenge glycemia during pregnancy as a marker of future risk of type 2 diabetes: a prospective cohort study. Gynecol Endocrinol 31(7):573–577. https://doi.org/10.3109/09513590.2015.1032926 PubMedGoogle Scholar
- 26.Cho NH, Ahn CH, Moon JH, Kwak SH, Choi SH, Lim S, Park KS, Metzger BE, Jang HC (2016) Metabolic syndrome independently predicts future diabetes in women with a history of gestational diabetes mellitus. Medicine 95(35):e4582. https://doi.org/10.1097/MD.0000000000004582 CrossRefPubMedPubMedCentralGoogle Scholar
- 43.Farrar D, Simmonds M, Bryant M et al (2017) Risk factor screening to identify women requiring oral glucose tolerance testing to diagnose gestational diabetes: a systematic review and meta-analysis and analysis of two pregnancy cohorts. PLoS ONE [Electronic Resource] 12(4):e0175288. https://doi.org/10.1371/journal.pone.0175288 CrossRefPubMedCentralGoogle Scholar
- 44.Goueslard K, Cottenet J, Mariet AS, Sagot P, Petit JM, Quantin C (2017) Early screening for type 2 diabetes following gestational diabetes mellitus in France: hardly any impact of the 2010 guidelines. Acta Diabetol 54(7):645–651. https://doi.org/10.1007/s00592-017-0986-x CrossRefPubMedGoogle Scholar
- 45.Ferrara A, Peng T, Kim C (2009) Trends in postpartum diabetes screening and subsequent diabetes and impaired fasting glucose among women with histories of gestational diabetes mellitus: a report from the Translating Research Into Action for Diabetes (TRIAD) Study. Diabetes Care 32(2):269–274. https://doi.org/10.2337/dc08-1184 CrossRefPubMedPubMedCentralGoogle Scholar