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 (GDM) 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 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. http://xnet.kp.org/newscenter/pressreleases/nat/2007/082707gestationaldiabetes.html
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.
