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Study Results Aid Understanding of Gestational Diabetes

A Division of Research study may lead toward less gestational diabetes.

Interview by Lynn Mundell, editor, Inside KP Northern California

Monique Hedderson, PhD, a research scientist at the region’s Division of Research (DOR), has been building her research career around mother-baby health.

Hedderson is principal investigator of 3 studies underway and co-lead on several more with her colleague Assiamira Ferrara, MD, PhD. Hedderson’s most recently published study has reached the mainstream news. She discusses how her research is making lives better for Kaiser Permanente members.

Please summarize your latest study findings.

It’s a 4-year study funded by the National Institutes of Health that is now in its fourth year. Essentially, we found that overweight women with low levels of a hormone that protects against insulin resistance are nearly 7 times more likely to develop gestational diabetes. The overweight women in the study with high levels of the hormone, called adiponectin, were only about twice as likely to have gestational diabetes. Among normal-weight women, low levels of adiponectin were also linked to gestational diabetes, although they had only a 3.5 times increased risk to develop the condition. Clearly both being overweight and having low levels of adiponectin is the worst combination, but we need more information to understand why some women have higher levels of the hormone, even when overweight.

What makes the study unique?
Typically, in pregnancy research studies, a mother is a study participant during her pregnancy. In this instance, the study was retrospective: We used our electronic health records to identify around 4,000 women who had given blood samples between 1985 and 1996 as part of the region’s Multiphasic Health Check-Up, and who later delivered a baby by 2010. We studied the approximately 256 women who had developed gestational diabetes and then 497 who had not.

One might hyper-focus on the role weight plays; is that fair?
The risk of gestational diabetes has been highest among Asian women, although they tend to be at a healthy weight. In fact, up to 10 percent of some Asian populations in the state develop gestational diabetes. This shows that there are other risk factors beyond weight. That said, our study showed a higher rate of gestational diabetes mellitus for the women who were overweight, so it is something to take seriously.

Tell us more about why gestational diabetes is a research focus for you.
No one wants gestational diabetes. High blood glucose levels during pregnancy can cause the baby to grow too large, increasing complications during delivery and upping the chances of a Caesarean-section birth.  Women with gestational diabetes are 7 times more likely to develop type 2 diabetes later, which can negatively affect the eyes, arteries, kidneys, nervous system, and blood vessels. Overly high blood sugars in the first trimester increase the chances of a baby having a birth defect. These babies are then at greater risk of becoming obese and of developing gestational diabetes themselves one day.

What is the take-away for caregivers and patients?

This study speaks to the importance of preventive medicine, in this case pre-pregnancy care. We can see from the study that physicians could potentially use adiponectin levels to identify women who are at risk for gestational diabetes before they even conceive. Also, pregnancy is a teachable moment. Women are concerned about their health and the baby’s, so they are more open to adopting healthy behaviors. These findings really confirm and perhaps cast most urgency on the fact that the healthier a woman is going into conception and pregnancy—both in her weight and exercise level—the better it is for her and her baby.

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