Osmulski Meredith E, Yu Yuanzhi, Kuang Alan, Josefson Jami L, Hivert Marie-France, Scholtens Denise M, Lowe William L
Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL.
Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL.
Diabetes Care. 2025 Mar 1;48(3):390-399. doi: 10.2337/dc24-1735.
Subtypes of gestational diabetes mellitus (GDM) based on insulin sensitivity and secretion have been described. We addressed the hypothesis that GDM subtypes are differentially associated with newborn and child anthropometric and glycemic outcomes.
Newborn and child (age 11-14 years) outcomes were examined in 7,970 and 4,160 mother-offspring dyads, respectively, who participated in the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study and HAPO Follow-Up Study. GDM was classified as insulin-deficient GDM (insulin secretion <25th percentile with preserved insulin sensitivity), insulin-resistant GDM (insulin sensitivity <25th percentile with preserved insulin secretion), or mixed-defect GDM (both <25th percentile). Regression models for newborn and child outcomes included adjustment for field center, maternal BMI, and other pregnancy covariates. Child models also included adjustment for child age, sex, and family history of diabetes.
Compared with mothers with normal glucose tolerance, all three GDM subtypes were associated with birth weight and sum of skinfolds >90th percentile. Insulin-resistant and mixed-defect GDM were associated with higher risk of cord C-peptide levels >90th percentile. Insulin-resistant GDM was associated with higher risk of neonatal hypoglycemia. Insulin-resistant GDM was associated with higher risk of neonatal hypoglycemia and childhood obesity (odds ratio [OR] 1.53, 95% CI 1.127-2.08). The risk of childhood impaired glucose tolerance was higher with insulin-resistant GDM (OR 2.21, 95% CI 1.50-3.25) and mixed-defect GDM (OR 3.01, 95% CI 1.47-6.19).
GDM subtypes are differentially associated with newborn and childhood outcomes. Better characterizing individuals with GDM could help identify at-risk offspring to offer targeted, preventative interventions early in life.
基于胰岛素敏感性和分泌情况对妊娠期糖尿病（GDM）的亚型进行了描述。我们探讨了GDM亚型与新生儿及儿童人体测量指标和血糖结局存在差异关联的这一假设。
分别在7970对母婴和4160对母婴中检查了新生儿及儿童（11 - 14岁）的结局，这些母婴参与了高血糖与不良妊娠结局（HAPO）研究及HAPO随访研究。GDM被分类为胰岛素缺乏型GDM（胰岛素分泌低于第25百分位数且胰岛素敏感性正常）、胰岛素抵抗型GDM（胰岛素敏感性低于第25百分位数且胰岛素分泌正常）或混合型缺陷GDM（两者均低于第25百分位数）。针对新生儿及儿童结局的回归模型对现场中心、母亲体重指数（BMI）及其他妊娠协变量进行了校正。儿童模型还对儿童年龄、性别及糖尿病家族史进行了校正。
与糖耐量正常的母亲相比，所有三种GDM亚型均与出生体重及皮褶厚度总和高于第90百分位数相关。胰岛素抵抗型和混合型缺陷GDM与脐血C肽水平高于第90百分位数的风险更高相关。胰岛素抵抗型GDM与新生儿低血糖风险更高相关。胰岛素抵抗型GDM与新生儿低血糖和儿童期肥胖风险更高相关（优势比[OR]为1.53，95%置信区间[CI]为1.127 - 2.08）。胰岛素抵抗型GDM（OR为2.21，95% CI为1.50 - 3.25）和混合型缺陷GDM（OR为3.01，95% CI为1.47 - 6.19）的儿童糖耐量受损风险更高。
GDM亚型与新生儿及儿童期结局存在差异关联。更好地对GDM个体进行特征描述有助于识别高危后代，以便在生命早期提供有针对性的预防性干预措施。
