Insulin Sensitivity and β-Cell Function During Early and Late Pregnancy in Women With and Without Gestational Diabetes Mellitus.

Abstract

OBJECTIVE:

To evaluate the metabolic alterations associated with gestational diabetes mellitus (GDM) in women with overweight or obesity.

RESEARCH DESIGN AND METHODS:

We compared fasting and postprandial plasma glucose and free fatty acid (FFA) concentrations, insulin sensitivity (IS; Matsuda index), and β-cell function (i.e., β-cell responsiveness to glucose) by using a frequently sampled oral glucose tolerance test (OGTT) at 15 and 35 weeks' gestation in women with overweight or obesity who had GDM (n = 29) or did not have GDM (No-GDM; n = 164) at 35 weeks.

RESULTS:

At 15 weeks, IS and β-cell function were lower, and fasting, 1-h, and total area-under-the-curve plasma glucose concentrations during the OGTT were higher (all P < 0.05) in the GDM than in the No-GDM group. At 35 weeks compared with 15 weeks, IS decreased, β-cell function increased, and postprandial suppression of plasma FFA was blunted in both the GDM and No-GDM groups, but the decrease in IS and the increase in postprandial FFA concentration were greater and the increase in β-cell function was less (all P ≤ 0.05) in the GDM than in the No-GDM group. A receiver operating characteristic curve analysis showed that both fasting plasma glucose and 1-h OGTT glucose concentration at 15 weeks are predictors of GDM, but the predictive power was <30%.

CONCLUSIONS:

Women with overweight or obesity and GDM, compared with those without GDM, have worse IS and β-cell function early during pregnancy and a greater subsequent decline in IS and blunted increase in β-cell function. Increased fasting and 1-h OGTT plasma glucose concentration early during pregnancy are markers of increased GDM risk, albeit with weak predictive power.

• Authors: Bettina Mittendorfer, Bruce W Patterson, Debra Haire-Joshu, Alison G Cahill, W Todd Cade, Richard I Stein, Samuel Klein
• Journal: Diabetes care (Diabetes Care) Vol. 46 Issue 12 Pg. 2147-2154 (Dec 01 2023) ISSN: 1935-5548 [Electronic] United States
• PMID: 37262059 (Publication Type: Journal Article)
• Copyright: © 2023 by the American Diabetes Association.

Chemical References

• Blood Glucose

Topics

• Pregnancy
• Female
• Humans
• Diabetes, Gestational
• Insulin Resistance
• Blood Glucose (metabolism)
• Overweight
• Obesity