Recurrent GDM and the development of type 2 diabetes have similar risk factors
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EDITORIAL
Recurrent GDM and the development of type 2 diabetes have similar risk factors Donald R. Coustan1,2
Received: 2 June 2016 / Accepted: 4 June 2016 / Published online: 9 July 2016 © Springer Science+Business Media New York 2016
Gestational diabetes mellitus (GDM) is an increasingly common condition complicating pregnancy. The International Diabetes Federation estimates its global prevalence at 17 %, with the highest rates (25 %) in Southeast Asia and the lowest (10 %) in North America and the Caribbean [1]. This estimate totaled 21.4 million live births worldwide to mothers with GDM in 2013. The same report estimated that approximately 16 % of GDM cases are attributable to (presumably undiagnosed) pre-existing diabetes in pregnancy. Attempts were made to compensate for the many different diagnostic criteria, by adjusting the estimates to reflect the International Association of Diabetes in Pregnancy Study Groups (IADPSG)-recommended diagnostic criteria [2]. The increasing prevalence of GDM most likely reflects the worldwide epidemic of obesity and type 2 diabetes. Mothers who experience GDM during their pregnancies have an approximately 50 % recurrence risk for GDM in a subsequent pregnancy [3], with wide variations from study to study. If it is possible to predict the recurrence risk from the characteristics of women with GDM and of their GDM pregnancies, it should be possible to concentrate resources on these individuals in order to lessen their chance of recurrence and to identify GDM earlier in subsequent pregnancies. The meta-analysis by Schwartz et al. published in this issue of Endocrine [4] follows a previous meta-analysis by the same authors [3] that found a pooled GDM recurrence risk of 48 % and reported that ethnicity was a strong
* Donald R. Coustan [email protected] 1
Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence RI 02903, USA
2
Women & Infants Hospital of Rhode Island, 101 Dudley Street, Providence RI 02905-2401, USA
predictor of GDM recurrence, with non-Hispanic whites and primiparous women less likely than other ethnicities and parous women to experience GDM in a subsequent pregnancy (39 % vs 56 %; 40 % vs 73 %, respectively). This analysis updates a number of previous publications by other investigators aimed at determining the strongest risk factors predictive of recurrence of GDM, by adding the results of 4 more recently published large studies. The strongest predictors included oral glucose tolerance test (OGTT) results (fasting, 1-h and 2-h), neonatal birth weight, insulin use during pregnancy, body mass index (BMI), and weight gain between pregnancies. The inter-pregnancy interval was not a significant predictor. Calculation of a standardized mean difference for each factor allowed comparison of effect size; weight gain between pregnancies had the greatest effect size, with OGTT glucose levels, BMI, and neonatal birth weight having approximately one-third to one-half as much effect. These risk factors can be grouped as measure
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