Cuiping Zhang

Increasing prevalence of gestational diabetes mellitus in Chinese women from 1999 to 2008

Diabet. Med. 28, 652–657 (2011)

Prevalence of Gestational Diabetes Mellitus and Its Risk Factors in Chinese Pregnant Women: A Prospective Population-Based Study in Tianjin, China

Objective We compared the increases in the prevalence of gestational diabetes mellitus (GDM) based on the 1999 World Health Organization (WHO) criteria and its risk factors in Tianjin, China, over a 12-year period. We also examined the changes in the prevalence using the criteria of International Association of Diabetes and Pregnancy Study Group (IADPSG). Methods In 2010-2012, 18589 women who registered within 12 weeks of gestation underwent a glucose challenge test (GCT) at 24-28 gestational weeks. Amongst them, 2953 women with 1-hour plasma glucose ≥7.8 mmol/L underwent a 75-gram 2-hour oral glucose tolerance test (OGTT) and 781 women had a positive GCT but absented from the standard OGTT. An adjusted prevalence of GDM was calculated for the whole cohort of women by including an estimate of the proportion of women with positive GCTs who did not have OGTTs but would have been expected to have GDM. Logistic regression was used to obtain odds ratios and 95% confidence intervals using the IADPSG criteria. The prevalence of GDM risk factors was compared to the 1999 survey. Results The adjusted prevalence of GDM by the 1999 WHO criteria was 8.1%, a 3.5-fold increase as in 1999. Using the IADPSG criteria increased the adjusted prevalence further to 9.3%. Advanced age, higher pre-pregnancy body mass index, Han-nationality, higher systolic blood pressure (BP), a family history of diabetes, weight gain during pregnancy and habitual smoking were risk factors for GDM. Compared to the 1999 survey, the prevalence of overweight plus obesity had increased by 1.8 folds, age≥30 years by 2.3 folds, systolic BP by 2.3 mmHg over the 12-year period. Conclusions Increasing prevalence of overweight/obesity and older age at pregnancy were accompanied by increasing prevalence of GDM, further increased by change in diagnostic criteria.

Tianjin Gestational Diabetes Mellitus Prevention Program: study design, methods, and 1-year interim report on the feasibility of lifestyle intervention program.

OBJECTIVE To assess whether lifestyle intervention can reduce type 2 diabetes risk in women with prior GDM in the Tianjin Gestational Diabetes Mellitus (GDM) Prevention Program. METHODS 1180 women who were diagnosed with GDM from 2005 to 2009 were randomly assigned to either a lifestyle intervention (n=586) or a control group (n=594). Major elements of the intervention include six face-to-face meetings with study dietitians in the first year, and two additional sessions and two telephone calls in second year. RESULTS During the first year, average body weight loss in the first 404 subjects was 1.40 kg (2.1%) in the intervention group vs 0.21 kg (0.3%) in the control group (P=0.001), and the decrease was more significant among baseline overweight women (body bass index [BMI]≥24 kg/m²) in the intervention (2.91 kg/4.2%) compared with that in the control group (0.51 kg/0.7%) (P<0.001). In addition, women in the intervention group, compared with those in the control group, have decreased BMI, body fat, waist circumference, and plasma insulin levels, and have improved behaviors including increased leisure time activity and dietary fiber intake and decreased sedentary time and fat consumptions. CONCLUSION The interim results support the efficacy and feasibility of the lifestyle intervention program.

Prepregnancy body mass index and weight change on postpartum diabetes risk among gestational diabetes women

To evaluate the effects of prepregnancy BMI and weight change from prepregnancy to postpartum on postpartum type 2 diabetes (T2D) risk among women with gestational diabetes (GDM).

Different Associations of Diabetes With β-Cell Dysfunction and Insulin Resistance Among Obese and Nonobese Chinese Women With Prior Gestational Diabetes Mellitus

OBJECTIVE To examine the relative contributions of β-cell dysfunction and insulin resistance to postpartum diabetes risk among obese and nonobese women with prior gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS We performed a cross-sectional survey 1–5 years after 1,263 women who had GDM gave birth. Polytomous logistic regression models were used to assess the associations of β-cell dysfunction (the lower quartile of HOMA-%β), insulin resistance (the upper quartile of HOMA-IR), decreased insulin sensitivity (the lower quartile of HOMA-%S), and different categories of BMI with prediabetes and diabetes risk. RESULTS β-Cell dysfunction, insulin resistance, and decreased insulin sensitivity all were significantly associated with hyperglycemic status across normal weight, overweight, and obese groups, and the patterns of insulin resistance and decreased insulin sensitivity were similar. BMI was inversely associated with β-cell dysfunction and positively associated with insulin resistance across normal glucose, prediabetes, and diabetes categories. Compared with women with normal glucose and weight, obese women with normal glucose had increased β-cell secretory function (odds ratio [OR] 0.09 [95% CI 0.02–0.37]) and insulin resistance (OR 17.4 [95% CI 9.47–31.9]). Normal weight diabetic women displayed the most β-cell dysfunction (OR 13.6 [95% CI 4.06–45.3]), whereas obese diabetic women displayed the highest insulin resistance (OR 45.8 [95% CI 18.5–113]). CONCLUSIONS For women with prior GDM, β-cell dysfunction had more pronounced contribution to postpartum diabetes among nonobese subjects, whereas insulin resistance contributed more to postpartum hyperglycemia among obese subjects.

Obesity index and the risk of diabetes among Chinese women with prior gestational diabetes.

There is some confusion regarding which anthropometric measurement of adiposity should be used to indicate diabetes, especially for Asians. The present study was to evaluate different indicators of adiposity (BMI, waist circumference and body fat) with Type 2 diabetes risk among women with prior gestational diabetes mellitus.

A randomised translational trial of lifestyle intervention using a 3-tier shared care approach on pregnancy outcomes in Chinese women with gestational diabetes mellitus but without diabetes.

Background: There are no randomised controlled trials to demonstrate whether lifestyle modifications can improve pregnancy outcomes of gestational diabetes mellitus (GDM) diagnosed by the International Association of Diabetes and Pregnancy Study Group’s (IADPSG) criteria. We tested the effectiveness of lifestyle modifications implemented in a 3-tier’s shared care (SC) on pregnancy outcomes of GDM. Methods: Between December 2010 and October 2012, we randomly assigned 700 women with IADPSG-defined GDM but without diabetes at 26.3 (interquartile range: 25.4-27.3) gestational weeks in Tianjin, China, to receive SC or usual care (UC). The SC group received individual consultations and group sessions and performed regular self-monitoring of blood glucose compared to one hospital-based education session in the UC group. The outcomes were macrosomia defined as birth weight ≥ 4.0 kg and the pregnancy-induced hypertension (PIH). Results: Women in the SC (n = 339) and UC (n = 361) groups delivered their infants at similar gestational weeks. Birth weight of infants in the SC group was lower than that in the UC group (3469 vs. 3371 grams, P = 0.021). The rate of macrosomia was 11.2% (38/339) in the SC group compared to 17.5% (63/361) in the UC group with relative risk (RR) of 0.64 (95% CI: 0.44-0.93). The rate of PIH was 8.0% (27/339) in the SC compared to 4.4% (16/361) in the UC with RR of 1.80 (0.99-3.28). Apgar score at 1 min < 7 was lower but preeclampsia was higher in the SC than in the UC.

Sleep duration and quality, and risk of gestational diabetes mellitus in pregnant Chinese women

To examine the association between sleep disturbances during pregnancy and risk of gestational diabetes mellitus.

Pregnancy outcomes of Chinese women with gestational diabetes mellitus defined by the IADPSG's but not by the 1999 WHO's criteria

To compare pregnancy outcomes of women with gestational diabetes mellitus (GDM) newly defined by the International Association of Diabetes and Pregnancy Study Group (IADPSG)s criteria vs GDM cases missed by a shift from the 1999 World Health Organization (WHO)s criteria to the IADPSGs.

Relationship between maternal fasting glucose levels at 4-12 gestational weeks and offspring growth and development in early infancy

OBJECTIVE To evaluate the association of maternal fasting glucose levels at 4-12 gestational weeks with anthropometry in the offspring from birth to 12 months in Tianjin, China. DESIGN AND METHODS A total of 57,454 pregnant women underwent a fasting glucose test during the first trimester, and their children had body weight/length measured from birth to 12 months of age. RESULTS Maternal fasting glucose concentrations at 4-12 gestational weeks were positively associated with Z scores for birth weight, birth length, birth weight for length, and birth body mass index (BMI). Infants born to mothers with fasting glucose concentrations ≥126mg/dL (7.0mmol/l) had had the highest mean Z scores for birth weight, birth length, birth weight for length and birth BMI for gestational age, and the lowest mean Z scores for weight and length for age at months 3, 6, 9, and 12, the smallest changes in Z scores for weight for age, weight for length, and BMI for age from birth to month 3, and largest changes in Z scores for weight for age, and BMI for age after 6 months. CONCLUSIONS Higher maternal fasting glucose during pregnancy was associated with larger birth weight and birth length, less weight gain and length gain in the first 3 months of life, and more weight gain in months 6-12 of life.