Eszter Madarász

Carbohydrate metabolism and cardiovascular risk factors 4 years after a pregnancy complicated by gestational diabetes

AIMS The aim of the present study was to determine the prevalence of abnormal glucose tolerance and the metabolic syndrome in a cohort of previously gestational diabetic (GDM) women 4 years after delivery. METHODS Sixty-eight prior GDM and a control group of 39 women with normal glucose tolerance during pregnancy were invited to participate in a follow-up study. RESULTS The prevalence of diabetes, impaired glucose tolerance and impaired fasting glucose (IFG) was 21%, 16%, and 6% among prior GDM women and 0%, 15%, and 0% among controls respectively (P=0.0039). Independently of the metabolic syndrome criteria used this status was found more frequently among women with prior GDM (all P<0.05). The prevalence of the metabolic syndrome showed a dose-response relationship with the level of weight categories (P<0.005) as well as with the level of glucose intolerance (P=0.024). CONCLUSION According to our results a disturbed carbohydrate metabolism and a clustering of cardiovascular risk factors might be observed in previous GDM women 4 years after delivery.

Height and gestational diabetes mellitus.

2002 19 0 Letters xxx Recently Kousta and co-workers reported in an intriguing paper that women with previous gestational diabetes mellitus (GDM) of European and South Asian origin are substantially shorter than metabolically healthy women from the same ethnic groups [1]. This finding confirms previous observations in Korean and Greek women [2,3]. Since the relationship to the fetal origin’s hypothesis is plausible, and may help us to understand the natural history of gestational diabetes, an early manifestation of the metabolic syndrome [4], we investigated the association between height and glucose intolerance in women from two cohorts with gestational diabetes. In 1999 we launched a screening programme for gestational diabetes in the Szent Imre Teaching Hospital using a 75 g oGTT according to WHO criteria [5]. This institute in Budapest serves an urbanized population of about 200 000 inhabitants. We studied a random sample of healthy women from the 1635 pregnancies during an 18-month period and the characteristics of all 94 GDM women. Among other variables, we recorded weight and height measured on a rigid stadiometer to the nearest cm by one or two experienced assistants. There was no difference between healthy and GDM women in height (Table 1), while GDM women were older, tended to be more obese, and more frequently had a positive parental history of diabetes. We also explored the relationship between height and different patient characteristics; the only significant correlate of height was weight ( r = 0.401, P < 0.0001), and neither the baseline ( r = –0.022, P = 0.6) nor the 120 min blood glucose values (during the 75 g oGTT; r = –0.058, P = 0.16), or age at menarche ( r = 0.027, P = 0.51), level of education (lower 164.3 ± 7.0 cm vs. higher 165.4 ± 5.7 cm, P = 0.12) or parental history of diabetes (negative 165.2 ± 5.9 vs. positive 164.9 ± 6.3, P = 0.74) were related to height. The other cohort described previously [6] contains 186 women referred to a national centre for care of gestational diabetes during their pregnancy between 1985 and 1990. We excluded 21 patients reclassified as Type 1 diabetes (ICA or GADA positivity and insulin treatment 8 years after delivery) from this analysis. This cohort represents patients with more pronounced disease, reinforced by our observation that 62% of them were insulinized during pregnancy. The patients were examined on average 8 years after delivery. Since previous reports found that height was related to the degree of glucose intolerance, we examined those who did and did not receive insulin during pregnancy. Although we found no significant difference in height (162.4 ± 6.0 cm vs. 161.1 ± 6.8 cm, P = 0.183), they were generally shorter than the women from the more recent screening. When the two cohorts were combined, GDM women (from both the previous follow-up and the screening project) were shorter (165.1 ± 6.0 cm vs. 161.9 ± 6.3 cm, P < 0.0001). After entering year of birth into a multiple regression model, however, height was no longer related to the diagnosis (mean difference between GDM and healthy women: 0.3 ± 0.7 cm, P = 0.70). We were therefore unable to demonstrate that Hungarian women (of European origin) with gestational diabetes are shorter than healthy pregnant women. Our results showed a highly significant birth cohort effect (although referral bias could have some effect on the findings using the combined patient groups), suggesting that height data should be treated with exceptional care. There are papers showing that the height of GDM women is lower than that of healthy pregnant women [1–3] and other positive observations comparing healthy and Type 2 diabetic (or impaired glucose tolerance) patients [7–10]. However, it should be noted that height is one of the basic anthropological measurements recorded in almost every study, so negative reports are not likely to be present in the literature. It could be argued, though, that since body mass index and waist–hip ratio are more closely related to diabetes [5], a relationship between height and diabetes could be overlooked. Socioeconomic factors could also have a significant effect on adult height; they were not taken into account in the Kousta paper [1]. Although we used level of education as a

Osteoprotegerin Levels in Women With Prior Gestational Diabetes Mellitus

Osteoprotegerin (OPG), an inhibitor of bone resorption, seems to be elevated in patients with diabetes as well as in nondiabetic subjects with cardiovascular disease (1). Following a pregnancy complicated by gestational diabetes mellitus (GDM), women present with an increased prevalence of glucose intolerance and an unfavorable cardiovascular risk profile, although definite cardiovascular diseases or late diabetes complications have only rarely been confirmed (2). Hence, our aim was to study OPG levels and their association with other cardiovascular risk factors in a sample of 30 former GDM (by World Health Organization criteria) and 14 age-matched women with normal glucose tolerance during pregnancy in an average 4 years after delivery. During the study investigation an assisted questionnaire was completed, followed by a detailed physical examination, …

Abnormal glucose tolerance is associated with diminished postload change in leptin levels in women.

It is generally accepted that the metabolic effects of leptin are diminished in the obese due to leptin resistance. Hormone resistance may develop if diurnal (including meal‐related) changes in hormone levels are disrupted. We sought to describe leptin changes after a 75g oral glucose tolerance test (OGTT) in women with a prior diagnosis of gestational diabetes mellitus (a high risk group for the metabolic syndrome) compared to that in healthy controls.