Journal
AMERICAN JOURNAL OF EPIDEMIOLOGY
Volume 172, Issue 10, Pages 1131-1143Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/aje/kwq267
Keywords
cohort studies; diabetes; gestational; lipids; longitudinal studies; obesity; preconception care; pregnancy; risk factors
Categories
Funding
- US National Institutes of Health from the National Heart, Lung, and Blood Institute [N01-HC-48047, N01-HC-48048, N01-HC-48049, N01-HC-48050, N01-HC-95095]
- National Institute of Diabetes and Digestive and Kidney Diseases [K01 DK059944]
- American Diabetes Association
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This study examined prepregnancy cardiometabolic risk factors and gestational diabetes mellitus (GDM) in subsequent pregnancies. The authors selected 1,164 women without diabetes before pregnancy who delivered 1,809 livebirths between 5 consecutive examinations from 1985 to 2006 in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. The authors measured prepregnancy cardiometabolic risk factors and performed multivariate repeated-measures logistic regression to compute the odds of GDM adjusted for race, age, parity, birth order, and other covariates. Impaired fasting glucose (100-125 vs. < 90 mg/dL), elevated fasting insulin (> 15-20 and > 20 vs. < 10 mu U/mL), and low levels of high-density lipoprotein cholesterol (< 40 vs. > 50 mg/dL) before pregnancy were directly associated with GDM: The odds ratios 4.74 (95% confidence interval (CI): 2.14, 10.51) for fasting glucose, 2.19 (95% CI: 1.15, 4.17) for middle insulin levels and 2.36 (95% CI: 1.20, 4.63) for highest insulin levels, and 3.07 (95% CI: 1.62, 5.84) for low levels of high-density lipoprotein cholesterol among women with a negative family history of diabetes; all P < 0.01. Among overweight women, 26.7% with 1 or more cardiometabolic risk factors developed GDM versus 7.4% with none. Metabolic impairment exists before GDM pregnancy in nondiabetic women. Interconceptual metabolic screening could be included in routine health assessments to identify high-risk women for GDM in a subsequent pregnancy and to potentially minimize fetal exposure to metabolic abnormalities that program future disease.
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