Predictors of recurrent gestational diabetes mellitus: A Japanese multicenter cohort study and literature review

Association between eating habits during adolescence and gestational diabetes: data from the Japan environment and children's study

Purpose

It is difficult to change pre-pregnancy eating habits, yet establishing healthy eating habits before pregnancy is important for preventing gestational diabetes mellitus (GDM). This study aimed to examine whether the weight-loss behavior of avoiding between-meal and midnight snacking in teenagers is associated with a reduction in the risk of subsequent GDM.

Methods

We used a dataset (jecs-an-20,180,131) from a nationwide, prospective birth cohort study, the Japan Environment and Children's Study (JECS). We included 89,227 (85.7% of the total) mother-infant pairs with live births. Participants in their second or third trimester were asked to report their weight-loss behavior during their teenage years. The prevalence of GDM was investigated. Differences in maternal characteristics were examined using chi-square tests. Crude and adjusted logistic regression models were constructed to assess the associations of various maternal characteristics with the weight-loss behavior of avoiding between-meal and midnight snacking during teenage years.

Results

A total of 2,066 (2.3%) participants had GDM. Weight-loss behavior in teenagers was associated with a decreased risk of GDM. Among participants with normal weight or overweight prior to pregnancy, the adjusted odds ratios were 0.79 (95% confidence interval, 0.70-0.89) and 0.82 (95% confidence interval, 0.69-0.98), respectively.

Conclusions

The results suggest that teenage weight-loss behaviors, such as avoiding between-meal and midnight snacking, are associated with a decreased risk of developing GDM.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-023-01294-2.

Screening methods for gestational diabetes mellitus in Japan in 2018: a retrospective cohort study using a national surveillance questionnaire

This study aimed to investigate the relationship between gestational diabetes mellitus (GDM) screening methods and GDM incidences. In 2018, a national questionnaire was administered at 231 institutions (56.6%) of all 408 perinatal medical centers in Japan. Of 100,485 women, 2,982 (3.0%) were diagnosed with GDM during their first pregnancy period (FPP) and 7,289 (7.3%) were diagnosed with GDM during their middle pregnancy period (MPP). The proportion of women diagnosed with GDM during FPP and MPP using 95 mg/dL as the cutoff value (CV) for random plasma glucose (PG) at FPP (4.3% and 9.2%) was significantly higher than that of women diagnosed with GDM using 100 mg/dL as the CV for random PG (2.7% and 6.9%, p < 0.0001, respectively). Compared with women screened for GDM using "random PG and random PG," women who were screened for GDM using "random PG and 50-g glucose challenge test (GCT)" had a significantly higher incidence of GDM (6.6% versus 8.9%, p < 0.0001). Using random PG and 50-g GCT, the incidence of GDM among women diagnosed at MPP using a CV of 95 mg/dL at FPP was significantly higher than that of women diagnosed using a CV of 100 mg/dL (16.5% versus 7.8%: p < 0.0001). While, using "random PG and random PG," the incidences of GDM among women were similar between institutions using a CV of 100 mg/dL and those using a CV of 95 mg/dL at FPP (6.7% versus 6.9%: p = 0.3581). This study showed random PG as a first-step screening method in MPP may overlook women with GDM.

The Impact of Ethnicity on Fetal and Maternal Outcomes of Gestational Diabetes

Background and Objectives: The prevalence of gestational diabetes mellitus (GDM) significantly varies across different ethnic groups. In particular, Africans, Latinos, Asians and Pacific Islanders are the ethnic groups with the highest risk of GDM. The aim of this study was to evaluate the impact of ethnicity on pregnancy outcomes in GDM. Patients and Methods: n = 399 patients with GDM were enrolled, n = 76 patients of high-risk ethnicity (HR-GDM), and n = 323 of low-risk ethnicity (LR-GDM). Clinical and biochemical parameters were collected during pregnancy until delivery. Fetal and maternal short-term outcomes were evaluated. Results: HR-GDM had significantly higher values of glycosylated hemoglobin checked at 26−29 weeks of gestation (p < 0.001). Gestational age at delivery was significantly lower in HR-GDM (p = 0.03). The prevalence of impaired fetal growth was significantly higher in HR-GDM than LR-GDM (p = 0.009). In logistic regression analysis, the likelihood of impaired fetal growth was seven times higher in HR-GDM than in LR-GDM, after adjustment for pre-pregnancy BMI and gestational weight gain (OR = 7.1 [2.0−25.7] 95% CI, p = 0.003). Conclusions: HR-GDM had worse pregnancy outcomes compared with LR-GDM. An ethnicity-tailored clinical approach might be effective in reducing adverse outcomes in GDM.

Analysis and Intervention of Factors Affecting Abnormal Postpartum Glucose Tolerance and Gestational Recurrence in Gestational Diabetes

ObjectiveTo investigate the influencing factors of abnormal postpartum glucose tolerance and pregnancy recurrence in gestational diabetes mellitus (GDM) and to develop reasonable interventions to prevent postpartum glucose tolerance and recurrence of pregnancy. Methods. Retrospective analysis of clinical data of 238 GDM patients during pregnancy, including age, body mass index (BMI) before and after pregnancy, regular exercise during pregnancy, insulin use, family history of diabetes, fasting blood glucose (FPG) during pregnancy, oral glucose tolerance test (OGTT) 2 h time value, blood lipid index, and whether pregnant again. At the same time, the women were followed up by telephone or home visits to understand and guide the patient's diet and exercise. The clinical characteristics of the two groups of patients were compared. According to the OGTT test, the recovery of glucose tolerance in pregnant women 6–8 weeks postpartum was divided into the normal postpartum glucose tolerance group and the abnormal group. Logistic multivariate analysis was used to find the influencing factors of postpartum glucose tolerance and recurrence of pregnancy. Results. Between 238 patients of followed-up, 150 pregnant women had abnormal postpartum glucose tolerance, accounting for 63.03%. There were 115 repregnants, of whom 37 (32.17%) had a recurrence of postpartum glucose tolerance. Pre and postpregnancy BMI, insulin use during pregnancy, family history of diabetes, FPG during pregnancy, OGTT 2 h values, and triglyceride (TG) were independent risk factors for abnormal postpartum diabetes and recurrence of pregnancy in GDM patients. Conclusions. Patients with GDM are at high risk of postpartum abnormal glucose tolerance and pregnancy recurrence, which may be influenced by the pregnant woman's prepregnancy and postpartum BMI, insulin use during pregnancy, family history of diabetes, FPG, OGGT 2 h values during pregnancy, and TG levels. Therefore, health education for pregnant women should be strengthened in the clinic, with guidance on proper diet for weight control, increased exercise, and regular blood glucose screening and monitoring for those at risk.