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Heterogeneity of gestational diabetes (GDM) and long-term risk of diabetes and metabolic syndrome: findings from the RADIEL study follow-up

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Abstract

Aims

To assess the metabolic health of obese and non-obese women at high GDM risk 5 years postpartum.

Methods

This is a secondary analysis of the 5-year follow-up of the RADIEL GDM prevention study including 333 women at high GDM risk (BMI ≥ 30 kg/m2 and/or previous GDM). Five years postpartum metabolic health was assessed including anthropometric measurements, oral glucose tolerance test, lipid metabolism, and body composition as well as medical history questionnaires. For the analysis, we divided the women into four groups based on parity, BMI, and previous history of GDM.

Results

Five years postpartum impaired glucose regulation (IFG, IGT, or diabetes) was diagnosed in 15% of the women; 3.6% had type 2 diabetes. The highest prevalence was observed among obese women with a history of GDM (26%), and the lowest prevalence (8%) among primiparous obese women (p = 0.021). At follow-up 25–39% of the obese women fulfilled the diagnostic criteria for the metabolic syndrome, in the non-obese group 11% (p < 0.001). This was associated with body fat percentage. The non-obese group, however, faced metabolic disturbances (IFG, IGT, diabetes, or metabolic syndrome) at a significantly lower BMI (p < 0.001). Among women who were non-obese before pregnancy, 5 years postpartum, the obesity prevalence based on BMI was 14% and based on body fat percentage 58%.

Conclusions

The prevalence of impaired glucose regulation and metabolic syndrome is high 5 years postpartum among women at high risk of GDM. There are high-risk women also among the non-obese, who develop metabolic derangements already at a lower BMI.

Clinical trial registration

ClinicalTrials.gov, www.clinicaltrials.com, NCT01698385.

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Acknowledgements

The study was funded by Ahokas Foundation, the Finnish Foundation for Cardiovascular Disease, Academy of Finland, Special state subsidy for health science research of Helsinki University Hospital (HUH), Samfundet Folkhälsan, Finska Läkaresällskapet, Juho Vainio Foundation, Viipuri Tuberculosis Foundation, The Finnish Diabetes Research Foundation, State Provincial Office of Southern Finland, Health Promotion Grant (Ministry of Social Affairs and Health) EU H2020-PHC-2014-DynaHealth Grant No. 633595, and The Social Insurance Institution of Finland. The funders have not had any role in designing or conducting the study; nor in collection, management, analysis, or interpretation of the data; nor in preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland

    Emilia Huvinen, Saila B. Koivusalo, Aila Tiitinen & Kristiina Rönö

  2. Department of General Practice and Primary Health Care, Biomedicum Helsinki, University of Helsinki, Tukholmankatu 8 B, P.O. Box 20, 00014, Helsinki, Finland

    Emilia Huvinen, Johan G. Eriksson & Nora Grotenfelt

  3. Folkhälsan Research Center, Helsinki, Finland

    Johan G. Eriksson & Nora Grotenfelt

  4. Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland

    Johan G. Eriksson

  5. Department of Obstetrics and Gynecology, South Karelia Central Hospital, Lappeenranta, Finland

    Beata Stach-Lempinen

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  1. Emilia Huvinen
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  2. Johan G. Eriksson
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  3. Saila B. Koivusalo
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Contributions

EH participated in the design and implementation of the study, literature search, data interpretation, and the drafting and editing of the article. JGE is the principal investigator of the study, participated in the implementation of the study, analysis of the results, and advised on drafting and editing the article. SBK initiated, participated in the design of the study, coordinated the study, and helped in the editing of the article. NG participated in the design of the study and helped with the editing of the article. AT participated in the design of the study and helped with the editing of the article. BS-L participated in the design of the study, coordinated the study in Lappeenranta, and helped with editing the article. KR participated in the design of the study and helped in the statistical analysis and drafting and editing of the article. All authors have read and approved the final version of the manuscript. EH is the guarantor of this work and, as such, had full access to all the data in the study and takes full responsibility for the integrity of the data and the accuracy of the data analysis.

Corresponding author

Correspondence to Emilia Huvinen.

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Conflict of interest

The authors declare that there is no conflict of interest associated with this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Ethics Committees of HUH and SKCH and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed written consent was obtained from all individual participants included in the study.

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Managed By Antonio Secchi.

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Huvinen, E., Eriksson, J.G., Koivusalo, S.B. et al. Heterogeneity of gestational diabetes (GDM) and long-term risk of diabetes and metabolic syndrome: findings from the RADIEL study follow-up. Acta Diabetol 55, 493–501 (2018). https://doi.org/10.1007/s00592-018-1118-y

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