Gestational Diabetes Mellitus Subtypes Classified by Oral Glucose Tolerance Test and Maternal and Perinatal Outcomes: Results of a Mexican Multicenter Prospective Cohort Study "Cuido Mi Embarazo"

Purpose: This study explores the impact of gestational diabetes mellitus (GDM) subtypes classified by oral glucose tolerance test (OGTT) values on maternal and perinatal outcomes.

Patients And Methods: This multicenter prospective cohort study (May 2019-December 2022) included participants from the Mexican multicenter cohort study (CME). Women were classified into four groups per 75-g 2-h OGTT: 1) normal glucose tolerance (normal OGTT), 2) GDM-Sensitivity (isolated abnormal fasting or abnormal fasting in combination with 1-h or 2-h abnormal results), 3) GDM-Secretion (isolated abnormal values at 1-h or 2-h or their combination), and 4) GDM-Mixed (three abnormal values). Cesarean delivery, neonates large for gestational age (LGA), and pre-term birth rates were among the outcomes compared. Between-group comparisons were analyzed using either the -test, chi-square test, or Fisher's exact test.

Results: Of 2,056 Mexican pregnant women in the CME cohort, 294 (14.3%) had GDM; 53.7%, 34.4%, and 11.9% were classified as GDM-Sensitivity, GDM-Secretion, and GDM-Mixed subtypes, respectively. Women with GDM were older (p = 0.0001) and more often multiparous (p = 0.119) vs without GDM. Cesarean delivery (63.3%; p = 0.02) and neonate LGA (10.7%; p = 0.078) were higher in the GDM-Mixed group than the overall GDM group (55.6% and 8.4%, respectively). Pre-term birth was more common in the GDM-Sensitivity group than in the overall GDM group (10.2% vs 8.5%, respectively; p=0.022). At 6 months postpartum, prediabetes was more frequent in the GDM-Sensitivity group than in the overall GDM group (31.6% vs 25.5%). Type 2 diabetes was more common in the GDM-Mixed group than in the overall GDM group (10.0% vs 3.3%).

Conclusion: GDM subtypes effectively stratified maternal and perinatal risks. GDM-Mixed subtype increased the risk of cesarean delivery, LGA, and type 2 diabetes postpartum. GDM subtypes may help personalize clinical interventions and optimize maternal and perinatal outcomes.

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References

Selen D, Edelson P, James K, Corelli K, Hivert M, Meigs J . Physiological subtypes of gestational glucose intolerance and risk of adverse pregnancy outcomes. Am J Obstet Gynecol. 2021; 226(2):241.e1-241.e14. PMC: 8810751. DOI: 10.1016/j.ajog.2021.08.016. View

Powe C, Hivert M, Udler M . Defining Heterogeneity Among Women With Gestational Diabetes Mellitus. Diabetes. 2020; 69(10):2064-2074. PMC: 7506831. DOI: 10.2337/dbi20-0004. View

Retnakaran R, Ye C, Hanley A, Connelly P, Sermer M, Zinman B . Subtypes of gestational diabetes and future risk of pre-diabetes or diabetes. EClinicalMedicine. 2021; 40:101087. PMC: 8548926. DOI: 10.1016/j.eclinm.2021.101087. View

Wang N, Peng Y, Wang L, Song L, Sun B, Wei J . Risk Factors Screening for Gestational Diabetes Mellitus Heterogeneity in Chinese Pregnant Women: A Case-Control Study. Diabetes Metab Syndr Obes. 2021; 14:951-961. PMC: 7936674. DOI: 10.2147/DMSO.S295071. View

Yerlikaya G, Falcone V, Stopp T, Mittlbock M, Tura A, Husslein P . To Predict the Requirement of Pharmacotherapy by OGTT Glucose Levels in Women with GDM Classified by the IADPSG Criteria. J Diabetes Res. 2018; 2018:3243754. PMC: 5964564. DOI: 10.1155/2018/3243754. View

Gallardo-Rincon H, Rios-Blancas M, Ortega-Montiel J, Montoya A, Martinez-Juarez L, Lomelin-Gascon J . MIDO GDM: an innovative artificial intelligence-based prediction model for the development of gestational diabetes in Mexican women. Sci Rep. 2023; 13(1):6992. PMC: 10144896. DOI: 10.1038/s41598-023-34126-7. View

Park S, Kim S . Women with rigorously managed overt diabetes during pregnancy do not experience adverse infant outcomes but do remain at serious risk of postpartum diabetes. Endocr J. 2015; 62(4):319-27. DOI: 10.1507/endocrj.EJ14-0529. View

ElSayed N, Aleppo G, Aroda V, Bannuru R, Brown F, Bruemmer D . 2. Classification and Diagnosis of Diabetes: Standards of Care in Diabetes-2023. Diabetes Care. 2022; 46(Suppl 1):S19-S40. PMC: 9810477. DOI: 10.2337/dc23-S002. View

Plows J, Stanley J, Baker P, Reynolds C, Vickers M . The Pathophysiology of Gestational Diabetes Mellitus. Int J Mol Sci. 2018; 19(11). PMC: 6274679. DOI: 10.3390/ijms19113342. View

10.

Liu Y, Hou W, Meng X, Zhao W, Pan J, Tang J . Heterogeneity of insulin resistance and beta cell dysfunction in gestational diabetes mellitus: a prospective cohort study of perinatal outcomes. J Transl Med. 2018; 16(1):289. PMC: 6201515. DOI: 10.1186/s12967-018-1666-5. View

11.

Layton J, Powe C, Allard C, Battista M, Doyon M, Bouchard L . Maternal lipid profile differs by gestational diabetes physiologic subtype. Metabolism. 2018; 91:39-42. PMC: 8058811. DOI: 10.1016/j.metabol.2018.11.008. View

12.

McIntyre H, Catalano P, Zhang C, Desoye G, Mathiesen E, Damm P . Gestational diabetes mellitus. Nat Rev Dis Primers. 2019; 5(1):47. DOI: 10.1038/s41572-019-0098-8. View

13.

Benhalima K, Van Crombrugge P, Moyson C, Verhaeghe J, Vandeginste S, Verlaenen H . Characteristics and pregnancy outcomes across gestational diabetes mellitus subtypes based on insulin resistance. Diabetologia. 2019; 62(11):2118-2128. DOI: 10.1007/s00125-019-4961-7. View

14.

Gallardo-Rincon H, Lomelin-Gascon J, Martinez-Juarez L, Montoya A, Ortega-Montiel J, Galicia-Hernandez V . Diagnostic Accuracy of Capillary Blood Glucometer Testing for Gestational Diabetes. Diabetes Metab Syndr Obes. 2022; 15:3855-3870. PMC: 9760076. DOI: 10.2147/DMSO.S389420. View

15.

Lee S, Shivakumar M, Park J, Jung Y, Choe E, Kwak S . Long-term cardiovascular outcomes of gestational diabetes mellitus: a prospective UK Biobank study. Cardiovasc Diabetol. 2022; 21(1):221. PMC: 9618212. DOI: 10.1186/s12933-022-01663-w. View

16.

Cosson E, Bentounes S, Nachtergaele C, Berkane N, Pinto S, Sal M . Prognosis Associated with Sub-Types of Hyperglycaemia in Pregnancy. J Clin Med. 2021; 10(17). PMC: 8432067. DOI: 10.3390/jcm10173904. View

17.

Zulueta M, Gallardo-Rincon H, Martinez-Juarez L, Lomelin-Gascon J, Ortega-Montiel J, Montoya A . Development and validation of a multivariable genotype-informed gestational diabetes prediction algorithm for clinical use in the Mexican population: insights into susceptibility mechanisms. BMJ Open Diabetes Res Care. 2023; 11(2). PMC: 10124192. DOI: 10.1136/bmjdrc-2022-003046. View

18.

Shao B, Mo M, Xin X, Jiang W, Wu J, Huang M . The interaction between prepregnancy BMI and gestational vitamin D deficiency on the risk of gestational diabetes mellitus subtypes with elevated fasting blood glucose. Clin Nutr. 2019; 39(7):2265-2273. DOI: 10.1016/j.clnu.2019.10.015. View

19.

Powe C, Allard C, Battista M, Doyon M, Bouchard L, Ecker J . Heterogeneous Contribution of Insulin Sensitivity and Secretion Defects to Gestational Diabetes Mellitus. Diabetes Care. 2016; 39(6):1052-5. PMC: 4878218. DOI: 10.2337/dc15-2672. View

20.

Li Z, Cheng Y, Wang D, Chen H, Chen H, Ming W . Incidence Rate of Type 2 Diabetes Mellitus after Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis of 170,139 Women. J Diabetes Res. 2020; 2020:3076463. PMC: 7204113. DOI: 10.1155/2020/3076463. View