Association between metabolic deteriorations and prior gestational diabetes according to weight status

Abstract

Objective: The aim of the present study is to investigate the effect of prior gestational diabetes mellitus (GDM) on glucose and insulin homeostasis according to weight status. Methods: The analysis included 299 women, 216 with [GDM(1)] and 83 without prior GDM [GDM(2)]. The mean time between pregnancy and testing was 3.9 years. Glucose values were obtained from a 2-h 75 g oral glucose tolerance test (OGTT). Body composition was measured by dual-energy X-ray. Results: In women with normal BMI, fasting glucose, 2-h post-OGTT glucose, and HbA1 were higher for GDM(1) (P < 0.05). Normal-weight women with GDM(1) presented lower HOMA-IS, insulin secretion, and insulinogenic index (P < 0.05) compared to GDM(2). Body fat and android fat mass were higher, gynoid fat mass was similar, and lean body mass was decreased in GDM(1) vs. GDM(2) with normal weight (P < 0.05). A greater proportion of GDM(1) with overweight/obesity had prediabetes (72.1%) or type 2 diabetes (T2D) (21.7%) vs. GDM(2) and overweight/obesity (17.1 and 2.4%) or GDM(1) and normal weight (60.5 and 14.0%). Conclusions: A combination of GDM and overweight/obesity is associated with T2D-related metabolic deteriorations. Nevertheless, normal-weight women with GDM(1) had increased android fat and greater metabolic complications, suggesting that women with prior GDM should benefit from lifestyle intervention, regardless of their weight status.