In a paper published online this week in the journal, Nutrition & Diabetes, the authors – led by Research Professor Anne Barden of UWA’s School of Medicine and Pharmacology (Royal Perth Hospital Unit) – write that obesity in the obstetric population is increasing to epidemic proportions worldwide and is likely to affect future incidence of gestational diabetes mellitus and cardiovascular disease.
Dr Barden and her colleagues describe how a woman’s risk of developing the diseases following gestational diabetes – a type of diabetes that can affect women during pregnancy – can be determined by measuring a series of cardiometabolic risk factors in pregnancy, including body mass index (BMI), blood pressure, lipids, glucose, insulin and high-density lipoprotein (HDL) (good) cholesterol.
In a study funded by a grant from the National Heart Foundation of Australia, the researchers studied 150 women with gestational diabetes and 72 overweight women with normal glucose tolerance between 1998 and 2001.
They measured the women’s cardiometabolic risk factors immediately after their gestational diabetes was diagnosed, then six months after delivery, and again 10 years after delivery.
They identified a group of women with gestational diabetes – about 35 per cent – who had higher levels than the rest of the group across a range of measures, including blood pressure, triglycerides and blood glucose. They also had lower levels of HDL cholesterol and were more overweight.
“This is a metabolic syndrome-like cluster,” Professor Barden said. “All these measures tend to track together.”
She said people might think the higher results were simply related to changes seen in pregnancy, but this was not the case.
“That metabolic syndrome-like cluster was still present six months and 10 years after pregnancy. When we studied the women 10 years later, the main finding was that the women with gestational diabetes who had a metabolic syndrome-like profile in pregnancy were six times more likely to have type 2 diabetes than the rest of the group.”
The researchers found that the metabolic syndrome-like cluster in pregnancy was a better predictor of developing type 2 diabetes than just measuring blood glucose or BMI in pregnancy.
Based on their findings, the researchers were able to derive a simple formula which should significantly help clinicians in identifying women who should be targeted for post-pregnancy intervention. They defined a set of cut-off values for each measure to help clinicians decide if a woman with gestational diabetes was in the high risk category.
“This information provides a means of identifying women, when they are pregnant, who are particularly high risk for future diabetes and cardiovascular disease, and allows for the implementation of programs after they’re pregnant in order to prevent those conditions in the long term,” Professor Barden said.