Study: Metabolic screenings may predict gestational diabetes

OAKLAND, Calif. Metabolic screenings may be beneficial to women prior to conceiving a child, as cardiometabolic risk factors that predict gestational diabetes are present before pregnancy, according to a new Kaiser Permanente study.

The study, published in the American Journal of Epidemiology, suggested that metabolic screenings could help identify those more likely to develop gestational diabetes mellitus, which typically occurs in the second or third trimester of pregnancy.

The researchers studied 1,164 women without diabetes before pregnancy who delivered 1,809 live births during the course of five consecutive exams from 1985 to 2006 as part of a "Coronary Artery Risk Development in Young Adults" study. Participant characteristics –– including  lifestyle, sociodemographic, medical conditions, medication use, family history of diabetes, pregnancies and births, and GDM status, as well as clinical assessments, body measurements and blood specimens –– were  obtained at baseline. Follow-up exams used standardized research methodologies, including self- and interviewer-administered questionnaires.

The researchers found that such cardiometabolic factors as impaired fasting glucose, elevated fasting insulin and low HDL-cholesterol before pregnancy were associated with higher risk of GDM. Of the 1,809 live births studied, 154 (8.5%) involved a GDM pregnancy. Among overweight women, 26.7% with one or more cardiometabolic risk factors before pregnancy developed gestational diabetes versus 7.4% who did not have cardiometabolic risk factors.

"Our study suggests that women may benefit from a focus on care before conception that would encourage screening for metabolic abnormalities before pregnancy, rather than only during pregnancy. Because weight loss is not advised, and the medication and behavioral treatment options are more limited during pregnancy, the time to prevent gestational diabetes is before pregnancy begins," said study lead investigator Erica Gunderson, an epidemiologist and research scientist at the Kaiser Permanente Division of Research in Oakland, Calif. "Screening and treatment of metabolic risk factors before pregnancy to prevent GDM may help reduce its lasting adverse health effects on children by possibly improving the uterine environment," she added.