Skip to main content
SpringerLink
Log in

ATLANTIC-DIP: prevalence of metabolic syndrome and insulin resistance in women with previous gestational diabetes mellitus by International Association of Diabetes in Pregnancy Study Groups criteria

  • Original Article
  • Published:
Acta Diabetologica Aims and scope Submit manuscript

Abstract

Women with previous gestational diabetes (GDM) are a high-risk group for future development of diabetes, metabolic syndrome, and cardiovascular disease. The new International Association of Diabetes in Pregnancy Study Groups (IADPSG) criteria significantly increase the number of women diagnosed with GDM. The long-term metabolic outcome in these women is unknown. We set out to determine the prevalence of metabolic syndrome, using adult treatment panel-III criteria; and insulin resistance, using HOMA2-IR, in white European women with previous GDM. Using a cohort design, we invited women meeting IADPSG GDM criteria across four Irish antenatal centres between 2007 and 2010 to participate. Two hundred and sixty-five women with previous values meeting IADPSG criteria for GDM participated (44 % of the population eligible for participation). Mean age was 36.7 years (SD 5.0). These women were compared with a randomly selected control group of 378 women (mean age 37.6 years, SD 5.1) known to have normal glucose tolerance (NGT) in pregnancy during the same period. A total of 25.3 % of women with previous IADPSG-defined GDM met metabolic syndrome criteria, compared to 6.6 % of women with NGT [at 2.6 (SD 1.0) vs. 3.3 years (SD 0.7) post-partum]. The prevalence of HOMA2-IR >1.8 was higher in women with previous IADPSG-defined GDM (33.6 vs. 9.1 % with NGT, p < 0.001). Women with previous GDM by IADPSG criteria demonstrate a greater than threefold prevalence of metabolic syndrome compared to women with NGT in pregnancy. Efforts to prevent projected long-term consequences of this should focus on interventions both in the preconception and post-partum periods.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Bellamy L, Casas JP, Hingorani AD, Williams D (2009) Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. The Lancet 373(9677):1773–1779

    Article  CAS  Google Scholar 

  2. Shah BR, Retnakaran R, Booth GL (2008) Increased risk of cardiovascular disease in young women following gestational diabetes mellitus. Diabetes Care 31(8):1668–1669. doi:10.2337/dc08-0706

    Article  PubMed Central  PubMed  Google Scholar 

  3. Lauenborg J, Mathiesen E, Hansen T, Glumer C, Jorgensen T, Borch-Johnsen K, Hornnes P, Pedersen O, Damm P (2005) The prevalence of the metabolic syndrome in a Danish population of women with previous gestational diabetes mellitus is three-fold higher than in the general population. J Clin Endocrinol Metab 90(7):4004–4010. doi:10.1210/jc.2004-1713

    Article  CAS  PubMed  Google Scholar 

  4. O’Sullivan JB, Mahan CM (1964) Criteria for the oral glucose tolerance test in pregnancy. Diabetes 13:278–285

    PubMed  Google Scholar 

  5. National Diabetes Data Group (1979) Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. Diabetes 28(12):1039–1057

    Article  Google Scholar 

  6. Carpenter MW, Coustan DR (1982) Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol 144(7):768–773

    CAS  PubMed  Google Scholar 

  7. O’Sullivan JB (1991) Diabetes mellitus after GDM. Diabetes 40(Suppl 2):131–135

    Article  PubMed  Google Scholar 

  8. WHO Expert Committee on Diabetes Mellitus (1980) Second report. World Health Organ Tech Rep Ser, vol 646, 1980/01/01 edn

  9. World Health Organisation (1999) Definition, diagnosis, and classification of diabetes and its complications. Part 1: diagnosis and classification of diabetes mellitus. World Health Organisation, Geneva

  10. Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P, Dyer AR, Leiva A, Hod M, Kitzmiler JL, Lowe LP, McIntyre HD, Oats JJ, Omori Y, Schmidt MI (2010) International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 33(3):676–682. doi:10.2337/dc09-1848

    Article  PubMed  Google Scholar 

  11. Sacks DA, Hadden DR, Maresh M, Deerochanawong C, Dyer AR, Metzger BE, Lowe LP, Coustan DR, Hod M, Oats JJ, Persson B, Trimble ER (2012) Frequency of gestational diabetes mellitus at collaborating centers based on IADPSG consensus panel-recommended criteria: the hyperglycemia and adverse pregnancy outcome (HAPO) study. Diabetes Care 35(3):526–528. doi:10.2337/dc11-1641

    Article  PubMed Central  PubMed  Google Scholar 

  12. American Diabetes Association (2011) Standards of medical care in diabetes. Diabetes Care 34(Suppl 1):S11–S61. doi:10.2337/dc11-S011

    Article  PubMed Central  Google Scholar 

  13. WHO (2013) Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy. World Health Organisation, Geneva

    Google Scholar 

  14. Kahn R, Buse J, Ferrannini E, Stern M (2005) The metabolic syndrome: time for a critical appraisal: joint statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 28(9):2289–2304

    Article  PubMed  Google Scholar 

  15. Ford ES, Li C, Sattar N (2008) Metabolic syndrome and incident diabetes: current state of the evidence. Diabetes Care 31(9):1898–1904. doi:10.2337/dc08-0423

    Article  PubMed Central  PubMed  Google Scholar 

  16. Ford ES (2005) Risks for all-cause mortality, cardiovascular disease, and diabetes associated with the metabolic syndrome: a summary of the evidence. Diabetes Care 28(7):1769–1778

    Article  PubMed  Google Scholar 

  17. O’Reilly MW, Avalos G, Dennedy MC, O’Sullivan EP, Dunne F (2011) Atlantic DIP: high prevalence of abnormal glucose tolerance post partum is reduced by breast-feeding in women with prior gestational diabetes mellitus. Eur J Endocrinol 165(6):953–959. doi:10.1530/EJE-11-0663

    Article  PubMed  Google Scholar 

  18. Noctor E, Crowe C, Carmody LA, Avalos GM, Kirwan B, Infanti JJ, O’Dea A, Gillespie P, Newell J, McGuire B, O’Neill C, O’Shea PM, Dunne FP (2013) ATLANTIC DIP: simplifying the follow-up of women with previous gestational diabetes. Eur J Endocrinol 169(5):681–687. doi:10.1530/EJE-13-0491

    Article  CAS  PubMed  Google Scholar 

  19. O’Sullivan EP, Avalos G, O’Reilly M, Dennedy MC, Gaffney G, Dunne F (2011) Atlantic diabetes in pregnancy (DIP): the prevalence and outcomes of gestational diabetes mellitus using new diagnostic criteria. Diabetologia 54(7):1670–1675. doi:10.1007/s00125-011-2150-4

    Article  PubMed  Google Scholar 

  20. Wallace TM, Levy JC, Matthews DR (2004) Use and abuse of HOMA modeling. Diabetes Care 27(6):1487–1495

    Article  PubMed  Google Scholar 

  21. Geloneze B, Vasques AC, Stabe CF, Pareja JC, Rosado LE, Queiroz EC, Tambascia MA, Investigators B (2009) HOMA1-IR and HOMA2-IR indexes in identifying insulin resistance and metabolic syndrome: Brazilian Metabolic Syndrome Study (BRAMS). Arq Bras Endocrinol Metabol 53(2):281–287

    Article  PubMed  Google Scholar 

  22. Mojiminiyi OA, Abdella NA (2010) Effect of homeostasis model assessment computational method on the definition and associations of insulin resistance. Clin Chem Lab Med 48(11):1629–1634. doi:10.1515/CCLM.2010.303

    Article  CAS  PubMed  Google Scholar 

  23. Radikova Z, Koska J, Huckova M, Ksinantova L, Imrich R, Vigas M, Trnovec T, Langer P, Sebokova E, Klimes I (2006) Insulin sensitivity indices: a proposal of cut-off points for simple identification of insulin-resistant subjects. Exp Clin Endocrinol Diabetes 114(5):249–256. doi:10.1055/s-2006-924233

    Article  CAS  PubMed  Google Scholar 

  24. Ascaso JF, Pardo S, Real JT, Lorente RI, Priego A, Carmena R (2003) Diagnosing insulin resistance by simple quantitative methods in subjects with normal glucose metabolism. Diabetes Care 26(12):3320–3325

    Article  CAS  PubMed  Google Scholar 

  25. Safar FH, Mojiminiyi OA, Al-Rumaih HM, Diejomaoh MF (2011) Computational methods are significant determinants of the associations and definitions of insulin resistance using the homeostasis model assessment in women of reproductive age. Clin Chem 57(2):279–285. doi:10.1373/clinchem.2010.152025

    Article  CAS  PubMed  Google Scholar 

  26. Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, Fruchart JC, James WP, Loria CM, Smith SC Jr (2009) Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 120(16):1640–1645. doi:10.1161/CIRCULATIONAHA.109.192644

    Article  CAS  PubMed  Google Scholar 

  27. Xiang AH, Kjos SL, Takayanagi M, Trigo E, Buchanan TA (2010) Detailed physiological characterization of the development of type 2 diabetes in Hispanic women with prior gestational diabetes mellitus. Diabetes 59(10):2625–2630. doi:10.2337/db10-0521

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  28. Retnakaran R, Qi Y, Connelly PW, Sermer M, Zinman B, Hanley AJ (2010) Glucose intolerance in pregnancy and postpartum risk of metabolic syndrome in young women. J Clin Endocrinol Metab 95(2):670–677. doi:10.1210/jc.2009-1990

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  29. Kousta E, Efstathiadou Z, Lawrence NJ, Jeffs JA, Godsland IF, Barrett SC, Dore CJ, Penny A, Anyaoku V, Millauer BA, Cela E, Robinson S, McCarthy MI, Johnston DG (2006) The impact of ethnicity on glucose regulation and the metabolic syndrome following gestational diabetes. Diabetologia 49(1):36–40. doi:10.1007/s00125-005-0058-6

    Article  CAS  PubMed  Google Scholar 

  30. Retnakaran R, Qi Y, Ye C, Hanley AJ, Connelly PW, Sermer M, Zinman B (2011) Hepatic insulin resistance is an early determinant of declining beta-cell function in the first year postpartum after glucose intolerance in pregnancy. Diabetes Care 34(11):2431–2434. doi:10.2337/dc11-0817

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  31. Xiang AH, Takayanagi M, Black MH, Trigo E, Lawrence JM, Watanabe RM, Buchanan TA (2013) Longitudinal changes in insulin sensitivity and beta cell function between women with and without a history of gestational diabetes mellitus. Diabetologia 56(12):2753–2760. doi:10.1007/s00125-013-3048-0

    Article  CAS  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgments

Funding for the study was provided by the Health Research Board (HRB) of Ireland. E.N. reports receiving an unrestricted educational grant from Novo Nordisk Ireland Ltd.

Conflict of interest

C.C., L.C., B.K., A.O.D., L.G., B.M.G., P.O.S., and F.D. have nothing to declare. E.N. reports receiving an unrestricted educational grant from Novo Nordisk Ireland Ltd. for this study.

Ethical standard

This study involved human participants and was approved by the ethics committees of the relevant institutions and conducted in accordance with the principles laid out in the 1964 Helsinki declaration.

Human and animal rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

Informed consent

All participants gave informed consent for participation in this study.

ATLANTIC-DIP collaborators

Dr. Geraldine Gaffney, University Hospital Galway, Dr. Maeve Durkan, Portiuncula Hospital, Co. Galway, Dr. Murtada Mohammed, Mayo General Hospital, Dr. Nandini Ravikumar, and Ms. Therese Gallacher, Letterkenny General Hospital.

Author information

Authors and Affiliations

  1. Galway Diabetes Research Centre, National University of Ireland, Galway, Ireland

    Eoin Noctor, Catherine Crowe, Louise A. Carmody, Breda Kirwan & Fidelma P. Dunne

  2. Department of General Practice, National University of Ireland, Galway, Ireland

    Angela O’Dea & Liam G. Glynn

  3. School of Psychology, National University of Ireland, Galway, Ireland

    Brian E. McGuire

  4. Department of Clinical Biochemistry, University Hospital Galway, Galway, Ireland

    Paula M. O’Shea

  5. Clinical Science Institute, University Hospital Galway, Galway, Ireland

    Eoin Noctor

Authors
  1. Eoin Noctor
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Catherine Crowe
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Louise A. Carmody
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Breda Kirwan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Angela O’Dea
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Liam G. Glynn
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Brian E. McGuire
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Paula M. O’Shea
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Fidelma P. Dunne
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eoin Noctor.

Additional information

Managed by Massimo Porta.

For the ATLANTIC-DIP investigators.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Noctor, E., Crowe, C., Carmody, L.A. et al. ATLANTIC-DIP: prevalence of metabolic syndrome and insulin resistance in women with previous gestational diabetes mellitus by International Association of Diabetes in Pregnancy Study Groups criteria. Acta Diabetol 52, 153–160 (2015). https://doi.org/10.1007/s00592-014-0621-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00592-014-0621-z

Keywords

Search

Navigation