Background and Aims: People with different glucose response patterns during the 2-h oral glucose tolerance test (OGTT) have substantially different clinical characteristics and risk for long-term outcomes in the general population. We aimed to identify comparable glucose response patterns in pregnancy and their association with maternal and fetal outcomes.
Materials and Methods: We used latent class trajectory modelling to identify glucose response patterns using 5-point 75g OGTT in 470 pregnant women at 27.3±2.2 weeks of gestation. We assessed these classes and investigated pregnancy outcomes in an independent cohort of 7073 pregnant women with 3-point OGTTs.
Results: We identified five different glucose response patterns (classes) . Rate of gestational diabetes (GDM) was lowest in class 1 (< 7%) and highest in class 5 (100%) for both cohorts. Class 3 was characterized by transient hyperinsulinemia at 30 minutes but the prevalence of GDM was only 25-36%. Compared to class 1, women in class 3 had an increased gestational weight gain (GWG, β=0.85 SE: 0.31kg, p=0.0065, adjusted for age, gestational age, pre-gestational BMI, GDM treatment and AUCGlucose) . New-borns in class 3 had the highest risk of macrosomia (OR 1.47 95% CI: [1.12, 1.93] vs. class 1) after adjustment for maternal age, parity and smoking, but this was attenuated by additional adjustment for pre-pregnancy BMI and GWG.
Conclusion: We found an easily identifiable group of pregnant women who have an increased risk of macrosomia without formally meeting GDM diagnosis. These women would most likely benefit from a therapy (e.g. nutritional counselling) aiming at preventing excessive glucose excursions and GWG.
Note: LF and AH contributed equally to this work.
L.Fritsche: None. R.Wagner: Advisory Panel; Akcea Therapeutics, Daiichi Sankyo, Sanofi-Aventis Deutschland GmbH, Speaker's Bureau; Lilly, Novo Nordisk, Sanofi-Aventis Deutschland GmbH. A.Hulman: None. K.Prystupa: None. M.Heni: Advisory Panel; Boehringer Ingelheim International GmbH, Research Support; Boehringer Ingelheim International GmbH, Sanofi, Speaker's Bureau; Amryt Pharma Plc, Boehringer Ingelheim International GmbH, Novo Nordisk. A.L.Birkenfeld: None. A.Peter: None. A.Fritsche: Advisory Panel; Boehringer Ingelheim International GmbH, Novo Nordisk, Sanofi-Aventis Deutschland GmbH. A.Kun: None. A.Tabak: Consultant; 77 Elektronika Kft., Boehringer Ingelheim International GmbH, Speaker's Bureau; 77 Elektronika Kft., AstraZeneca, Sanofi_aventis Zrt.
The PREG study is supported in part by a grant from the Federal Ministry of Education and Research (BMBF) (01GI0925) to the German Center for Diabetes Research (DZD)