Physiologic subtypes of Gestational Glucose Intolerance and
Women with gestational glucose intolerance, defined as an abnormal initial gestational diabetes screening test, are at risk for adverse pregnancy outcomes even if they do not have gestational diabetes.

Researchers defined gestational glucose intolerance physiologic subtypes based on the presence of insulin resistance, insulin deficiency, or mixed pathophysiology, and aimed to determine if these subtypes are at differential risk for adverse outcomes. They hypothesized that women with the insulin-resistant subtype of gestational glucose intolerance would have the greatest risk of adverse pregnancy outcomes.

In a hospital-based cohort study, they studied women with gestational glucose intolerance and normal glucose tolerance. They applied homeostasis model assessment to fasting glucose and insulin levels at 16-20 weeks’ gestation to assess insulin resistance and deficiency and used these measures to classify women with gestational glucose intolerance into subtypes.

- They found increased odds of large for gestational age birth weight, in women with the insulin-resistant subtype compared to women with normal glucose tolerance.

- The odds of large for gestational age birth weight in women with the insulin-deficient subtype were increased only after adjustment for covariates.

- Among secondary outcomes, there was a trend toward increased odds of neonatal intensive care unit admission in the insulin-resistant subtype in an unadjusted model; this finding was driven by an increased risk of NICU admission in women with the insulin-resistant subtype and body mass index <25 kg/m2.

- Infants of women with other subtypes did not have increased odds of neonatal intensive care unit admission. The odds of pregnancy-related hypertension in the insulin-resistant subtype were increased compared to women with normal glucose tolerance; other subtypes did not have increased odds of pregnancy-related hypertension.

- There was no difference in cesarean delivery rates in nulliparous women across subtypes.

Insulin-resistant gestational glucose intolerance is a high-risk subtype for adverse pregnancy outcomes. Delineating physiologic subtypes may provide opportunities for a more personalized approach to gestational glucose intolerance.

American Journal of Obstetrics & Gynecology
Source: https://doi.org/10.1016/j.ajog.2021.08.016
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