Metabolic Risk and Life Style Factors in Women With Previous Gestational Diabetes Mellitus (GDM)

Study Overview
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Brief Summary
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Women with previous Gestational Diabetes Mellitus (GDM) are characterized by several metabolic abnormalities i.e. insulin resistance, beta-cell dysfunction and increased risk of later Diabetes Mellitus (DM). These latent disorders of glucose metabolism are demasked by the metabolic stress of pregnancy and as a routine, clinical assessment and measurement of HbA1c in addition to an oral glucose tolerance test (OGTT) is offered 3 months post partum. In this study, women with previous GDM and a control group matched on age, time of birth and BMI around 8 years after pregnancy will be investigated. Information from pregnancy and post partum examination (GDM only) will be used to identify risk factors for later development of DM. Further, life-style factors and mental health according to diabetes status will be studied.

Detailed Description
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Background It is well established that women with previous GDM are characterized by several metabolic abnormalities i.e. insulin resistance, beta-cell dysfunction and increased risk of later Diabetes Mellitus (DM). Furthermore, GDM is a heterogeneous condition covering both women with a strong genetic disposition to type 2 DM, women in the early stages of autoimmune DM and rare cases of monogenetic DM. These latent disorders of glucose metabolism are damasked by the metabolic stress of pregnancy. Aims To study predictors of DM and pre-DM after GDM: a) At the time of pregnancy: age, blood pressure, pre-pregnancy Body Mass Index (BMI), b) 3 months post partum: indices of insulin sensitivity and beta-cell function, lipid profile, GAD-autoantibodies, HbA1c To study lifestyle factors 7-8 years after GDM pregnancy in relation to current diabetes status Materials and methods During 2011-2017 women with previous GDM and a control group are invited to a long-term follow-up. Data collection is performed 7-8 years after pregnancy. GDM subjects (n 150), controls (n 50): Anthropometrics: weight, height, waist circumference, blood pressure and length Analyses: p-glucose, s-insulin at 0, 30 and 120 minutes during a 2-h 75 g OGTT. Fasting: total cholesterol, HDL, LDL triglycerides, GAD- autoantibodies, Hba1C, Urine albumin/creatinine ratio. Questionnaires: Information on lifestyle and health status Data available around pregnancy Pregnancy data from hospital journals (GDM subjects and controls): Examinations 3 months post-partum (GDM subjects only): Clinical examination, 2-h 75 g OGTT with measurements of p-glucose and s- insulin at 0, 30 and 120 minutes, fasting total cholesterol, HDL, LDL and triglycerides, HbA1c and GAD- autoantibodies. Perspectives Our current population is unique as clinical, metabolic and autoimmune markers were determined prospectively a few months after GDM pregnancy and at follow-up. Hopefully, the results will enable us to target preventive actions in women with previous GDM and improve our understanding of pathophysiologic mechanisms in pre-diabetic conditions.

Official Title
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Diabetes, Metabolic Risk Factors, Autoimmunity and Self-reported Life Style Factors in Women With Previous Gestational Diabetes Mellitus (GDM)

Conditions
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Type2 Diabetes, Gestational Diabetes, Life Style

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Previous GDM with information from post partum OGTT Danish speaking Exclusion Criteria: Bariatric surgery Poorly controlled psychiatric disorder
Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| previous GDM<br>Women with previous GDM | |
| no previous GDM<br>Women without previous GDM matched on age, pregestational body mass index end time of pregnancy. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Type 2 diabetes |  | 7 to 8 years after giving birth | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Plasma glucose (mmol/l) at 0, 30 and 120 minutes during oral glucose tolerance test |  | 7 to 8 years after giving birth | 
| Serum insulin (mU/l) at 0, 30 and 120 minutes during oral glucose tolerance test |  | 7 to 8 years after giving birth | 
| Body mass index (kg/m2) |  | 7 to 8 years after giving birth | 
| Blood pressure (mmHg) |  | 7 to 8 years after giving birth | 
| Questionnaires, quality of life (SF12), physical and mental summary scores |  | 7 to 8 years after giving birth | 
| Questionnaires, mental health (WHO-5), WHO-Five well being index |  | 7 to 8 years after giving birth | 
| Questionnaires, physical activity (PAS 2), physical activity score |  | 7 to 8 years after giving birth |