Modifiable Risk Factors and Trends in Changes in Glucose Regulation during the First Three Years Postdelivery: The St Carlos Gestational Diabetes Mellitus Prevention Cohort
Abstract
:1. Introduction
2. Research Design and Methods
2.1. Study Design
2.2. Study Population
2.3. Study Timeline and Intervention
2.4. Data Collection
2.5. Categorization of Glucose Testing at 3 Months and 3 Years Postpartum
2.6. Unmodifiable and Modifiable RF
2.7. Study Outcomes
2.8. Statistical Analysis
3. Results
- Women with 3-month AGR, and their 3-year evolution
- Women with 3-month NGR, and their 3-year evolution
- Women with 3-year AGR
- Analysis of modifiable and unmodifiable risk factors
4. Discussion
- Implications for Future Research
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Non-Participants (n = 1129) | Participants (n = 1400) | p | |
---|---|---|---|
Sociodemographic features | |||
Age (years) | 32.1 ± 5.5 | 33.1 ± 4.9 | 0.001 |
Ethnicity | |||
Caucasian | 724 (64.1) | 935 (66.8) | |
Latin American | 364 (32.2) | 430 (30.7) | |
Others | 41 (3.6) | 35 (2.5) | 0.040 |
University degree | 683 (60.5) | 964 (68.9) | 0.001 |
Workers | 839 (74.3) | 1134 (81.0) | 0.001 |
Smoking status | |||
Never smokers | 604 (53.5) | 801 (57.2) | |
Current smokers | 113 (10.0) | 95 (6.8) | 0.001 |
Pregnancies | |||
First | 458 (40.6) | 625 (44.6) | |
Second | 347 (30.7) | 415 (29.6) | |
Third or above | 324 (28.7) | 360 (25.7) | 0.251 |
In a previous pregnancy: | |||
GDM | 37 (3.3) | 48 (3.4) | 0.535 |
Miscarriage | 417 (36.9) | 458 (32.7) | 0.018 |
Family history of some components of MetS | 463 (41.0) | 603 (43.1) | 0.130 |
Pre-pregnancy features | |||
Body weight (kg) | 61.9 ± 11.4 | 61.7 ± 11.2 | 0.655 |
BMI (kg/m2) | 23.4 ± 4.0 | 23.4 ± 4.0 | 0.896 |
Questionnaires (scores) | |||
Nutrition | 0.1 ± 3.2 | 0.5 ± 3.1 | 0.003 |
MEDAS | 4.8 ± 1.7 | 5.0 ± 1.8 | 0.016 |
Physical activity | −1.8 ± 1.0 | −1.9 ± 1.0 | 0.441 |
Pregnancy and delivery features | |||
SBP (mmHg) (8–12 GWs) | 109 ± 10 | 109 ± 10 | 0.167 |
DBP (mmHg) (8–12 GWs) | 67 ± 9 | 67 ± 9 | 0.613 |
FSG (mg/dL) (8–12 GWs) | 80 ± 6 | 80 ± 6 | 0.560 |
HbA1 c (%) (8–12 GWs) | 5.1 ± 0.3 | 5.2 ± 0.2 | 0.181 |
HOMA-IR (8–12 GWs) | 1.2 ± 1.4 | 1.1 ± 1.3 | 0.126 |
Triglycerides (mg/dL) (8–12 GWs) | 80 ± 33 | 82 ± 41 | 0.901 |
GDM (24–28 w) | 172 (15.2) | 289 (20.6) | <0.001 |
Bodyweight gain (24 GWs) | 7.4 ± 4.8 | 7.1 ± 4.1 | 0.176 |
Bodyweight gain (38 GWs) | 11.7 ± 6.7 | 11.8 ± 6.3 | 0.863 |
Insulin treatment | 40 (23.3) | 70 (24.2) | 0.432 |
High BP or preeclampsia | 45 (4.0) | 53 (3.8) | 0.960 |
Prematurity (<37 GWs) | 40 (3.5) | 90 (6.4) | 0.001 |
Cesarean section | 244 (21.6) | 296 (21.2) | 0.740 |
LGA (>90 percentile) | 42 (3.7) | 50 (3.6) | 0.471 |
SGA (<10 percentile) | 34 (3.0) | 80 (5.7) | 0.001 |
Participants (n = 1400) | |||
---|---|---|---|
NGR (n = 1290) | AGR (n = 110) | p | |
Sociodemographic features | |||
Age (years) | 33.1 ± 4.9 | 33.3 ± 4.6 | 0.724 |
Ethnicity | |||
Caucasian | 878 (68.1) | 57 (51.8) | |
Latin American | 383 (29.7) | 47 (42.7) | |
Others | 29 (2.2) | 6 (5.5) | 0.002 |
University degree | 903 (70.0) | 61 (55.5) | 0.001 |
Workers | 1051 (81.5) | 83 (75.5) | 0.231 |
Smoking status | |||
Never smokers | 734 (56.9) | 67 (60.9) | |
Current smokers | 85 (6.6) | 10 (9.1) | 0.505 |
First pregnancy | 585 (45.3) | 40 (36.4) | 0.422 |
Prior | |||
GDM | 42 (3.3) | 6 (5.5) | |
Miscarriage | 411 (31.9) | 47 (42.7) | 0.347 |
Family history MetS (>2 components) | 257 (19.9) | 25 (22.7) | 0.893 |
Pre-pregnancy features | |||
Body weight (kg) | 61.0 ± 11.0 | 64.0 ± 14.0 | 0.012 |
BMI (kg/m2) | 23.3 ± 3.9 | 24.6 ± 4.8 | 0.001 |
Questionnaires (scores) | |||
Nutrition | 0.5 ± 3.1 | 0.1 ± 3.1 | 0.095 |
MEDAS | 5.0 ± 1.8 | 4.7 ± 1.7 | 0.166 |
Physical activity | −1.9 ± 1.0 | −1.8 ± 0.9 | 0.784 |
Pregnancy and delivery features | |||
SBP (mmHg) (8–12 GWs) | 108 ± 10 | 110 ± 11 | 0.021 |
DBP (mmHg) (8–12 GWs) | 67 ± 9 | 68 ± 9 | 0.396 |
FSG (mg/dL) (8–12 GWs) | 80.3 ± 6.0 | 82.8 ± 5.6 | <0.001 |
HbA1c (%) (8–12 GWs) | 5.1 ± 0.2 | 5.3 ± 0.4 | 0.045 |
HOMA-IR (8–12 GWs) | 1.1 ± 1.3 | 1.4 ± 1.5 | 0.007 |
Triglycerides (mg/dL) (8–12 GWs) | 80 ± 37 | 104 ± 73 | <0.001 |
GDM (24–28 w) | 245 (19.0) | 44 (40.0) | <0.001 |
Bodyweight gain (24 w) | 7.2 ± 4.2 | 6.7 ± 3.7 | 0.343 |
Bodyweight gain (38 w) | 11.8 ± 6.4 | 11.3 ± 5.4 | 0.407 |
Insulin treatment | 55 (4.3) | 15 (13.6) | 0.204 |
High BP or preeclampsia | 43 (3.3) | 10 (9.1) | 0.036 |
Prematurity (<37 w) | 79 (6.1) | 11 (10.0) | 0.088 |
Cesarean section | 267 (20.7) | 29 (26.4) | 0.567 |
LGA (>90 percentile) | 43 (3.3) | 7 (6.4) | 0.091 |
SGA (<10 percentile) | 67 (5.2) | 13 (11.8) | 0.007 |
3 months postpartum | |||
Body weight (kg) | 66.3 ± 11.6 | 69.7 ± 12.8 | 0.015 |
BMI (kg/m2) | 25.1 ± 4.3 | 26.6 ± 4.8 | 0.005 |
Weight change (3 m—pregestational) | 4.7 ± 5.5 | 6.0 ± 7.1 | 0.052 |
Waist circumference (cm) | 85.4 ± 9.5 | 90.0 ± 9.9 | <0.001 |
SBP (mmHg) | 111 ± 12 | 113 ± 11 | 0.142 |
DBP (mmHg) | 71 ± 9 | 72 ± 9 | 0.583 |
FSG (mg/dL) | 83.6 ± 7.0 | 94.9 ± 12.1 | <0.001 |
HbA1c (%) | 5.2 ± 0.3 | 5.6 ± 0.3 | <0.001 |
HOMA-IR | 1.8 ± 2.4 | 3.4 ±4.9 | <0.001 |
Triglycerides (mg/dL) | 80 ± 43 | 95 ± 65 | 0.006 |
HDL-cholesterol (mg/dL) | 64 ± 17 | 60 ± 13 | 0.027 |
Questionnaires (scores) | |||
Nutrition | 3.9 ± 3.5 | 3.5 ± 3.5 | 0.071 |
MEDAS | 6.2 ± 1.9 | 5.9 ± 1.8 | 0.377 |
Physical activity | −1.6 ± 0.9 | −1.7 ± 0.8 | 0.618 |
Exercise activity (min/d) | 16 ± 90 | 3 ± 16 | 0.065 |
3 m AGR (110) | 3 m NGR (n = 1290) | |||||
---|---|---|---|---|---|---|
3 y NGR Reversion (n = 83) | 3 y AGR Persistence (n = 27) | p | 3 y AGR Progression (n = 110) | 3 y NGR Persistence (n = 1180) | p | |
Age (years) | 32.7 ± 4.6 | 34.9 ± 4.5 | 0.031 | 34.8 ± 4.5 | 32.9 ± 4.9 | 0.001 |
GDM (24–28 GWs) | 30 (36.1) | 14 (51.2) | 0.001 | 50 (45.5) | 195 (16.5) | 0.001 |
Breastfeeding 3 m. n (%) | 79 (95) | 25 (92) | 0.653 | 101 (92) | 1125 (95) | 0.165 |
Exclusive (months) | 5.2 + 1.3 | 4.9 + 1.5 | 0.121 | 4.6 + 1.9 | 4.9 + 1.6 | 0.095 |
Mixed (months) | 10.4 + 6.9 | 9.9 + 7.8 | 0.351 | 10.1 + 7.4 | 10.6 + 7.9 | 0.314 |
3 m body weight (kg) | 69.5 ± 11.8 | 69.8 ± 12.3 | 0.008 | 69.0 ± 11.8 | 66.0 ± 11.5 | 0.031 |
3 m BMI (kg/m2) | 26.2 ± 4.6 | 27.6 ± 5.1 | 0.014 | 26.3 ± 4.9 | 25.0 ± 4.2 | 0.014 |
<25 | 57 (68.7) | 15 (55.6) | 69 (62.7) | 859 (72.8) | ||
25–29.9 | 16 (19.3) | 6 (22.2) | 25 (22.7) | 232 (19.7) | ||
≥30 | 10 (12.0) | 6 (22.2) | 0.138 | 16 (14.5) | 89 (7.5) | 0.034 |
Pre-gestational obesity | 11 (13.3) | 3 (11.1) | 0.907 | 13 (11.8) | 63 (5.3) | 0.005 |
3 y weight (kg) | 64.0 ± 13.4 | 67.6 ± 10.8 | 0.023 | 67.3 ± 11.1 | 63.0 ± 10.8 | 0.023 |
Bodyweight change | ||||||
3 m minus pregestational | 4.2 ± 6.5 | 6.6 ± 7.1 | 0.056 | 6.6 ± 6.9 | 4.7 ± 5.5 | 0.011 |
3 y minus 3 m | −4.1 ± 3.9 | −2.1 ± 5.1 | 0.026 | −0.7 ± 5.0 | −2.0 ± 5.6 | 0.014 |
3 y minus pregestational | 0.8 ± 0.5 | 0.9 ± 0.6 | 0.917 | 4.8 ± 5.6 | 1.2 ± 2.5 | 0.033 |
3 m waist (cm) | 88.9 ± 8.9 | 90.3 ± 10.2 | 0.036 | 87.6 ± 8.9 | 85.2 ± 9.6 | 0.036 |
3 m SBP (mmHg) | 110 ± 10 | 113 ± 12 | 0.071 | 113 ± 14 | 110 ± 12 | 0.071 |
3 m DBP (mmHg) | 68 ± 6 | 73 ± 9 | 0.175 | 73 ± 12 | 71 ± 9 | 0.175 |
3 m FSG (mg/dL) | 92 ± 11 | 96 ± 12 | 0.021 | 86 ± 7 | 83 ± 7 | 0.001 |
3 m HbA1c (%) | 5.6 ± 0.3 | 5.7 ± 0.3 | 0.042 | 5.3 ± 0.2 | 5.2 ± 0.3 | 0.001 |
3 m HOMA-IR | 2.6 ± 2.2 | 3.5 ± 5.5 | 0.907 | 1.8 ± 1.2 | 1.7 ± 2.4 | 0.907 |
3 m HDL-c (mg/dL) | 62 ± 13 | 52 ± 12 | 0.016 | 62 ± 19 | 64 ± 16 | 0.627 |
3 m Triglycerides (mg/dL) | 90 ± 51 | 109 ± 94 | 0.399 | 82 ± 34 | 80 ± 43 | 0.006 |
3 m Questionnaires (scores) | ||||||
Nutrition | 3.7 ± 3.6 | 2.9 ± 3.3 | 0.429 | 4.0 ± 3.5 | 4.1 ± 3.5 | 0.282 |
MEDAS | 6.1 ± 1.8 | 5.6 ± 1.6 | 0.366 | 6.0 ± 2.1 | 6.2 ± 1.8 | 0.377 |
Physical activity | −1.6 ± 0.9 | −1.8 ± 0.6 | 0.499 | −1.5 ± 0.9 | −1.6 ± 0.9 | 0.339 |
3 m exercise activity (min/d) | 32 ± 18 | 0 ± 6 | 0.415 | 14 ± 69 | 34 ± 96 | 0.065 |
Normal Glucose Regulation (NGR) | Abnormal Glucose Regulation (AGR) | |||||||
---|---|---|---|---|---|---|---|---|
Persistence (n = 1180): NGR at Both 3 Months and 3 Years Postpartum | Reversion (n = 83) from AGR at 3 Months to NGR at 3 Years Postpartum | Progression (n = 110): NGR at 3 Months, with AGR at 3 Years Postpartum | Persistence (n = 27): AGR at Both 3 Months and 3 Years Postpartum | |||||
n (%) | OR (95% CI) | n (%) | OR (95% CI) | n (%) | OR (95% CI) | n (%) | OR (95% CI) | |
GDM (24–28 w) | 195 (78.9) | 0.22(0.15–0.33) | 30 (68.2) | 0.51 (0.21–1.23) | 50 (20.4) | 1.60 (1.33–1.92) | 14 (31.2) | 1.34 (0.88–2.05) |
Unmodifiable risk factors | ||||||||
Family history MetS | 225 (19.1) | 0.64 (0.43–0.96) | 21 (25.3) | 0.87 (0.70–1.08) | 32 (29.1) | 1.63 (1.04–2.54) | 4 (14.8) | 0.51 (0.16–1.66) |
Parity | 634 (53.7) | 0.79 (0.55–1.14) | 49 (59.0) | 0.50 (0.22–1.14) | 67 (60.9) | 1.29 (0.87–1.93) | 21 (77.8) | 2.49 (0.89–6.65) |
Age ≥ 35 years | 577 (48.9) | 0.63 (0.44–0.92) | 41 (49.4) | 1.06 (0.86–1.32) | 66 (60.0) | 1.64 (1.10–2.46) | 15 (55.6) | 1.28 (0.54–3.06) |
Unfavorable group ≥ 2 | 435 (36.9) | 0.56 (0.39–0.80) | 34 (41.0) | 0.80 (0.42–1.55) | 59 (53.6) | 1.90 (1.28–2.83) | 13 (48.1) | 1.34 (0.56–3.20) |
Modifiable risk factors | ||||||||
Preg-BMI ≥ 25 kg/m2 | 307 (26.0) | 0.59 (0.41–0.85) | 27 (32.5) | 0.45 (0.22–0.92) | 43 (39.1) | 1.80 (1.19–2.71) | 14 (51.9) | 2.85 (1.12–7.25) |
Del-BMI ≥ 25 kg/m2 | 321 (27.2) | 0.69 (0.48–1.01) | 26 (31.1) | 0.66 (0.35–1.26) | 41 (37.3) | 1.50 (1.00–2.27) | 12 (44.4) | 1.75 (0.72–4.27) |
Weight change > 0 kg | 833 (70.6) | 0.53 (0.29–0.94) | 51 (61.4) | 0.43 (0.20–0.93) | 93 (84.5) | 2.22 (1.10–4.48) | 7 (25.9) | 3.64 (0.93–14.39) |
WC ≥ 89.5 cm | 205 (17.4) | 0.54 (0.36–0.79) | 24 (28.9) | 0.76 (0.39–1.48) | 32 (29.1) | 2.02 (1.29–3.12) | 10 (37.0) | 1.45 (0.58–3.61) |
Hypertension | 55 (4.7) | 0.61 (0.35–1.08) | 3 (3.6) | 0.84 (0.65–1.08) | 12 (10.9) | 1.94 (1.04–4.04) | 6 (22.2) | 2.31 (0.35–15.14) |
Dyslipidemia | 164 (13.9) | 0.98 (0.94–1.02) | 13 (15.7) | 0.64 (0.31–1.29) | 12 (10.9) | 1.28 (0.72–2.29) | 7 (25.9) | 1.89 (0.66–5.36) |
Alcohol consumption | 69 (5.8) | 0.99 (0.92–1.05) | 2 (2.4) | 0.47 (0.17–1.33) | 7 (6.4) | 0.25 (0.53–2.98) | 2 (7.4) | 3.24 (0.43–24.20) |
Smoking | 7 (0.6) | na | 0 | na | 0 | na | 0 | na |
Nutrition score < 4 | 636 (53.9) | 0.68 (0.45–1.04) | 32 (38.6) | 0.79 (0.33–1.85) | 71 (64.5) | 1.42 (0.97–2.07) | 12 (44.4) | 1.38 (0.45–4.22) |
MEDAS score < 6 | 683 (57.9) | 0.99 (0.95–1.02) | 52 (62.7) | 0.87 (0.36–2.11) | 68 (61.8) | 1.19 (0.79–1.66) | 16 (59.3) | 1.11 (0.57–2.16) |
Physical activity < 0 | 906 (76.8) | 0.66 (0.32–1.37) | 77 (92.8) | 0.57 (0.09–3.58) | 99 (90.0) | 1.45 (0.76–2.76) | 26 (96.3) | 2.03 (0.23–17.62) |
Exercise activity < 15 min | 1026 (86.9) | 0.93 (0.84–1.03) | 81 (97.6) | na | 100 (90.9) | 1.83 (1.00–3.35) | 27 (100) | 1.33 (1.19–1.49) |
Unfavorable group > 5 | 387 (32.8) | 0.74 (0.51–0.99) | 33 (39.8) | 0.49 (0.25–0.97) | 46 (41.8) | 1.40 (1.00–2.09) | 17 (63.0) | 2.57 (1.05–6.31) |
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Arnoriaga-Rodriguez, M.; Melero, V.; Barabash, A.; Valerio, J.; del Valle, L.; O’Connor, R.M.; de Miguel, P.; Diaz, J.A.; Familiar, C.; Moraga, I.; et al. Modifiable Risk Factors and Trends in Changes in Glucose Regulation during the First Three Years Postdelivery: The St Carlos Gestational Diabetes Mellitus Prevention Cohort. Nutrients 2023, 15, 4995. https://doi.org/10.3390/nu15234995
Arnoriaga-Rodriguez M, Melero V, Barabash A, Valerio J, del Valle L, O’Connor RM, de Miguel P, Diaz JA, Familiar C, Moraga I, et al. Modifiable Risk Factors and Trends in Changes in Glucose Regulation during the First Three Years Postdelivery: The St Carlos Gestational Diabetes Mellitus Prevention Cohort. Nutrients. 2023; 15(23):4995. https://doi.org/10.3390/nu15234995
Chicago/Turabian StyleArnoriaga-Rodriguez, Maria, Verónica Melero, Ana Barabash, Johanna Valerio, Laura del Valle, Rocio Martin O’Connor, Paz de Miguel, José A. Diaz, Cristina Familiar, Inmaculada Moraga, and et al. 2023. "Modifiable Risk Factors and Trends in Changes in Glucose Regulation during the First Three Years Postdelivery: The St Carlos Gestational Diabetes Mellitus Prevention Cohort" Nutrients 15, no. 23: 4995. https://doi.org/10.3390/nu15234995