Diabetes & Metabolism Journal

Original Articles

Guideline/Statement/Fact Sheet
Diabetes in Pregnancy in Korea: Prevalence, Clinical Characteristics, and Postpartum Comorbidities: Joon Ho Moon, Han Na Jung, Bongseong Kim, Seung-Hyun Ko, Soo Heon Kwak, Kyung-Do Han, Sung Hee Choi, on Behalf of the Committee of Public Relation of the Korean Diabetes Association; Diabetes Metab J. 2026;50(2):280-290. Published online March 1, 2026; DOI: https://doi.org/10.4093/dmj.2025.1161

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Abstract PDF: Background
Diabetes in pregnancy (DIP), encompassing gestational diabetes mellitus (GDM) and pregestational diabetes mellitus (PGDM), has limited nationwide data in Korea. This study aimed to evaluate the clinical characteristics and management of DIP using representative national data.
Methods
Using the Korean National Health Insurance Service database, we analyzed 3,451,648 delivery records from 2013 to 2023 and 1,401,233 health examination records. The prevalence of DIP according to maternal factors, management modalities, and postpartum surveillance was examined. Long-term cardiovascular disease (CVD) risk was evaluated among 3,068,834 deliveries from 2003 to 2013 using Cox regression models.
Results
The prevalence of GDM and PGDM increased over the decade, reaching 12.4% and 2.1% in 2023. Both were more common with advancing maternal age, adiposity, and preexisting hypertension or dyslipidemia. Approximately 90% of women with GDM were managed by lifestyle modification alone, whereas 70% with PGDM received insulin monotherapy. Postpartum glycemic testing within 1 year increased from 32.0% to 42.9% for GDM and from 61.1% to 68.1% for PGDM between 2018 and 2022, though rates remained suboptimal. During a median follow-up of 13.4 to 16.2 years, CVD risk was significantly higher in women with GDM (adjusted hazard ratio [aHR], 1.47; 95% confidence interval [CI], 1.40 to 1.55) and PGDM (aHR, 3.04; 95% CI, 2.82 to 3.28) than in those without DIP.
Conclusion
The prevalence of DIP is rising in Korea, particularly among older and metabolically unhealthy women. Despite this burden, postpartum glucose surveillance remains insufficient, and DIP is linked to increased long-term cardiovascular risk, underscoring the need for improved postpartum monitoring and preventive care.

Lifestyle and Behavioral Interventions
The Preventive Effect of Physical Activity on Gestational Diabetes Mellitus: A Korean Longitudinal Prospective Cohort Study: Ji Hyae Lim, Min Hyoung Kim, Hye-Ji Han, Su Ji Yang, Myung-Gwan Kim, Hyun Jung Lee, You Jung Han, Jin Hoon Chung, Dong Wook Kwak, Seongwoo Yang, Moon Young Kim, Hyun Mee Ryu; Diabetes Metab J. 2025;49(5):1116-1125. Published online April 23, 2025; DOI: https://doi.org/10.4093/dmj.2024.0280

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Background
To assess longitudinally physical activity patterns and intensity from pre-pregnancy to postpartum and evaluate the association between timing and type of physical activity and the development of gestational diabetes mellitus (GDM).
Methods
The Korean Pregnancy Outcome Study (KPOS) is a prospective cohort study conducted from 2013 to 2017. Our study included 3,457 participants with singleton pregnancies in KPOS, classified according to the pregnancy outcome: GDM (n=231) and normal (n=3,226). Physical activity data were collected at five time points using the short form of the International Physical Activity Questionnaire: before pregnancy, at 12, 24, and 36 gestational weeks (GW), and 6–8 weeks postpartum. Pre-pregnancy physical activity was collected through recall at 12 GW.
Results
Maternal age, pre-pregnancy body mass index, educational status, smoking, mini dietary assessment index, first-degree family history of diabetes, hypertension, parity, pre-existing GDM, and previous macrosomia showed significant differences between the GDM group and the normal group (P<0.05 for all). Pre-pregnancy muscle-strengthening activity was significantly associated with a lower risk of GDM (adjusted odds ratio, 0.46; 95% confidence interval, 0.25 to 0.85).
Conclusion
These findings suggest that physical activity, such as muscle-strengthening activities before pregnancy, could be a preventive strategy to reduce GDM risk. Although the study does not provide evidence that physical activity during pregnancy and postpartum reduces GDM risk, it offers significant insights into the importance of maintaining a healthy level of physical activity from pre-pregnancy to prevent GDM.

Citations

Citations to this article as recorded by

Pre-Conception Physical Activity and the Risk of Gestational Diabetes Mellitus: Findings from the BORN 2020 Study
Antigoni Tranidou, Antonios Siargkas, Ioannis Tsakiridis, Emmanuela Magriplis, Aikaterini Apostolopoulou, Georgia Koutsouki, Michail Chourdakis, Themistoklis Dagklis
Nutrients.2025; 17(11): 1832. CrossRef
Prediction of Gestational Diabetes Mellitus: A Nomogram Model Incorporating Lifestyle, Nutrition and Health Literacy Factors
Minghan Fu, Menglu Qiu, Zhencheng Xie, Laidi Guo, Yun Zhou, Jia Yin, Wanyi Yang, Lishan Ouyang, Ye Ding, Zhixu Wang
Nutrients.2025; 17(21): 3400. CrossRef

Metabolic Risk/Epidemiology
Pregravid Weight Gain Is Associated with an Increased Risk of Gestational Diabetes: Sunmie Kim, Kyungdo Han, Su-Yeon Choi, Min Joo Kim, Sun Young Yang, Seung Ho Choi, Jeong Yoon Yim, Jin Ju Kim, Min-Jeong Kim; Diabetes Metab J. 2025;49(4):826-836. Published online March 26, 2025; DOI: https://doi.org/10.4093/dmj.2024.0491

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Background
Studies have reported a significant association between pregravid weight gain and the subsequent development of gestational diabetes mellitus (GDM) in various populations. The current study aims to investigate this relationship using data from the Korean National Health Insurance Service database.
Methods
We conducted a retrospective nationwide population-based cohort study, involving 159,798 women who gave birth between 2015 and 2017 and had undergone two national health screening examinations: 1 year (index checkup) and 3 years before (baseline checkup) their respective estimated conception date. Participants were categorized into five groups based on the extent of weight change between the two examinations: more than 10%, 5% to 10%, –5% to 5% (reference group), –10% to –5%, and more than –10%. The study assessed the association between pregravid weight change and GDM risk.
Results
Among the 146,363 women analyzed, 11,012 (7.52%) were diagnosed with GDM. Multiple regression analysis revealed that women who gained 5% to 10% of their weight had a 12% increased risk of GDM (adjusted odds ratio [aOR], 1.12; 95% confidence interval [CI], 1.06 to 1.17), while those who gained ≥10% had a 34% higher risk (aOR, 1.34; 95% CI, 1.26 to 1.43). Notably, pregravid weight gain was particularly associated with GDM risk in non-obese or non-metabolic syndrome groups at index checkup.
Conclusion
Pregravid weight gain showed a dose-dependent association with a higher risk of GDM. This association was more pronounced in non-obese individuals emphasizing the importance of minimizing pregravid weight gain for GDM prevention, even in non-obese women.

Citations

Citations to this article as recorded by

Advancing Early Prediction of Gestational Diabetes Mellitus with Circular RNA Biomarkers
Joon Ho Moon, Sung Hee Choi
Diabetes & Metabolism Journal.2025; 49(3): 403. CrossRef
Gestational Diabetes Mellitus and Postpartum Depressive Symptoms in Women with Low and Late Fertility
Vincenzo Zanardo, Gianluca Straface, Francesca Volpe, Agnese Suppiej, Tiziana Battistin
Journal of Personalized Medicine.2025; 15(12): 609. CrossRef

Metabolic Risk/Epidemiology
Validating Multicenter Cohort Circular RNA Model for Early Screening and Diagnosis of Gestational Diabetes Mellitus: Shuo Ma, Yaya Chen, Zhexi Gu, Jiwei Wang, Fengfeng Zhao, Yuming Yao, Gulinaizhaer Abudushalamu, Shijie Cai, Xiaobo Fan, Miao Miao, Xun Gao, Chen Zhang, Guoqiu Wu; Diabetes Metab J. 2025;49(3):462-474. Published online February 21, 2025; DOI: https://doi.org/10.4093/dmj.2024.0205

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Background
Gestational diabetes mellitus (GDM) is a metabolic disorder posing significant risks to maternal and infant health, with a lack of effective early screening markers. Therefore, identifying early screening biomarkers for GDM with higher sensitivity and specificity is urgently needed.
Methods
High-throughput sequencing was employed to screen for key circular RNAs (circRNAs), which were then evaluated using reverse transcription quantitative polymerase chain reaction. Logistic regression analysis was conducted to examine the relationship between clinical characteristics, circRNA expression, and adverse pregnancy outcomes. The diagnostic accuracy of circRNAs for early and mid-pregnancy GDM was assessed using receiver operating characteristic curves. Pearson correlation analysis was utilized to explore the relationship between circRNA levels and oral glucose tolerance test results. A predictive model for early GDM was established using logistic regression.
Results
Significant alterations in circRNA expression profiles were detected in GDM patients, with hsa_circ_0031560 and hsa_ circ_0000793 notably upregulated during the first and second trimesters. These circRNAs were associated with adverse pregnancy outcomes and effectively differentiated GDM patients, with second trimester cohorts achieving an area under the curve (AUC) of 0.836. In first trimester cohorts, these circRNAs identified potential GDM patients with AUCs of 0.832 and 0.765, respectively. The early GDM prediction model achieved an AUC of 0.904, validated in two independent cohorts.
Conclusion
Hsa_circ_0031560, hsa_circ_0000793, and the developed model serve as biomarkers for early prediction or midterm diagnosis of GDM, offering clinical tools for early GDM screening.

Citations

Citations to this article as recorded by

Advancing Early Prediction of Gestational Diabetes Mellitus with Circular RNA Biomarkers
Joon Ho Moon, Sung Hee Choi
Diabetes & Metabolism Journal.2025; 49(3): 403. CrossRef
Enhancing early gestational diabetes mellitus prediction with imputation-based machine learning framework: A comparative study on real-world clinical records
Leyao Ma, Lin Yang, Yaxin Wang, Jie Hao, Yini Li, Liangkun Ma, Ziyang Wang, Ye Li, Suhan Zhang, Mingyue Hu, Jiao Li, Yin Sun
DIGITAL HEALTH.2025;[Epub] CrossRef
Social Services for Women with Gestational Diabetes Mellitus in Korea
Yu Jeong Park
The Journal of Korean Diabetes.2025; 26(4): 245. CrossRef

Genetics
Identification and Potential Clinical Utility of Common Genetic Variants in Gestational Diabetes among Chinese Pregnant Women: Claudia Ha-ting Tam, Ying Wang, Chi Chiu Wang, Lai Yuk Yuen, Cadmon King-poo Lim, Junhong Leng, Ling Wu, Alex Chi-wai Ng, Yong Hou, Kit Ying Tsoi, Hui Wang, Risa Ozaki, Albert Martin Li, Qingqing Wang, Juliana Chung-ngor Chan, Yan Chou Ye, Wing Hung Tam, Xilin Yang, Ronald Ching-wan Ma; Diabetes Metab J. 2025;49(1):128-143. Published online September 20, 2024; DOI: https://doi.org/10.4093/dmj.2024.0139

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Background
The genetic basis for hyperglycaemia in pregnancy remain unclear. This study aimed to uncover the genetic determinants of gestational diabetes mellitus (GDM) and investigate their applications.
Methods
We performed a meta-analysis of genome-wide association studies (GWAS) for GDM in Chinese women (464 cases and 1,217 controls), followed by de novo replications in an independent Chinese cohort (564 cases and 572 controls) and in silico replication in European (12,332 cases and 131,109 controls) and multi-ethnic populations (5,485 cases and 347,856 controls). A polygenic risk score (PRS) was derived based on the identified variants.
Results
Using the genome-wide scan and candidate gene approaches, we identified four susceptibility loci for GDM. These included three previously reported loci for GDM and type 2 diabetes mellitus (T2DM) at MTNR1B (rs7945617, odds ratio [OR], 1.64; 95% confidence interval [CI], 1.38 to 1.96), CDKAL1 (rs7754840, OR, 1.33; 95% CI, 1.13 to 1.58), and INS-IGF2-KCNQ1 (rs2237897, OR, 1.48; 95% CI, 1.23 to 1.79), as well as a novel genome-wide significant locus near TBR1-SLC4A10 (rs117781972, OR, 2.05; 95% CI, 1.61 to 2.62; P_meta=7.6×10^-9), which has not been previously reported in GWAS for T2DM or glycaemic traits. Moreover, we found that women with a high PRS (top quintile) had over threefold (95% CI, 2.30 to 4.09; P_meta=3.1×10^-14) and 71% (95% CI, 1.08 to 2.71; P=0.0220) higher risk for GDM and abnormal glucose tolerance post-pregnancy, respectively, compared to other individuals.
Conclusion
Our results indicate that the genetic architecture of glucose metabolism exhibits both similarities and differences between the pregnant and non-pregnant states. Integrating genetic information can facilitate identification of pregnant women at a higher risk of developing GDM or later diabetes.

Citations

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GWAS in Gestational Diabetes Mellitus: Research Advances
Dikun Zhou, Z. Shi, A.H. Hashash, Z.H. Khan
BIO Web of Conferences.2025; 174: 01018. CrossRef
Advancing Early Prediction of Gestational Diabetes Mellitus with Circular RNA Biomarkers
Joon Ho Moon, Sung Hee Choi
Diabetes & Metabolism Journal.2025; 49(3): 403. CrossRef
Association between maternal glucose levels in pregnancy and offspring’s metabolism and adiposity: an 18-year birth cohort study
Yuzhi Deng, Hanbin Wu, Noel Y. H. Ng, Claudia H. T. Tam, Atta Y. T. Tsang, Michael H. M. Chan, Kenneth Ka Hei Lo, Chi Chiu Wang, Wing Hung Tam, Ronald C. W. Ma
Diabetologia.2025; 68(10): 2205. CrossRef
DNA Methylation Biomarkers Predict Offspring Metabolic Risk From Mothers With Hyperglycemia in Pregnancy
Johnny Assaf, Ishant Khurana, Ram Abou Zaki, Claudia H.T. Tam, Ilana Correa, Scott Maxwell, Julie Kinnberg, Malou Christiansen, Caroline Frørup, Heung Man Lee, Harikrishnan Kaipananickal, Jun Okabe, Safiya Naina Marikar, Kwun Kiu Wong, Cadmon K.P. Lim, La
Diabetes.2025; 74(9): 1695. CrossRef
Polygenic Risk Score Associated with Gestational Diabetes Mellitus in an AmericanIndian Population
Karrah Peterson, Camille E. Powe, Quan Sun, Crystal Azure, Tia Azure, Hailey Davis, Kennedy Gourneau, Shyanna LaRocque, Craig Poitra, Sabra Poitra, Shayden Standish, Tyler J. Parisien, Kelsey J. Morin, Lyle G. Best
Journal of Personalized Medicine.2025; 15(9): 395. CrossRef
Apolipoprotein C1 -317H1/H2 and the rs4420638 genetic variations and risk of gestational diabetes mellitus in Chinese women: a case-control study
Wandi Ma, Linbo Guan, Xinghui Liu, Yujie Wu, Zhengting Zhu, Yuwen Guo, Ping Fan, Huai Bai
Frontiers in Endocrinology.2025;[Epub] CrossRef
Hexokinase Domain Containing 1 (HKDC1) Gene Variants and Their Association With Gestational Diabetes Mellitus: A Mini-Review
Sekar Kanthimathi, Polina Popova, Viswanathan Mohan, Wesley Hannah, Ranjit Mohan Anjana, Venkatesan Radha
Journal of Diabetology.2024; 15(4): 354. CrossRef

Review

Metabolic Risk/Epidemiology
Gestational Diabetes Mellitus and Its Implications across the Life Span: Brandy Wicklow, Ravi Retnakaran; Diabetes Metab J. 2023;47(3):333-344. Published online February 8, 2023; DOI: https://doi.org/10.4093/dmj.2022.0348

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Gestational diabetes mellitus (GDM) has historically been perceived as a medical complication of pregnancy that also serves as a harbinger of maternal risk of developing type 2 diabetes mellitus (T2DM) in the future. In recent decades, a growing body of evidence has detailed additional lifelong implications that extend beyond T2DM, including an elevated risk of ultimately developing cardiovascular disease. Furthermore, the risk factors that mediate this lifetime cardiovascular risk are evident not only after delivery but are present even before the pregnancy in which GDM is first diagnosed. The concept thus emerging from these data is that the diagnosis of GDM enables the identification of women who are already on an enhanced track of cardiometabolic risk that starts early in life. Studies of the offspring of pregnancies complicated by diabetes now suggest that the earliest underpinnings of this cardiometabolic risk profile may be determined in utero and may first manifest clinically in childhood. Accordingly, from this perspective, GDM is now seen as a chronic metabolic disorder that holds implications across the life span of both mother and child.

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Original Articles

Basic Research
Long Non-Coding RNA TUG1 Attenuates Insulin Resistance in Mice with Gestational Diabetes Mellitus via Regulation of the MicroRNA-328-3p/SREBP-2/ERK Axis: Xuwen Tang, Qingxin Qin, Wenjing Xu, Xuezhen Zhang; Diabetes Metab J. 2023;47(2):267-286. Published online January 19, 2023; DOI: https://doi.org/10.4093/dmj.2021.0216

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Background
Long non-coding RNAs (lncRNAs) have been illustrated to contribute to the development of gestational diabetes mellitus (GDM). In the present study, we aimed to elucidate how lncRNA taurine upregulated gene 1 (TUG1) influences insulin resistance (IR) in a high-fat diet (HFD)-induced mouse model of GDM.
Methods
We initially developed a mouse model of HFD-induced GDM, from which islet tissues were collected for RNA and protein extraction. Interactions among lncRNA TUG1/microRNA (miR)-328-3p/sterol regulatory element binding protein 2 (SREBP-2) were assessed by dual-luciferase reporter assay. Fasting blood glucose (FBG), fasting insulin (FINS), homeostasis model assessment of insulin resistance (HOMA-IR), HOMA pancreatic β-cell function (HOMA-β), insulin sensitivity index for oral glucose tolerance tests (ISOGTT) and insulinogenic index (IGI) levels in mouse serum were measured through conducting gain- and loss-of-function experiments.
Results
Abundant expression of miR-328 and deficient expression of lncRNA TUG1 and SREBP-2 were characterized in the islet tissues of mice with HFD-induced GDM. LncRNA TUG1 competitively bound to miR-328-3p, which specifically targeted SREBP-2. Either depletion of miR-328-3p or restoration of lncRNA TUG1 and SREBP-2 reduced the FBG, FINS, HOMA-β, and HOMA-IR levels while increasing ISOGTT and IGI levels, promoting the expression of the extracellular signal-regulated kinase (ERK) signaling pathway-related genes, and inhibiting apoptosis of islet cells in GDM mice. Upregulation miR-328-3p reversed the alleviative effects of SREBP-2 and lncRNA TUG1 on IR.
Conclusion
Our study provides evidence that the lncRNA TUG1 may prevent IR following GDM through competitively binding to miR-328-3p and promoting the SREBP-2-mediated ERK signaling pathway inactivation.

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Others
Influence of Maternal Diabetes on the Risk of Neurodevelopmental Disorders in Offspring in the Prenatal and Postnatal Periods: Verónica Perea, Xavier Urquizu, Maite Valverde, Marina Macias, Anna Carmona, Esther Esteve, Gemma Escribano, Nuria Pons, Oriol Giménez, Teresa Gironés, Andreu Simó-Servat, Andrea Domenech, Núria Alonso-Carril, Carme Quirós, Antonio J. Amor, Eva López, Maria José Barahona; Diabetes Metab J. 2022;46(6):912-922. Published online April 29, 2022; DOI: https://doi.org/10.4093/dmj.2021.0340

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Background
This study aimed to evaluate the influence of maternal diabetes in the risk of neurodevelopmental disorders in offspring in the prenatal and postnatal periods.
Methods
This cohort study included singleton gestational diabetes mellitus (GDM) pregnancies >22 weeks’ gestation with live newborns between 1991 and 2008. The control group was randomly selected and matched (1:2) for maternal age, weeks of gestation and birth year. Cox regression models estimated the effect of GDM on the risk of attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and maternal type 2 diabetes mellitus (T2DM). Moreover, interaction between maternal T2DM and GDM-ADHD relationship was evaluated.
Results
Children (n=3,123) were included (1,073 GDM; 2,050 control group). The median follow-up was 18.2 years (interquartile range, 14.2 to 22.3) (n=323 with ADHD, n=36 with ASD, and n=275 from women who developed T2DM). GDM exposure was associated with ADHD (hazard ratio [HR]_crude, 1.67; 95% confidence interval [CI], 1.33 to 2.07) (HR_adjusted, 1.64; 95% CI, 1.31 to 2.05). This association remained significant regardless of the treatment (diet or insulin) and diagnosis after 26 weeks of gestation. Children of mothers who developed T2DM presented higher rates of ADHD (14.2 vs. 10%, P=0.029). However, no interaction was found when T2DM was included in the GDM and ADHD models (P>0.05). GDM was not associated with an increased risk of ASD (HR_adjusted, 1.46; 95% CI, 0.74 to 2.84).
Conclusion
Prenatal exposure to GDM increases the risk of ADHD in offspring, regardless of GDM treatment complexity. However, postnatal exposure to maternal T2DM was not related to the development of ADHD.

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Metabolic Risk/Epidemiology
Higher Muscle Mass Protects Women with Gestational Diabetes Mellitus from Progression to Type 2 Diabetes Mellitus: Yujin Shin, Joon Ho Moon, Tae Jung Oh, Chang Ho Ahn, Jae Hoon Moon, Sung Hee Choi, Hak Chul Jang; Diabetes Metab J. 2022;46(6):890-900. Published online April 28, 2022; DOI: https://doi.org/10.4093/dmj.2021.0334

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Background
We evaluated whether postpartum muscle mass affects the risk of type 2 diabetes mellitus (T2DM) in Korean women with gestational diabetes mellitus (GDM).
Methods
A total of 305 women with GDM (mean age, 34.9 years) was prospectively evaluated for incident prediabetes and T2DM from 2 months after delivery and annually thereafter. Appendicular skeletal muscle mass (ASM) was assessed with bioelectrical impedance analysis at the initial postpartum visit, and ASM, either divided by body mass index (BMI) or squared height, and the absolute ASM were used as muscle mass indices. The risk of incident prediabetes and T2DM was assessed according to tertiles of these indices using a logistic regression model.
Results
After a mean follow-up duration of 3.3 years, the highest ASM/BMI tertile group had a 61% lower risk of incident prediabetes and T2DM compared to the lowest tertile group, and this remained significant after we adjusted for covariates (adjusted odds ratio, 0.37; 95% confidence interval [CI], 0.15 to 0.92; P=0.032). Equivalent findings were observed in normal weight women (BMI <23 kg/m²), but this association was not significant for overweight women (BMI ≥23 kg/m²). Absolute ASM or ASM/height² was not associated with the risk of postpartum T2DM.
Conclusion
A higher muscle mass, as defined by the ASM/BMI index, was associated with a lower risk of postpartum prediabetes and T2DM in Korean women with GDM.

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Tomoki Kawahara, Nobutoshi Nawa, Keiko Murakami, Toshihiro Tanaka, Hisashi Ohseto, Ippei Takahashi, Akira Narita, Taku Obara, Mami Ishikuro, Masatsugu Orui, Aoi Noda, Genki Shinoda, Yuki Nagata, Satoshi Nagaie, Soichi Ogishima, Junichi Sugawara, Shigeo Ku
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Metabolic Risk/Epidemiology
Effect of Different Types of Diagnostic Criteria for Gestational Diabetes Mellitus on Adverse Neonatal Outcomes: A Systematic Review, Meta-Analysis, and Meta-Regression: Fahimeh Ramezani Tehrani, Marzieh Saei Ghare Naz, Razieh Bidhendi-Yarandi, Samira Behboudi-Gandevani; Diabetes Metab J. 2022;46(4):605-619. Published online March 8, 2022; DOI: https://doi.org/10.4093/dmj.2021.0178

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Background
Evidence supporting various diagnostic criteria for diagnose gestational diabetes mellitus (GDM) are consensus-based, needs for additional evidence related to outcomes. Therefore, the aim of this systematic-review and meta-analysis was to assess the impact of different GDM diagnostic-criteria on the risk of adverse-neonatal-outcomes.
Methods
Electronic databases including Scopus, PubMed, and Web of Sciences were searched to retrieve English original, population-based studies with the universal GDM screening approach, up to January-2020. GDM diagnostic criteria were classified in seven groups and International Association of the Diabetes and Pregnancy Study Groups (IADPSG) was considered as reference one. We used the Mantel–Haenszel method to calculate the pooled odds of events. The possibility of publication bias was examined by Begg’s test.
Results
A total of 55 population-based studies consisting of 1,604,391 pregnant women with GDM and 7,770,855 non-GDM counterparts were included. Results showed that in all diagnostic-criteria subgroups, the risk of adverse neonatal outcomes including macrosomia, hyperbilirubinemia, respiratory distress syndrome, neonatal hypoglycemia, neonatal intensive care unit admission, preterm birth, and birth-trauma were significantly higher than the non-GDM counterparts were significantly higher than non-GDM counterparts. Meta-regression analysis revealed that the magnitude of neonatal risks in all diagnostic-criteria subgroups are similar.
Conclusion
Our results showed that the risk of adverse-neonatal-outcome increased among women with GDM, but the magnitude of risk was not different among those women who were diagnosed through more or less intensive strategies. These findings may help health-care-providers and policy-makers to select the most cost-effective approach for the screening of GDM among pregnant women.

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Review

Metabolic Risk/Epidemiology
Gestational Diabetes Mellitus: Diagnostic Approaches and Maternal-Offspring Complications: Joon Ho Moon, Hak Chul Jang; Diabetes Metab J. 2022;46(1):3-14. Published online January 27, 2022; DOI: https://doi.org/10.4093/dmj.2021.0335

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Gestational diabetes mellitus (GDM) is the most common complication during pregnancy and is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. GDM is associated with adverse pregnancy outcomes and long-term offspring and maternal complications. For GDM screening and diagnosis, a two-step approach (1-hour 50 g glucose challenge test followed by 3-hour 100 g oral glucose tolerance test) has been widely used. After the Hyperglycemia and Adverse Pregnancy Outcome study implemented a 75 g oral glucose tolerance test in all pregnant women, a one-step approach was recommended as an option for the diagnosis of GDM after 2010. The one-step approach has more than doubled the incidence of GDM, but its clinical benefit in reducing adverse pregnancy outcomes remains controversial. Long-term complications of mothers with GDM include type 2 diabetes mellitus and cardiovascular disease, and complications of their offspring include childhood obesity and glucose intolerance. The diagnostic criteria of GDM should properly classify women at risk for adverse pregnancy outcomes and long-term complications. The present review summarizes the strengths and weaknesses of the one-step and two-step approaches for the diagnosis of GDM based on recent randomized controlled trials and observational studies. We also describe the long-term maternal and offspring complications of GDM.

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World Journal of Diabetes.2025;[Epub] CrossRef
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International Journal of Women's Health.2025; Volume 17: 2511. CrossRef
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Short Communication

Metabolic Risk/Epidemiology
Influence of Pre-Pregnancy Underweight Body Mass Index on Fetal Abdominal Circumference, Estimated Weight, and Pregnancy Outcomes in Gestational Diabetes Mellitus: Minji Kim, Kyu-Yeon Hur, Suk-Joo Choi, Soo-Young Oh, Cheong-Rae Roh; Diabetes Metab J. 2022;46(3):499-505. Published online January 24, 2022; DOI: https://doi.org/10.4093/dmj.2021.0059

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Abstract PDF Supplementary Material PubReader ePub

This study aimed to determine the influence of pre-pregnancy body mass index on pregnancy outcomes in gestational diabetes mellitus (GDM), comparing underweight patients with GDM with normal weight patients with GDM. Maternal baseline characteristics, ultrasonographic results, and pregnancy and neonatal outcomes were reviewed in 946 women with GDM with singleton pregnancies. Underweight patients with GDM showed a benign course in most aspects during pregnancy, except for developing a higher risk of giving birth to small for gestational age neonates. Underweight women with GDM required less insulin treatment, had a higher rate of vaginal delivery, and had a lower rate of cesarean delivery. In addition, their neonates were more likely to have fetal abdominal circumference and estimated fetal weight below the 10th percentile both at the time of GDM diagnosis and before delivery. Notably, their risk for preeclampsia and macrosomia were lower. Collectively, our data suggest that underweight women with GDM may require a different approach in terms of diagnosis and management throughout their pregnancy.

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Original Articles

Metabolic Risk/Epidemiology
Postprandial Free Fatty Acids at Mid-Pregnancy Increase the Risk of Large-for-Gestational-Age Newborns in Women with Gestational Diabetes Mellitus: So-Yeon Kim, Young Shin Song, Soo-Kyung Kim, Yong-Wook Cho, Kyung-Soo Kim; Diabetes Metab J. 2022;46(1):140-148. Published online August 9, 2021; DOI: https://doi.org/10.4093/dmj.2021.0023

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Background
To investigate the association between free fatty acid (FFA) level at mid-pregnancy and large-for-gestational-age (LGA) newborns in women with gestational diabetes mellitus (GDM).
Methods
We enrolled 710 pregnant women diagnosed with GDM from February 2009 to October 2016. GDM was diagnosed by a ‘two-step’ approach with Carpenter and Coustan criteria. We measured plasma lipid profiles including fasting and 2-hour postprandial FFA (2h-FFA) levels at mid-pregnancy. LGA was defined if birthweights of newborns were above the 90th percentile for their gestational age.
Results
Mean age of pregnant women in this study was 33.1 years. Mean pre-pregnancy body mass index (BMI) was 22.4 kg/m². The prevalence of LGA was 8.3% (n=59). Levels of 2h-FFA were higher in women who delivered LGA newborns than in those who delivered non-LGA newborns (416.7 μEq/L vs. 352.5 μEq/L, P=0.006). However, fasting FFA was not significantly different between the two groups. The prevalence of delivering LGA newborns was increased with increasing tertile of 2h-FFA (T1, 4.3%; T2, 9.8%; T3, 10.7%; P for trend <0.05). After adjustment for maternal age, pre-pregnancy BMI, and fasting plasma glucose, the highest tertile of 2h-FFA was 2.38 times (95% confidence interval, 1.11 to 5.13) more likely to have LGA newborns than the lowest tertile. However, there was no significant difference between groups according to fasting FFA tertiles.
Conclusion
In women with GDM, a high 2h-FFA level (but not fasting FFA) at mid-pregnancy is associated with an increasing risk of delivering LGA newborns.

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Postpartum Glucose Intolerance in Women with a History of Gestational Diabetes Mellitus: An In-Depth Review
Kyung-Soo Kim, Soo-Kyung Kim, Yong-Wook Cho
Endocrinology and Metabolism.2026; 41(1): 26. CrossRef
Longitudinal Trajectory of Free Fatty Acids in Pregnancy According to First-Trimester Maternal Metabolic Status and the Presence of Gestational Diabetes
Otilia Perichart-Perera, Isabel González-Ludlow, Omar Piña-Ramírez, Maricruz Tolentino-Dolores, Guadalupe Estrada-Gutierrez, Sandra B. Parra-Hernández, Maribel Sánchez-Martínez, Omar Granados-Portillo, Ameyalli M. Rodríguez-Cano
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Jiao Chen, Juan Wang, Zhongwen Wang, Mei Huang, Meixiang Luo, Yanyu Cai
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Advances in free fatty acid profiles in gestational diabetes mellitus
Haoyi Du, Danyang Li, Laura Monjowa Molive, Na Wu
Journal of Translational Medicine.2024;[Epub] CrossRef
Association between serum free fatty acids and gestational diabetes mellitus
Danyang Li, Haoyi Du, Na Wu
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Fetal Abdominal Obesity Detected at 24 to 28 Weeks of Gestation Persists until Delivery Despite Management of Gestational Diabetes Mellitus (Diabetes Metab J 2021;45:547-57)
Wonjin Kim, Soo Kyung Park, Yoo Lee Kim
Diabetes & Metabolism Journal.2021; 45(6): 970. CrossRef

Metabolic Risk/Epidemiology
Fetal Abdominal Obesity Detected At 24 to 28 Weeks of Gestation Persists Until Delivery Despite Management of Gestational Diabetes Mellitus: Wonjin Kim, Soo Kyung Park, Yoo Lee Kim; Diabetes Metab J. 2021;45(4):547-557. Published online March 5, 2021; DOI: https://doi.org/10.4093/dmj.2020.0078

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Background
Fetal abdominal obesity (FAO) has been reported to be affected at gestational diabetes mellitus (GDM) diagnosis at 24 to 28 weeks of gestation in older and/or obese women. This study investigated whether the management of GDM improves FAO in GDM subjects near term.
Methods
Medical records of 7,099 singleton pregnant women delivering at CHA Gangnam Medical Center were reviewed retrospectively. GDM was diagnosed by 100-g oral glucose tolerance test after 50-g glucose challenge test based on Carpenter–Coustan criteria. GDM subjects were divided into four study groups according to maternal age and obesity. FAO was defined as ≥90th percentile of fetal abdominal overgrowth ratios (FAORs) of the ultrasonographically estimated gestational age (GA) of abdominal circumference per actual GA by the last menstruation period, biparietal diameter, or femur length, respectively.
Results
As compared with normal glucose tolerance (NGT) subjects near term, FAORs and odds ratio for FAO were significantly higher in old and/or obese women with GDM but not in young and nonobese women with GDM. For fetuses of GDM subjects with FAO at the time of GDM diagnosis, the odds ratio for exhibiting FAO near term and being large for GA at birth were 7.87 (95% confidence interval [CI], 4.38 to 14.15) and 10.96 (95% CI, 5.58 to 20.53) compared with fetuses of NGT subjects without FAO at GDM diagnosis.
Conclusion
Despite treatment, FAO detected at the time of GDM diagnosis persisted until delivery. Early diagnosis and treatment might be necessary to prevent near term FAO in high-risk older and/or obese women.

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Ana M. Fernández‐Alonso, Angélica Monterrosa‐Blanco, Álvaro Monterrosa‐Castro, Faustino R. Pérez‐López
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The effects of gestational diabetes mellitus on fetal growth: is it different for low-risk and medium–high-risk pregnant women?
Jie Wang, Xin Cheng, Zhen-Hua Li, Yi-Cheng Mao, Xin-Qiang Wang, Kang-Di Zhang, Wen-Jie Yu, Ying-Qing Li, Jia-wen Zhao, Mao-Lin Chen, Guo-peng Gao, Cheng-Yang Hu, Xiu-Jun Zhang
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Fetal abdominal obesity and the ensuing adverse perinatal outcomes in older obese pregnant women with or without obesity and with normal glucose tolerance
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Wenrui Ye, Cong Luo, Jing Huang, Chenglong Li, Zhixiong Liu, Fangkun Liu
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Fetal abdominal overgrowth is already present at 20–24 gestational weeks prior to diagnosis of gestational diabetes mellitus
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Metabolic Risk/Epidemiology
Maternal Hyperglycemia during Pregnancy Increases Adiposity of Offspring: Hye Rim Chung, Joon Ho Moon, Jung Sub Lim, Young Ah Lee, Choong Ho Shin, Joon-Seok Hong, Soo Heon Kwak, Sung Hee Choi, Hak Chul Jang; Diabetes Metab J. 2021;45(5):730-738. Published online February 22, 2021; DOI: https://doi.org/10.4093/dmj.2020.0154

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Background
The effect of intrauterine hyperglycemia on fat mass and regional fat proportion of the offspring of mothers with gestational diabetes mellitus (OGDM) remains to be determined.
Methods
The body composition of OGDM (n=25) and offspring of normoglycemic mothers (n=49) was compared using dualenergy X-ray absorptiometry at age 5 years. The relationship between maternal glucose concentration during a 100 g oral glucose tolerance test (OGTT) and regional fat mass or proportion was analyzed after adjusting for maternal prepregnancy body mass index (BMI).
Results
BMI was comparable between OGDM and control (median, 16.0 kg/m² vs. 16.1 kg/m² ). Total, truncal, and leg fat mass were higher in OGDM compared with control (3,769 g vs. 2,245 g, P=0.004; 1,289 g vs. 870 g, P=0.017; 1,638 g vs. 961 g, P=0.002, respectively), whereas total lean mass was lower in OGDM (15,688 g vs. 16,941 g, P=0.001). Among OGDM, total and truncal fat mass were correlated with fasting and 3-hour glucose concentrations of maternal 100 g OGTT during pregnancy (total fat mass, r=0.49, P=0.018 [fasting], r=0.473, P=0.023 [3-hour]; truncal fat mass, r=0.571, P=0.004 [fasting], r=0.558, P=0.006 [3-hour]), but there was no correlation between OGDM leg fat mass and maternal OGTT during pregnancy. Regional fat indices were not correlated with concurrent maternal 75 g OGTT values.
Conclusion
Intrauterine hyperglycemia is associated with increased fat mass, especially truncal fat, in OGDM aged 5 years.

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Metabolic Risk/Epidemiology
A Vegetable Dietary Pattern Is Associated with Lowered Risk of Gestational Diabetes Mellitus in Chinese Women: Qiong Chen, Weiwei Wu, Hailan Yang, Ping Zhang, Yongliang Feng, Keke Wang, Ying Wang, Suping Wang, Yawei Zhang; Diabetes Metab J. 2020;44(6):887-896. Published online September 11, 2020; DOI: https://doi.org/10.4093/dmj.2019.0138

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Background
Identification of modifiable dietary factors, which are involved in the development of gestational diabetes mellitus (GDM), could inform strategies to prevent GDM.
Methods
We examined the dietary patterns in a Chinese population and evaluated their relationship with GDM risk using a case-control study including 1,464 cases and 8,092 control subjects. Propensity score matching was used to reduce the imbalance of covariates between cases and controls. Dietary patterns were identified using factor analysis while their associations with GDM risk were evaluated using logistic regression models.
Results
A “vegetable” dietary pattern was characterized as the consumption of green leafy vegetables (Chinese little greens and bean seedling), other vegetables (cabbages, carrots, tomatoes, eggplants, potatoes, mushrooms, peppers, bamboo shoots, agarics, and garlic), and bean products (soybean milk, tofu, kidney beans, and cowpea). For every quartile increase in the vegetables factor score during 1 year prior to conception, the first trimester, and the second trimester of pregnancy, the GDM risk lowered by 6% (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.89 to 0.99), 7% (OR, 0.94; 95% CI, 0.88 to 0.99), and 9% (OR, 0.91; 95% CI, 0.86 to 0.96).
Conclusion
In conclusion, our study suggests that the vegetable dietary pattern is associated with lower GDM risk; however, the interpretation of the result should with caution due to the limitations in our study, and additional studies are necessary to explore the underlying mechanism of this relationship.

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Metabolic Risk/Epidemiology
A Comparison of Predictive Performances between Old versus New Criteria in a Risk-Based Screening Strategy for Gestational Diabetes Mellitus: Subeen Hong, Seung Mi Lee, Soo Heon Kwak, Byoung Jae Kim, Ja Nam Koo, Ig Hwan Oh, Sohee Oh, Sun Min Kim, Sue Shin, Won Kim, Sae Kyung Joo, Errol R. Norwitz, Souphaphone Louangsenlath, Chan-Wook Park, Jong Kwan Jun, Joong Shin Park; Diabetes Metab J. 2020;44(5):726-736. Published online April 13, 2020; DOI: https://doi.org/10.4093/dmj.2019.0126

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Background

The definition of the high-risk group for gestational diabetes mellitus (GDM) defined by the American College of Obstetricians and Gynecologists was changed from the criteria composed of five historic/demographic factors (old criteria) to the criteria consisting of 11 factors (new criteria) in 2017. To compare the predictive performances between these two sets of criteria.

Methods

This is a secondary analysis of a large prospective cohort study of non-diabetic Korean women with singleton pregnancies designed to examine the risk of GDM in women with nonalcoholic fatty liver disease. Maternal fasting blood was taken at 10 to 14 weeks of gestation and measured for glucose and lipid parameters. GDM was diagnosed by the two-step approach.

Results

Among 820 women, 42 (5.1%) were diagnosed with GDM. Using the old criteria, 29.8% (n=244) of women would have been identified as high risk versus 16.0% (n=131) using the new criteria. Of the 42 women who developed GDM, 45.2% (n=19) would have been mislabeled as not high risk by the old criteria versus 50.0% (n=21) using the new criteria (1-sensitivity, 45.2% vs. 50.0%, P>0.05). Among the 778 patients who did not develop GDM, 28.4% (n=221) would have been identified as high risk using the old criteria versus 14.1% (n=110) using the new criteria (1-specificity, 28.4% vs. 14.1%, P<0.001).

Conclusion

Compared with the old criteria, use of the new criteria would have decreased the number of patients identified as high risk and thus requiring early GDM screening by half (from 244 [29.8%] to 131 [16.0%]).

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Metabolic Risk/Epidemiology
Glucose Effectiveness from Short Insulin-Modified IVGTT and Its Application to the Study of Women with Previous Gestational Diabetes Mellitus: Micaela Morettini, Carlo Castriota, Christian Göbl, Alexandra Kautzky-Willer, Giovanni Pacini, Laura Burattini, Andrea Tura; Diabetes Metab J. 2020;44(2):286-294. Published online January 13, 2020; DOI: https://doi.org/10.4093/dmj.2019.0016

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Background

This study aimed to design a simple surrogate marker (i.e., predictor) of the minimal model glucose effectiveness (S_G), namely calculated S_G (CS_G), from a short insulin-modified intravenous glucose tolerance test (IM-IVGTT), and then to apply it to study women with previous gestational diabetes mellitus (pGDM).

Methods

CS_G was designed using the stepwise model selection approach on a population of subjects (n=181) ranging from normal tolerance to type 2 diabetes mellitus (T2DM). CS_G was then tested on a population of women with pGDM (n=57). Each subject underwent a 3-hour IM-IVGTT; women with pGDM were observed early postpartum and after a follow-up period of up to 7 years and classified as progressors (PROG) or non-progressors (NONPROG) to T2DM. The minimal model analysis provided a reference S_G.

Results

CS_G was described as CS_G=1.06×10⁻²+5.71×10⁻²×K_G/G_peak, K_G being the mean slope (absolute value) of loge glucose in 10–25- and 25–50-minute intervals, and G_peak being the maximum of the glucose curve. Good agreement between CS_G and S_G in the general population and in the pGDM group, both at baseline and follow-up (even in PROG and NONPROG subgroups), was shown by the Bland-Altman plots (<5% observations outside limits of agreement), and by the test for equivalence (equivalence margin not higher than one standard deviation). At baseline, the PROG subgroup showed significantly lower S_G and CS_G values compared to the NONPROG subgroup (P<0.03).

Conclusion

CS_G is a valid S_G predictor. In the pGDM group, glucose effectiveness appeared to be impaired in women progressing to T2DM.

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Unraveling the Factors Determining Development of Type 2 Diabetes in Women With a History of Gestational Diabetes Mellitus Through Machine-Learning Techniques
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Clinical Diabetes & Therapeutics
Early Assessment of the Risk for Gestational Diabetes Mellitus: Can Fasting Parameters of Glucose Metabolism Contribute to Risk Prediction?: Veronica Falcone, Grammata Kotzaeridi, Melanie Hanne Breil, Ingo Rosicky, Tina Stopp, Gülen Yerlikaya-Schatten, Michael Feichtinger, Wolfgang Eppel, Peter Husslein, Andrea Tura, Christian S. Göbl; Diabetes Metab J. 2019;43(6):785-793. Published online March 12, 2019; DOI: https://doi.org/10.4093/dmj.2018.0218

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Background

An early identification of the risk groups might be beneficial in reducing morbidities in patients with gestational diabetes mellitus (GDM). Therefore, this study aimed to assess the biochemical predictors of glycemic conditions, in addition to fasting indices of glucose disposal, to predict the development of GDM in later stage and the need of glucose-lowering medication.

Methods

A total of 574 pregnant females (103 with GDM and 471 with normal glucose tolerance [NGT]) were included. A metabolic characterization was performed before 15⁺⁶ weeks of gestation by assessing fasting plasma glucose (FPG), fasting insulin (FI), fasting C-peptide (FCP), and glycosylated hemoglobin (HbA1c). Thereafter, the patients were followed-up until the delivery.

Results

Females with NGT had lower levels of FPG, FI, FCP, or HbA1c at the early stage of pregnancy, and therefore, showed an improved insulin action as compared to that in females who developed GDM. Higher fasting levels of FPG and FCP were associated with a higher risk of developing GDM. Moreover, the predictive accuracy of this metabolic profiling was also good to distinguish the patients who required glucose-lowering medications. Indices of glucose disposal based on C-peptide improved the predictive accuracy compared to that based on insulin. A modified quantitative insulin sensitivity check index (QUICKIc) showed the best differentiation in terms of predicting GDM (area under the receiver operating characteristics curve [ROC-AUC], 72.1%) or need for pharmacotherapy (ROC-AUC, 83.7%).

Conclusion

Fasting measurements of glucose and C-peptide as well as the surrogate indices of glycemic condition could be used for stratifying pregnant females with higher risk of GDM at the beginning of pregnancy.

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Response: Early Assessment of the Risk for Gestational Diabetes Mellitus: Can Fasting Parameters of Glucose Metabolism Contribute to Risk Prediction? (Diabetes Metab J 2019;43:785–93)
Christian S. Göbl, Andrea Tura
Diabetes & Metabolism Journal.2020; 44(1): 209. CrossRef
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Clinical Care/Education
Pregnancy Outcomes of Women Additionally Diagnosed as Gestational Diabetes by the International Association of the Diabetes and Pregnancy Study Groups Criteria: Min Hyoung Kim, Soo Heon Kwak, Sung-Hoon Kim, Joon Seok Hong, Hye Rim Chung, Sung Hee Choi, Moon Young Kim, Hak C. Jang; Diabetes Metab J. 2019;43(6):766-775. Published online February 28, 2019; DOI: https://doi.org/10.4093/dmj.2018.0192

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Background

We investigated the pregnancy outcomes in women who were diagnosed with gestational diabetes mellitus (GDM) by the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria but not by the Carpenter-Coustan (CC) criteria.

Methods

A total of 8,735 Korean pregnant women were identified at two hospitals between 2014 and 2016. Among them, 2,038 women participated in the prospective cohort to investigate pregnancy outcomes. Diagnosis of GDM was made via two-step approach with 50-g glucose challenge test for screening followed by diagnostic 2-hour 75-g oral glucose tolerance test. Women were divided into three groups: non-GDM, GDM diagnosed exclusively by the IADPSG criteria, and GDM diagnosed by the CC criteria.

Results

The incidence of GDM was 2.1% according to the CC criteria, and 4.1% by the IADPSG criteria. Women diagnosed with GDM by the IADPSG criteria had a higher body mass index (22.0±3.1 kg/m² vs. 21.0±2.8 kg/m², P<0.001) and an increased risk of preeclampsia (odds ratio [OR], 6.90; 95% confidence interval [CI], 1.84 to 25.87; P=0.004) compared to non-GDM women. Compared to neonates of the non-GDM group, those of the IADPSG GDM group had an increased risk of being large for gestational age (OR, 2.39; 95% CI, 1.50 to 3.81; P<0.001), macrosomia (OR, 2.53; 95% CI, 1.26 to 5.10; P=0.009), and neonatal hypoglycemia (OR, 3.84; 95% CI, 1.01 to 14.74; P=0.049); they were also at an increased risk of requiring phototherapy (OR, 1.57; 95% CI, 1.07 to 2.31; P=0.022) compared to the non-GDM group.

Conclusion

The IADPSG criteria increased the incidence of GDM by nearly three-fold, and women diagnosed with GDM by the IADPSG criteria had an increased risk of adverse pregnancy outcomes in Korea.

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Clinical Diabetes & Therapeutics
Progression to Gestational Diabetes Mellitus in Pregnant Women with One Abnormal Value in Repeated Oral Glucose Tolerance Tests: Sunyoung Kang, Min Hyoung Kim, Moon Young Kim, Joon-Seok Hong, Soo Heon Kwak, Sung Hee Choi, Soo Lim, Kyong Soo Park, Hak C. Jang; Diabetes Metab J. 2019;43(5):607-614. Published online February 28, 2019; DOI: https://doi.org/10.4093/dmj.2018.0159

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Background

Women with one abnormal value (OAV) in a 100 g oral glucose tolerance test (OGTT) during pregnancy are reported to have an increased risk of adverse pregnancy outcomes. However, there is limited data about whether women with OAV will progress to gestational diabetes mellitus (GDM) when the OGTT is repeated.

Methods

To identify clinical and metabolic predictors for GDM in women with OAV, we conducted a retrospective study and identified women with OAV in the OGTT done at 24 to 30 weeks gestational age (GA) and repeated the second OGTT between 32 and 34 weeks of GA.

Results

Among 137 women with OAV in the initial OGTT, 58 (42.3%) had normal, 40 (29.2%) had OAV and 39 (28.5%) had GDM in the second OGTT. Maternal age, prepregnancy body mass index, weight gain from prepregnancy to the second OGTT, GA at the time of the OGTT, and parity were similar among normal, OAV, and GDM groups. Plasma glucose levels in screening tests were different (151.8±15.7, 155.8±14.6, 162.5±20.3 mg/dL, P<0.05), but fasting, 1-, 2-, and 3-hour glucose levels in the initial OGTT were not. Compared to women with screen negative, women with untreated OAV had a higher frequency of macrosomia.

Conclusion

We demonstrated that women with OAV in the initial OGTT significantly progressed to GDM in the second OGTT. Clinical parameters predicting progression to GDM were not found. Repeating the OGTT in women with OAV in the initial test may be helpful to detect GDM progression.

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Fetal abdominal obesity in women with one value abnormality on diagnostic test for gestational diabetes mellitus
Wonjin Kim, Soo Kyung Park, Yoo Lee Kim, Clive J. Petry
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Epidemiology
Oral Glucose Tolerance Testing Allows Better Prediction of Diabetes in Women with a History of Gestational Diabetes Mellitus: Tae Jung Oh, Yeong Gi Kim, Sunyoung Kang, Joon Ho Moon, Soo Heon Kwak, Sung Hee Choi, Soo Lim, Kyong Soo Park, Hak C. Jang, Joon-Seok Hong, Nam H. Cho; Diabetes Metab J. 2019;43(3):342-349. Published online December 7, 2018; DOI: https://doi.org/10.4093/dmj.2018.0086

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Background

We aimed to identify the postpartum metabolic factors that were associated with the development of diabetes in women with a history of gestational diabetes mellitus (GDM). In addition, we examined the role of the oral glucose tolerance test (OGTT) in the prediction of future diabetes.

Methods

We conducted a prospective study of 179 subjects who previously had GDM but did not have diabetes at 2 months postpartum. The initial postpartum examination including a 75-g OGTT and the frequently sampled intravenous glucose tolerance test (FSIVGTT) was performed 12 months after delivery, and annual follow-up visits were made thereafter.

Results

The insulinogenic index (IGI30) obtained from the OGTT was significantly correlated with the acute insulin response to glucose (AIRg) obtained from the FSIVGTT. The disposition indices obtained from the OGTT and FSIVGTT were also significantly correlated. Women who progressed to diabetes had a lower insulin secretory capacity including IGI30, AIRg, and disposition indices obtained from the FSIVGTT and OGTT compared with those who did not. However, the insulin sensitivity indices obtained from the OGTT and FSIVGTT did not differ between the two groups. Multivariate logistic regression analysis showed that the 2-hour glucose and disposition index obtained from the FSIVGTT were significant postpartum metabolic risk factors for the development of diabetes.

Conclusion

We identified a crucial role of β-cell dysfunction in the development of diabetes in Korean women with previous GDM. The 2-hour glucose result from the OGTT is an independent predictor of future diabetes. Therefore, the OGTT is crucial for better prediction of future diabetes in Korean women with previous GDM.

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Clinical Diabetes & Therapeutics
Adipokines and Insulin Resistance According to Characteristics of Pregnant Women with Gestational Diabetes Mellitus: Eon Ju Jeon, Seong Yeon Hong, Ji Hyun Lee; Diabetes Metab J. 2017;41(6):457-465. Published online November 15, 2017; DOI: https://doi.org/10.4093/dmj.2017.41.6.457

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Background

The aim of this study was to evaluate adipokines concentration and insulin resistance according to maternal age or obesity at pregnancy and weight change at diagnosed gestational diabetes mellitus (GDM) in pregnant women with GDM.

Methods

This study included 57 pregnant women who were diagnosed with GDM at 24 to 28 weeks of gestation. The subjects were classified into two or three groups according to pre-pregnancy body mass index (BMI, <25 kg/m² vs. ≥25 kg/m²), maternal age at pregnancy (<35 years old vs. ≥35 years old), and weight change during pregnancy at screening for GDM (weight change below, within, and in excess of the recommended range). They were respectively compared in each group.

Results

Leptin, homeostasis model assessment of insulin resistance (HOMA-IR), and HOMA2-%B were increased in the group with pre-pregnancy BMI ≥25 kg/m². Leptin and HOMA-IR were positively correlated with BMI both before pregnancy and at screening for GDM. There were no significant correlations between HOMA-IR and adipokines. HOMA-IR showed positive correlation with HOMA2-%B and negative correlation with HOMA2-%S.

Conclusion

Leptin and HOMA-IR at diagnosed GDM were increased in the GDM patients with obesity before pregnancy. They were positively correlated with BMI both before pregnancy and at screening for GDM. The effect of maternal age at pregnancy and weight change during pregnancy at GDM screening on adipokines and insulin resistance might be less pronounced than the effect of maternal obesity.

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Letter: Adipokines and Insulin Resistance According to Characteristics of Pregnant Women with Gestational Diabetes Mellitus (Diabetes Metab J 2017;41:457-65)
Ohk-Hyun Ryu
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Obesity and Metabolic Syndrome
Prediction of Gestational Diabetes Mellitus in Pregnant Korean Women Based on Abdominal Subcutaneous Fat Thickness as Measured by Ultrasonography: Sung Hee Yang, Changsoo Kim, Hyun Sook An, Hyun An, Jin Soo Lee; Diabetes Metab J. 2017;41(6):486-491. Published online September 22, 2017; DOI: https://doi.org/10.4093/dmj.2017.41.6.486

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Background

This study was performed to verify the correlation between abdominal subcutaneous fat thickness (ASFT) measured by ultrasonography (US) during the first trimester of pregnancy and gestational diabetes mellitus (GDM) of the second trimester in Korean women and to establish a standard of ASFT for predicting GDM.

Methods

A total of 333 singleton pregnant women participated in this study. Their ASFT was measured by US during the 10⁺⁶ to 13⁺⁶ weeks of pregnancy; then a GDM confirmatory test (100 g oral glucose tolerance test) was conducted during the 24 to 28 week period of pregnancy. Based on the GDM tests, comparative analyses of the ages of the subjects, pre-pregnancy body mass index (BMI), and weight gain during pregnancy were conducted.

Results

The ages of the subjects and weight gains during pregnancy were not correlated to the GDM of the second trimester of pregnancy, but the pre-pregnancy BMIs (22±3.3 kg/m²) and the ASFT (1.9±0.5 cm) measurements between the control group and subjects during the first trimester of pregnancy were found to show significant differences (P<0.001). The cut-off value of the ASFT for predicting GDM was determined to be 2.4 cm (area under the curve=0.90, sensitivity 75.61%, specificity 91.78%, P<0.001). The odds ratio was 2.91 (95% confidence interval, 1.07 to 7.92; P=0.034), which was higher than the 2.4 cm ASFT.

Conclusion

It was determined that ASFT as measured by US during the first trimester of pregnancy can be used to predict the risk of developing GDM during the second trimester of pregnancy and for prognosis.

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Obesity and Metabolic Syndrome
The Usefulness of the Glycosylated Hemoglobin Level for the Diagnosis of Gestational Diabetes Mellitus in the Korean Population: Ah Jeong Ryu, Hyuk Jin Moon, Joo Ok Na, Yeo Joo Kim, Sang Jin Kim, Sang Il Mo, Jeong Ran Byun; Diabetes Metab J. 2015;39(6):507-511. Published online November 23, 2015; DOI: https://doi.org/10.4093/dmj.2015.39.6.507

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Background

An oral glucose tolerance test (OGTT) is the current method used for screening and diagnosis of gestational diabetes mellitus (GDM). OGTT is a relatively complicated procedure and is expensive. Thus, new strategies that do not require fasting or more than a single blood draw may improve the diagnosis of GDM and increase the rate of GDM testing. We investigated the utility of monitoring glycosylated hemoglobin (HbA1c) levels for the diagnosis of GDM.

Methods

The data from 992 pregnant women with estimated gestational ages ranging from 24 to 28 weeks were retrospectively reviewed. There were 367 women with plasma glucose levels ≥140 mg/dL 1 hour after a 50-g OGTT. GDM was diagnosed according to the Carpenter-Coustan criteria for a 3-hour 100 g OGTT. A HbA1c assessment was performed at the same time.

Results

We enrolled 343 women in this study, and there were 109 women with GDM. The area under the curve the receiver operating characteristic curve for HbA1c detection of GDM was 0.852 (95% confidence interval, 0.808 to 0.897). A HbA1c cutoff value ≥5.35% had maximal points on the Youden index (0.581). The sensitivity was 87.2% and the specificity was 70.9% for diagnosing GDM. A threshold value ≥5.35% indicated that 163 patients had GDM and that 68 (41.7%) were false positive. The positive predictive value was 58.3% at this threshold value.

Conclusion

Despite substantial progress in methodology, HbA1c values cannot replace OGTT for the diagnosis of GDM.

Citations

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Review

Gestational Diabetes Mellitus in Korean Women: Similarities and Differences from Other Racial/Ethnic Groups: Catherine Kim; Diabetes Metab J. 2014;38(1):1-12. Published online February 19, 2014; DOI: https://doi.org/10.4093/dmj.2014.38.1.1

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Gestational diabetes mellitus (GDM) reflects defects in insulin secretion in response to the metabolic demands of pregnancy. While GDM is increasingly common worldwide due in large part to the obesity epidemic, its frequency is relatively low in Korean women. In this report, the prevalence and risk factors for GDM, perinatal outcomes, and postpartum course are compared in non-Korean and Korean women. While Koreans and non-Koreans with GDM share pathophysiology and complications, there may be differences in the role of obesity and thus the effectiveness of interventions targeting obesity in GDM women. Further investigations of the effectiveness of weight loss interventions and pharmacotherapy specifically among Korean women are needed. Dietary and other lifestyle data from Korean populations could inform prevention and treatment strategies in other countries which suffer from significantly higher prevalences of GDM.

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Original Articles

Carotid Intimal-Medial Thickness Is Not Increased in Women with Previous Gestational Diabetes Mellitus: Yun Hyi Ku, Sung Hee Choi, Soo Lim, Young Min Cho, Young Joo Park, Kyong Soo Park, Seong Yeon Kim, Hak Chul Jang; Diabetes Metab J. 2011;35(5):497-503. Published online October 31, 2011; DOI: https://doi.org/10.4093/dmj.2011.35.5.497

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Background

Gestational diabetes mellitus (GDM) is known to increase the risk of cardiovascular diseases. Measuring the carotid artery intimal-medial thickness (CIMT) is a non-invasive technique used to evaluate early atherosclerosis and to predict future cardiovascular diseases. We examined the association between CIMT and cardiovascular risk factors in young Korean women with previous GDM.

Methods

One hundred one women with previous GDM and 19 women who had normal pregnancies (NP) were recruited between 1999 and 2002. At one year postpartum, CIMT was measured using high-resolution B-mode ultrasonography, and oral glucose tolerance tests were performed. Fasting glucose, glycated hemoglobin A1c (HbA1c), insulin levels and lipid profiles were also measured. CIMTs in the GDM and NP groups were compared, and the associations between CIMT and cardiovascular risk factors were analyzed in the GDM group.

Results

CIMT results of the GDM group were not significantly different from those of the NP group (GDM, 0.435±0.054 mm; NP, 0.460±0.046 mm; P=0.069). In the GDM group, a higher HbA1c was associated with an increase in CIMT after age adjustment (P=0.011). CIMT results in the group with HbA1c >6.0% were higher than those of the normal HbA1c (HbA1c ≤6.0%) (P=0.010). Nine of the patients who are type 2 diabetes mellitus converters within one year postpartum but showed no significant difference in CIMT results compared to NP group.

Conclusion

Higher HbA1c is associated with an increase in CIMT in women with previous GDM. However, CIMT at one year postpartum was not increased in these women compared to that in NP women.

Citations

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Women with a history of gestational diabetes mellitus present an accumulation of cardiovascular risk factors at age 46—A birth cohort study
Evi Bakiris, Kaisu Luiro, Jari Jokelainen, Laure Morin‐Papunen, Sirkka Keinänen‐Kiukaanniemi, Kari Kaikkonen, Terhi Piltonen, Juha S. Tapanainen, Juha Auvinen
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The effect of gestational diabetes mellitus on carotid artery intima-media thickness in and after pregnancy: a systematic review and meta-analysis
Andrea Sonaglioni, Elisabetta Piergallini, Angelo Naselli, Gian Luigi Nicolosi, Anna Ferrulli, Stefano Bianchi, Michele Lombardo, Giuseppe Ambrosio
Acta Diabetologica.2023; 61(2): 139. CrossRef
Prognostic indicators of persistent carotid intima-media thickness increase in postpartum period in a population of normotensive women with gestational diabetes mellitus
Andrea Sonaglioni, Gian Luigi Nicolosi, Valentina Esposito, Stefano Bianchi, Michele Lombardo
European Journal of Obstetrics & Gynecology and Reproductive Biology.2022; 269: 47. CrossRef
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Angelo Maria Patti, Rosaria Vincenza Giglio, Kalliopi Pafili, Manfredi Rizzo, Nikolaos Papanas
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Women with a history of gestational diabetes on long-term follow up have normal vascular function despite more dysglycemia, dyslipidemia and adiposity
Olubukola Ajala, Louise A. Jensen, Edmond Ryan, Constance Chik
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Gestational Diabetes Mellitus in Korean Women: Similarities and Differences from Other Racial/Ethnic Groups
Catherine Kim
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Erica P. Gunderson, Vicky Chiang, Mark J. Pletcher, David R. Jacobs, Charles P. Quesenberry, Stephen Sidney, Cora E. Lewis
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A Comparative Study of Eating Habits and Food Intake in Women with Gestational Diabetes according to Early Postpartum Glucose Tolerance Status: You Jeong Hwang, Bo Kyung Park, Sunmin Park, Sung-Hoon Kim; Diabetes Metab J. 2011;35(4):354-363. Published online August 31, 2011; DOI: https://doi.org/10.4093/dmj.2011.35.4.354

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Background

Women with gestational diabetes mellitus (GDM) are at high risk for type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD); continuous life-style intervention, especially diet, is central to managing T2DM and CVD. However, little is known about the dietary patterns of women with GDM after delivery. The goal of this study was to compare the eating habits and food intakes of women diagnosed with GDM during the early postpartum period.

Methods

We performed a 75 g oral glucose tolerance test (OGTT) in 184 women with GDM between 6 and 12 weeks after delivery. Based on the results of the OGTT, the subjects were divided into three groups according to the American Diabetes Association criteria; normal glucose tolerance (NGT) (n=100), pre-diabetes (n=73), and diabetes mellitus (DM) (n=11). Eating habits and usual food intake after delivery were investigated using a questionnaire, based on 24 hour-recall, which was administered by a trained dietitian. The daily intake data were analyzed using CAN Pro 3.0. Blood tests were performed pre- and post-delivery.

Results

Eating habits were not significantly different among the three groups. However, animal fat consumption was significantly different among the three groups. The intake ratio of fat calories to total calories was also significantly higher in the pre-diabetes and DM groups.

Conclusion

Although diet in the period 6 to 12 weeks postpartum did not influence glucose level, it may be important to educate women with GDM about the risks of excessive animal fat intake during pregnancy and the postpartum period in order to prevent later onset of T2DM.

Citations

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Adherence to Dietary and Lifestyle Guidelines Among Women With a History of Gestational Diabetes Mellitus and the Influence of a Student‐Led Dietetic Clinics
Klaudia Illenberger, Julia Sekula, Robyn Lawrence
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Dan Yedu Quansah, Justine Gross, Leah Gilbert, Celine Helbling, Antje Horsch, Jardena J. Puder
Eating Behaviors.2019; 34: 101304. CrossRef
Prevention of Diabetes after Gestational Diabetes: Better Translation of Nutrition and Lifestyle Messages Needed
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Insulin Secretion and Incretin Hormone Concentration in Women with Previous Gestational Diabetes Mellitus: Sung Hoon Yu, Bongjun Cho, Yejin Lee, Eunhye Kim, Sung Hee Choi, Soo Lim, Ka Hee Yi, Young Joo Park, Kyong Soo Park, Hak Chul Jang; Diabetes Metab J. 2011;35(1):58-64. Published online February 28, 2011; DOI: https://doi.org/10.4093/dmj.2011.35.1.58

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Background

We examined the change in the levels of incretin hormone and effects of glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide 1 (GLP-1) on insulin secretion in women with previous gestational diabetes (pGDM).

Methods

A 75-g oral glucose tolerance test (OGTT) was conducted on 34 women with pGDM. In addition, 11 women with normal glucose tolerance, matched for age, height and weight, were also tested. The insulin, GIP, GLP-1, and glucagon concentrations were measured, and their anthropometric and biochemical markers were also measured.

Results

Among 34 women with pGDM, 18 had normal glucose tolerance, 13 had impaired glucose tolerance (IGT) and 1 had diabetes. No significant differences were found in GLP-1 concentration between the pGDM and control group. However, a significantly high level of glucagon was present in the pGDM group at 30 minutes into the OGTT. The GIP concentration was elevated at 30 minutes and 60 minutes in the pGDM group. With the exception of the 30-minute timepoint, women with IGT had significantly high blood glucose from 0 to 120 minutes. However, there was no significant difference in insulin or GLP-1 concentration. The GIP level was significantly high from 0 to 90 minutes in patients diagnosed with IGT.

Conclusion

GLP-1 secretion does not differ between pGDM patients and normal women. GIP was elevated, but that does not seem to induce in increase in insulin secretion. Therefore, we conclude that other factors such as heredity and environment play important roles in the development of type 2 diabetes.

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Review

Gestational Diabetes in Korea: Incidence and Risk Factors of Diabetes in Women with Previous Gestational Diabetes: Hak Chul Jang; Diabetes Metab J. 2011;35(1):1-7. Published online February 28, 2011; DOI: https://doi.org/10.4093/dmj.2011.35.1.1

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Korean women with a history of gestational diabetes mellitus (GDM) have a 3.5 times greater risk of developing postpartum diabetes than the general population. The incidence of type 2 diabetes mellitus in early postpartum is reported as 10-15% in Korean women. A prospective follow-up study on Korean women with GDM showed that approximately 40% of women with previous GDM were expected to develop diabetes within 5 years postpartum. Independent risk factors for the development of diabetes in Korean women with previous GDM are pre-pregnancy body weight, gestational age at diagnosis, antepartum hyperglycemia on oral glucose tolerance test, low insulin response to oral glucose load, and family history of diabetes. Women with postpartum diabetes have greater body mass indexes, body weight, and waist circumferences than women with normal glucose tolerance. Multiple logistic regression analysis has revealed that waist circumference is the strongest obesity index along with systolic blood pressure and that triglyceride levels are a major independent risk factor for developing diabetes. These results in Korean women with previous GDM underline the importance of postpartum testing in Korean women diagnosed with GDM, and demonstrate that impaired B-cell function, obesity, and especially visceral obesity, are associated with the development of diabetes.

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Original Articles

Adipokine Concentrations in Pregnant Korean Women with Normal Glucose Tolerance and Gestational Diabetes Mellitus.: Eun Suk Oh, Jung Hee Han, Sung Min Han, Jee Aee Im, Eun Jung Rhee, Cheol Young Park, Ki Won Oh, Won Young Lee; Korean Diabetes J. 2009;33(4):279-288. Published online August 1, 2009; DOI: https://doi.org/10.4093/kdj.2009.33.4.279

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BACKGROUND
The aims of this study were to compare adipokine concentrations of pregnant women in the 24th~28th weeks of gestation to those of non-pregnant women. We compared the concentrations of adipokines in women with gestational diabetes mellitus (GDM), gestational impaired glucose tolerance (GIGT) and normal glucose tolerance (NGT). We also investigated the role of adipokines in the development of gestational glucose intolerance. METHODS: We surveyed 129 pregnant women who underwent a 100 g oral glucose tolerance test (OGTT) during the 24th~28th weeks of gestation. Participants were classified into three groups: (1) NGT (n = 40), (2) GIGT (n = 45), and (3) GDM (n = 44). Pregnant subjects with NGT were matched to non-pregnant controls for BMI and age (n = 41). RESULTS: Pregnant women with NGT exhibited significantly decreased adiponectin levels and elevated leptin levels compared to non-pregnant controls. Mean plasma resistin levels were significantly higher in women with GDM and GIGT than in women with NGT. Resistin and fasting glucose were significant predictors for the development of gestational glucose intolerance. CONCLUSION: Plasma adiponectin levels were decreased and leptin levels were increased in pregnant subjects with NGT compared to BMI and age matched non-pregnant controls. Women with GDM and GIGT exhibit significantly elevated concentrations of resistin compared with women with NGT. Increased resistin levels were also associated with the development of gestational glucose intolerance. Resistin may play an important role on the development of gestational glucose intolerance in Korean women.

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Shi-Min Hu, Meng-Shi Chen, Hong-Zhuan Tan
World Journal of Clinical Cases.2019; 7(5): 585. CrossRef
Letter: Adipokines and Insulin Resistance According to Characteristics of Pregnant Women with Gestational Diabetes Mellitus (Diabetes Metab J 2017;41:457-65)
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Mutation Screening of HNF-1alpha Gene in Korean Women with Gestational Diabetes Mellitus.: Hun Sung Kim, Sun Hee Hwang, Eun Sun Choi, So Young Park, Chang Hoon Yim, Ki Ok Han, Hyun Koo Yoon, Ho Yeon Chung, Kyung Seon Kim, Jeong Bok, Jong Young Lee, Sung Hoon Kim; Korean Diabetes J. 2008;32(1):38-43. Published online February 1, 2008; DOI: https://doi.org/10.4093/kdj.2008.32.1.38

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Abstract PDF

BACKGROUND
S: Gestational diabetes mellitus (GDM) is defined as glucose intolerance with onset or first detection during pregnancy and mostly caused by insulin resistance and beta-cell dysfunction like type 2 diabetes. However, autoimmune or monogenic diabetes can contribute to GDM. Maturity-onset diabetes of the young (MODY) is a monogenic form of diabetes characterized by an early age of onset and an autosomal dominant pattern of inheritance. Most MODY cases are attributable to mutations in HNF-1alpha gene, also known as MODY3. We investigated whether mutations in HNF-1alpha gene are present in Korean women with GDM. METHODS: A total of 96 Korean women with GDM who have a family history of DM were screened for mutations in the HNF-1alpha gene. We evaluated the clinical characteristics of GDM women with HNF-1alpha gene mutations. RESULTS: Five of 96 patients (5.2%) were found to have a mutation in HNF-1alpha gene. Four of those (-23C > G, 833G > A (Arg278Gln), 923C > T, IVS5 + 106A > G) were novel and one (-124G > C) in promoter region was reported in previous study. The mean age of GDM women with mutations of HNF-1alpha gene was 34 years. Four women with MODY3 gene mutations required insulin therapy during pregnancy. GDM women with MODY3 gene mutations appeared to be decreased insulin secretion (HOMA-%B) than those without mutations. CONCLUSIONS: We have found the existence of MODY3 as well as novel HNF-1alpha gene mutations in Korean women with GDM.

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Update on Monogenic Diabetes in Korea
Ye Seul Yang, Soo Heon Kwak, Kyong Soo Park
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Case Reports

A Case of Diabetic Ketoacidosis in Gestational Diabetes Mellitus.: Myung Hwan Kim, Eui Dal Jung, Seung Pyo Hong, Gyu Hwan Bae, Sun Young Ahn, Eon Ju Jeon, Seong Yeon Hong, Ji Hyun Lee, Ho Sang Son; Korean Diabetes J. 2007;31(4):368-371. Published online July 1, 2007; DOI: https://doi.org/10.4093/jkda.2007.31.4.368

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Abstract PDF: Gestational diabetes mellitus (GDM) is defined as glucose intolerance of variant severity with onset or first recognition during present pregnancy. Recently the prevalence of GDM in Korean has reported as 1.7~4.0%. Diabetic ketoacidosis is a serious metabolic complication of diabetes with high mortality if undetected. Its occurrence is very rare in gestational diabetes patients, but is harmful to fetal and maternal health. A 26 years-old pregnant woman was admitted at 37 weeks gestation because of progressive generalized weakness, anorexia and weight loss. Initial physical examination reveals that she had been dehydrated, and blood pressure 130/80 mmHg, pulse rate 100/min, respiratory rate 20/min, and body temperature was 36.9 degrees C. Serum glucose was 545 mg/dL, pH 7.282, HCO3- 10.5 mmol/L, urine ketone 3+, urine glucose 2+ when initial laboratory work was done. She was treated with intravenous fluid and insulin under the impression of diabetic ketoacidosis. Her delivery was performed after 24 hours from admission because of suggestive fetal distress. After recovery, she is being treated with insulin at outpatient department. We experienced a appropriately treated case of diabetic ketoacidosis in pregnant woman with GDM, and report it with a literature review.

Clinical Courses of Two Women with Gestational Diabetes Mellitus Who are GAD Antibody Positive.: Sung Hoon Yu, Min Jun Song, Sung Hoon Kim, Chang Hoon Yim, Ki Ok Han, Won Kun Park, Hyun Koo Yoon, Ho Yeon Chung; Korean Diabetes J. 2006;30(5):398-402. Published online September 1, 2006; DOI: https://doi.org/10.4093/jkda.2006.30.5.398

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Abstract PDF: Gestational diabetes mellitus (GDM) is defined as glucose intolerance of various degrees with onset or first recognition during pregnancy. Women with GDM are at high risk of developing type 2 diabetes later in life, but the risk of developing type 1 diabetes is also increased. Positivity for glutamic acid decarboxylase (GAD) antibodies during pregnancy confers a high risk for subsequent progression to type 1 diabetes. Here, we reported the two cases with GDM who were GAD antibody positive and progressed to type 1 diabetes with different time-courses. One woman with GDM progressed rapidly to classical type 1 diabetes while the other became slowly progressive IDDM (SPIDDM) [or latent autoimmune diabetes in adults (LADA)].

Original Articles

Pregnancy Outcome in Korean Women with Gestational Diabetes Mellitus Diagnosed by the Carpenter-Coustan Criteria.: Hak Chul Jang, Young Min Cho, Kyong Soo Park, Seong Yeon Kim, Hong Kyu Lee, Moon Young Kim, Jae Hyug Yang, Son Moon Shin; Korean Diabetes J. 2004;28(2):122-130. Published online April 1, 2004

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Abstract PDF: BACKGROUND
The American Diabetes Association recently proposed the Carpenter-Coustan criteria for the diagnosis of gestational diabetes mellitus(GDM) based on the results of the Toronto Tri-Hospital Study. The prevalence of GDM in Korean women increased, on average, by 60% when the Carpenter-Coustan criteria were applied. However, the pregnancy outcome of Korean women with GDM with regard to the Carpenter-Coustan criteria tremains to be reported. The pregnancy outcomes of those Korean women with GDM by the Carpenter- Coustan criteria, but not by the NDDG criteria were assessed. METHODS: In this study, a total of 2776 pregnant women underwent universal screening for GDM, between January 1993 and December 1994, as recommended by the Third International Workshop-Conference on Gestational Diabetes Mellitus with minor modifications. The primary pregnancy outcomes were preeclampsia, premature delivery, delivery by C-section, birth weight and LGA infants. RESULTS: Of the 2776 women, 656 screened-positive for GDM. Of these, 37 and 74 had GDM by the Carpenter-Coustan and NDDG criteria, respectively. With increasing glucose intolerance, there was a stepwise increase in premature deliveries, deliveries by C-section and preeclampsia from those screening negative to GDM by the NDDG criteria, with a similar trend for the frequency of LGA infants. The LGA infant screening-negative and positive were 13.5 and 16.1%, but those with a normal glucose tolerance were 27.0 and 33.8% in those screening positive to GDM by the Carpenter-Coustan and NDDG criteria, respectively(P<0.001). CONCLUSION: Our study demonstrated that increasing glucose tolerance was associated with increasing frequencies of adverse pregnancy outcomes in Korean women. The maternally complicated and LGA infants were significantly higher in women with GDM by the Carpenter-Coustan criteria. Thus the Carpenter- Coustan criteria are recommended for the diagnosis of GDM in Korean Women.

Pospartum Assessment of Insulin Secretion and Sensitivity in Women with Gestational Diabetes Mellitus (GDM).: Eun Soon Hong, Hye Jin Lee, Young Sun Hong, Eon Ah Sung, Yeon Jin Jang; Korean Diabetes J. 2002;26(5):319-327. Published online October 1, 2002

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Abstract PDF: BACKGROUND
Gestational diabetes mellitus (GDM) affects 2~4% of all pregnant women. Women with a history of GDM are at high risk of developing type 2 DM, in the future; with a cumulative incidence is 40~60%. Therefore, the assessment of insulin secretion and sensitivity in women with a history of GDM should help in the elucidation of some of the underlying defects of insulin secretion or action in the evolution of type 2 DM. This study was performed to evaluate the characteristics of insulin secretory capacity and sensitivity in women with gestational diabetes following child birth. METHODS: Oral glucose tolerance tests were carried out at 6~8 weeks postpartum in 22 women with a history of GDM, and 20 age and weight matched non- pregnant controls. Frequently sampled intravenous glucose tolerance test (FSIGT) were done at 10~14 weeks postpartm, and insulin secretion was measured as the acute insulin response to glucose (AIRg) and insulin sensitivity as minimal model derived sensitivity index (SI). AIRg*SI was used as an index for beta-cell function because AIRg can be modulated by SI. RESULTS: According to the results of OGTT, the subjects with a history of GDM were classified into 2 groups, one of normal glucose tolerance (postpartum-NGT) (n=11) and the other of an impaired glucose tolerance (postpartum-IGT)(n=11). There were no significant differences in WHR (waist to hip ratio), blood pressure, and serum lipid concentrations among the controls, postpartum-NGT and postpartum-IGT group. The fasting glucose level was significantly higher in the postpartum-IGT group compared to the postpartum-NGT and control groups (p<0.05). The fasting serum insulin level was significantly lower in the postpartum-NGT and -IGT groups than in the control group (p<0.05). The AIRg and AIRg*SI were significantly lower in the postpartum-NGT and -IGT groups compared to the control group (p<0.05), however the SI was lower in the postpartum-NGT and -IGT groups compared to the control group, but the difference did not reach statistical significance. The percentage of parental with history of type 2 diabetes was significantly greater in the postpartum-IGT group compared to the postpartum-NGT group (p<0.05). No significant predictive factors for subsequent IGT were found inform a logistic regression analysis. CONCLUSION: The insulin secretory capacity of women previously having suffered GDM was impaired, even though their glucose tolerance was restored to normal following child birth. Our results suggest that impaired insulin secretion may be a major path-ophysiological factor in the development of type 2 DM in women with a previous history of GDM.

Effect of Self-monitoring of Blood Glucose on Pregnancy Outcome in Women with Mild Gestational Diabetes.: Hak Chul Jang, Jeong Eun Park, Chang Hoon Yim, Ho Yeun Chung, Ki Ok Han, Hyun Koo Yoon, In Kwon Han, Moon Young Kim, Jae Hyug Yang, Mi Jung Kim, Sun Young Ko, Yeon Kyung Lee; Korean Diabetes J. 2001;25(1):93-102. Published online February 1, 2001

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Abstract PDF: BACKGROUND
Self-monitoring of blood glucose (SMBG) and intensive therapy with insulin demonstrated to have a positive effects in the reduction of the neonatal complications in women with gestational diabetes (GDM). However the utility of SMBG in the mild GDM who does not requiring insulin has not been formally reported. Therefore, to evaluate the effectiveness of SMBG in the management of mild GDM, we compared the pregnancy outcome and the postpartum glucose tolerance of women who monitored their glycemic control by SMBG to those of women who monitored by laboratory glucose test at each office visit during pregnancy. METHODS: We studied 185 women diagnosed as a GDM by NDDG criteria and their fasting glucose concentration < 5.8 mM. All subjects had singleton pregnancy,and no medical diseases that may affect fetal growth, and were certain of gestational age by early ultrasonography. They were treated with an identical GDM management protocol except glucose monitoring. One hundred five women were monitored by laboratory glucose test at each office visit (office group) and 80 women were monitored by SMBG (SMBG group). Pregnancy outcome including rates of cesarian section, obstetric complication, LGA infant and glucose tolerance status at postpartum were compared between two groups. RESULTS: The age, height, prepregnancy weight, weight at delivery and parity were not significantly different between the two groups. Fasting, 1-h, 2-h glucose concentration during the diagnostic test of GDM in SMBG group were similar to those of office group. However, 3-h glucose concentration of office group was 0.3 mM higher than that of SMBG group. The rate of primary cesarian section, preterm labor and pregnancy-induced hypertension of SMBG group were similar to those of office group. The mean postprandial 2-h glucose concentration of office group measured at each office was 0.5 mM higher than that of SMBG group. Although 5% of office group were treated with insulin, 24% of SMBG group were requiring insulin therapy. The birth weight and LGA infant rate of office group were 3403 432 g and 28%, those were heavier and higher than those of SMBG group (3169 447 g, 13.8%). The 90% of office group and 84% of SMBG group were performed 75 g oral glucose tolerance test at postpartum 6-8 weeks. There was no significant difference in rates of diabetes and IGT between office and SMBG group (9.5%, 11.6%; 7.5%, 9.0% respectively). CONCLUSIONS: This study demonstrated that SMBG is very seful in early detection of maternal hyperglycemia and lowing the postprandial glucose, as well as reducing the rate of LGA infants in women with mild GDM.

Antepartum Characteristics Predicting Persistent Postpartum Glucose lntolerance in the Patients with Gestational Diabetes Mellitus (GDM).: Yoo Lee Kim, Yong Wook Cho, Seok Won Park, Seog Ki Lee, In Sup Ahn, Byung Wook Na, Jun Lee, Yun Kyung Cho, Hwa Young Lee, Sang Jong Lee; Korean Diabetes J. 2000;24(1):46-59. Published online January 1, 2001

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Abstract PDF: BACKGROUND
The aim of this study is to investigate the prevalence of persistent postpartum glucose intolerance and to examine antepartum clinical characteri-stics for their predictability of persistent postpartum glucose intolerance in the patients with GDM. METHODS: In 211 GDM patients who showed more than two abnormal glucose values of O'Sullivan and Mahan's criteria on 100g-oral glucose tolerance test (OGTT), 75g-OGTT were performed at 6 weeks postpartum. The incidence of postpartum normal glucose tolerance (NGT), impaired glucose tolerance (IGT), and diabetes mellitus (DM) were investigated and antepartum ciinical parameters were compared among the three groups, Predictability of antepartum clinical characteristics for postpartum IGT and DM were also investigated by logistic regression analysis. RESULTS: When we grouped the patients into postpartum NGT, IGT, DM according to the results of 75g-OGTT performed 6 weeks postpartum, The incidence were 81,5% of subjects had NGT, 9.0% had IGT, and 9.5% had DM. Plasma glucose levels and GAUC on antepartum 100 g-OGTT(NGT: 1660+/-159, IGT: 1948+/-730, DM: 2538+/-629mmol/L ' min), and proportion of patients receiving insulin therapy increased progressively and significantly in association with worsening postpartum glucose tolerance. Frequency of positive family history of DM in qroups with IGT and DM (63,2% & 80.0%) were significantly higher than that in group with NGT(37,2%). Weight gain before diagnosis of GDM in groups with IGT and DM(6.7+/-3.9kg & 6.8+/-4.1 kg) were significantly smaller than that of group with NGT(9.5+/-3,5kg), Gestational age at diagnosis of GDM in group with DM(25.8+/-5.4 weeks) was significantly shorter than that in group with NGT(30.0+/-3,3 weeks), Proportion of subjects diagnosed earlier than 24 weeks of gestation were significantly higher in groups with IGT (15.8%) and DM (25.0%) than in group with NGT (1.2%). Proportions of subjects delivered heavier infants, > or =4 kg,were significantly higher in the DM group (40.0%) than in the NGT group (9.3%). In the patients having fasting plasma glucose levels hlgher than 5.8 mmol/L on antepartum 100g-OGTT, the prevalence of persistent glucose intolerance was significantly higher than in the patients FPG level lower than 5.8 mmol/L (61.9% vs 7.7%), Logistic regression analysis were performed using IGT and DM as the outcome of interest. The GAUC on antepartum 100g-OGTT, family history of DM, and the gestational age at diagnosis of GDM were independent predictors for both postpartum DM and postpartum IGT. CONCLUSION: The prevalence of persistent postpartum glucose intolerance in GDM patients were 18.5% and the most important independent predictor for persistent postpartum glucose intolerance was the degree of severity in glucose intolerance during pregnancy.

Fetal Hyperinsulinemia and Ultrasonographic Measurement of Fetal Growth in Pregnancy Complicated by Gestational Diabetes Mellitus.: In Kwon Han, Chang Hoon Yim, Ho Yeon Jeong, Hak Chul Chang, Ki Ok Han, Hyun Ku Yoon, Park Jeong Eun, Soo Young Lee, Young Ho Lee; Korean Diabetes J. 1999;23(4):506-517. Published online January 1, 2001

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Abstract PDF: BACKGROUND
Recently we reported that the large for gestational age (LGA) fetus of women with gestational diabetes mellitus (GDM) had disproportionate growth characterized by larger abdominal circumference (AC) but similar biparietal diameter (BPD) at third trimester compared to the fetus of normal pregnant women. The AC of LGA fetus appeared to be accelerated after 33 weeks gestation, and measurement of AC could be an effective method for prediction of LGA. Thus this study was performed to find the relationship between fetal hyperinsulinemia and disproportionate growth and to find the highly sensitive index for prediction of LGA infant in GDM. METHODS: We prospectively studied ultrasono- graphic growth patterns at 30, 34, 38 gestational weeks in 20 women with GDM and 15 normal pregnant women. The ultrasonographic measurements of fetus included biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), femur length (FL), mid-thigh circumference (MTC), mid-upper arm circumference (MUAC), mid-thigh subcutaneous fat thickness (MTFT), mid-upper arm subcutaneous fat thickness (MUAFT), fetal liver length (FLL), chest circumference (CC) and heart circumference (HTC). RESULTS: Compared to the fetus of normal pregnant women and appropriate for gestational age (AGA) fetus of GDM, LGA fetus of GDM had thicker MUAFT (3.9+0.9, 5.0+1.1, 5.6+1.7 mm, p=0.008) at 34 weeks, MUAFT (5.3+0.8, 5.6+0.9, 7.2+1.4 mm p=0.045) at 38 weeks and MTFT (5.2 +1.1, 5.5+0.8, 7.1+1.5 mm, p=0.019) at 38 weeks. They also had longer MUAC (120.3+9.9, 119.4+ 8.3, 138.7+11.2 mm, p=0.020) and CC(322.6+11.7, 324.4+15.7, 351.7+15.0mm, p=.025, respectively). There was a positive correlation between umbilical venous C-peptide concentration and birthweight (r=0.626, p=0.005) and symmetry index (r=0.523, p=0.03) of newborns. There was also a positive correlation between C-peptide concentration and MUAC (r=0.449, p=0.038) and MUAFT (r=0.426, p=0.045) in GDM group. CONCLUSION: The LGA fetus of women with GDM showed an accelerated growth of predominantly subcutaneous fat tissues that should be caused by the fetal hyperinsulinemia. Ultrasonographic measurement of subcutaneous tissues may be the most sensitive index for prediction of growth abnormalities in GDM at late gestation.

Prediction of Large for Gestational Age Infant in Women with Gestational Age Infant in Women with Gestational Diabetes Mellitus by Yltrasound Examination.: In Kwon Han, Hun Kee Min, Chang Hoon Yim, Ho Yeon Jeong, Hak Chul Chang, Ki Ok Han, Hyun Ku Yoon, Jeong Eun Park, Jae Eun Park, So Ra Park, Soo Young Lee, Young Ho Lee; Korean Diabetes J. 1999;23(3):326-335. Published online January 1, 2001

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Abstract PDF: BACKGROUND
In pregnancies complicated by diabetes, fetal hyperinsulinemia increases the deposition of fat, protein and glycogen in insulin-sensitive tissues leading to macrosomia, characterized by shoulder and truncal obesity. This may result in a shoulder dystocia, birth injury or fetal asphyxia. Thus, antenatal prediction of a large fetus for gestational age (LGA) can provide important information for the prevention of obstetric and perinatal complications. However, the measurement of materrml blood glucose concentration has yielded a low sensitivity for the prediction of LGA infants. This study was performed to determine whether fetal ultrasound examination could establish the onset of accelerated fetal growth in women with gestational diabetes mellitus (GDM) and to find the ultrasound indices for prediction of LGA infant. METHODS: The study subjects consisted of 77 women with GDM who had a singleton, and 156 women with a negative screen for GDM matched for age, height, and weight. All subjects had an early ultrasound examination before 14 weeks, assuring accurate dating and did not have any other medical condition that might affect fetal growth. Two ultrasound measurements including biparietal diameter (BPD), abdominal circumference (AC) and femur length (FL) were performed at the 2nd trimester (24.7+2.7 vs. 24.1+2.4 wks, p>0.05) and the 3rd trimester (35.0+1.9 vs. 35.3+1.3 wks,p>0.05, respectively). RESULTS: Although gestational age at delivery of GDM group was earlier than the control group (39.0 +1.4 vs. 39.7+1.1, p<0.01), birth weight and frequency of LGA infant were similar between two groups (3204+439 vs. 3288+371 g, p>0.05; 27.3% vs. 20.5%, p>0.05, respectively). However, the LGA subgroup of GDM had a larger AC and longer FL at the 3rd trimester compared to the appropriate gestational age (AGA) subgroup and control group. The AC of LGA subgroup of GDM appeared to be accelerated at 33 weeks gestation compared to the control group. When the upper limit of 95% confidential interval of AC of the control group was used for a cutoff value for predicting LGA in GDM at the 3rd trimester, sensitivity and specificity was 71% and 78%, respectively. CONCLUSION: The prediction of LGA infant in women with GDM might be achieved by an ultrasound examination of fetal AC at the 3rd trimester, especially after 33 weeks gestation.

Can the Oral Glucose Tolerance Test (OGTT) done at Postpartum (PPT) 1 Wddk Substitute OGTT at PPT 6 Week OGTT at PPT 6 Week in Diagnosing Rersistent PPT Glucose Intolerance in the Patients with Gastrational Diagetes Melltus (GDM)?.: Yoo Lee Kim, Yong Wook Cho, Seok Won Park, Yun Kyung Cho, Hwa Young Lee, In Hyun Kim, Jong Gun Won, Hye Sun Jun, Ho Taek Lee, Seog Ki Lee, Sang Jong Lee; Korean Diabetes J. 2000;24(2):267-280. Published online January 1, 2001

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Abstract PDF: BACKGROUND
Although 75 g-OGTT at PPT 6 week is necessary to diagnose persistent PPT glucose intolerance (PPGI) in GDM patients, it 1s difficult to perform this test because many patients drop-out during the follow-up period. Thus we tested whether OGTT done at PPT 1 week can substitute OGTT at PPT 6 week in diagnosing PPGI in GDM patients. METHOD: In 370 GDM patients, 75 g-OGTT was performed at PPT 1 week and repeat OGTT was done in 196 patients at PPT 6 week. Results of OGTT were classified as normal glucose tolerance(NGT), impaired glucose tolerance(IGT), and diabetes mellitus (DM) according to National Diabetes Data Group(NDDG) criteria. Changes in glucose tolerance state between PPT 1 and 6 week were assessed, and the predictability of clinical characteristics for these changes were investigated by logistic regression analysis. RESULTS: Among 370 GDM patients who performed OGTT at PPT 1 week, 79.4% had NGT, 12.2% had IGT, and 8.4% had DM. 53% (196/370) of subjects repeated OGTT at PPT 6 week. In OGTT at PPT 6 week, 77.6% (152/196, 140/149 in NGT, 4/26 in IGT and 8/21 in DM) were in the same glucose tolerance state as at PPT 1 week. The glucose tolerance improved in 14.8% (29/196, 16/26 in IGT and 13/21 in DM) and deteriorated in 7,6% (15/196, 9/149 in NGT and 6/26 in IGT). 94%(140/149) of patients who had NGT at PPT 1 week had NGT at PPT b week and 48.9/o (23/47) of patients who had abnormal glucose tolerance at PPT 1 week had abnormal glucose tolerance at PPT 6 week. Mean fasting plasma glucose level on OGTT became lower at PPT 1 week than during pregnancy (4.6+/-0,8 vs 5.1+/-1.2mmol/L, p<0.05) and became higher at PPT 6 week than at PPT 1 week (5.4+/-1.1 vs 4.6+/-0.8 mmol/L, p<0.05). Mean plasma glucose level at 2 hour after glucose load was significantly lower at PPT 6 week than at PPT 1 week (7.2+/-2.7 vs 8.3+/-2.5 mmol/L). When the subjects were grouped into NGT, IGT, and DM according to glucose tolerance state at PPT 6 week, the NGT group already showed normal glucose tolerance at PPT 1 week. The IGT and DM group showed slightly lower glucose levels at PPT 1 week than during pregnancy but became high to the level during pregnancy at PPT 6 week. In the patients group showing deterioration in glucose tolerance state between PPT 1 and 6 week, prevalence of insulin treatment was higher (63.4% vs 9.4, 20.7%), the gestational age at diagnosis of GDM were lower (25.0+/-6.2 week vs 29.8+/-3.3, 29.9+/-4,8 waek), and prepregnant weight was higher (113.4+/-21.2% vs 102.5+/-12.4, 102.4+/-14.6%) than those in the patients groups showing no change and improvement in glucose tolerance state, Weight gain until diagnosis of GDM during pregnancy(5.7+/-4.4kg vs 9.4+/-3.4kg) and weight change between prepregnancy and PPT 5 week(-1,3+/-3.5kg vs 1.5+/-29kg) was smaller in the deterioration group than those in the no change group. Logistic regression analysis performed using improvement and deterioration of glucose tolerance state between PPT 1 and 6 week as an outcome of interest revealed that an earlier diagnosis of GDM and a smaller weight at PPT 6 week than prepregnant weight were independent predictors for deterioration of glucose tolerance between PPT 1 and 6 week. In conclusion, OGTT done at PPT 1 week can substitute OGTT at PPT 6 week in a large subgroup of GDM patients who has NGT at PPT 1 week without any risk factors for deterioration in glucose tolerance.

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