Early Postpartum Glucose Intolerance, Metabolic Syndrome and Gestational Diabetes Mellitus Determinants after Assisted Conception: A Prospective Cohort Study

Document Type : Original Article

Authors

1 Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran

2 Department of Regenerative Biomedicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran

3 Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran

4 Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Tehran, Iran

5 Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran

6 Department of Gynecology and Obstetrics, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran

7 Breast Disease Research Center (BDRC), Tehran University of Medical Sciences, Tehran, Iran

Abstract

Background: This study aimed to determine the prevalence of postpartum metabolic syndrome (MetS), glucose intolerance, and the determinants, 6-12 weeks postpartum in women with assisted reproduction technology conception
gestational diabetes mellitus diagnosis (ART-GDM) compared to women with spontaneous conception and GDM
diagnosis (SC-GDM).
Materials and Methods: In this prospective cohort study, two groups consisting of 62 ART-GDM and 64 SC-GDM
singleton pregnant women were followed 6-12 weeks after delivery for postpartum MetS. Fasting glucose, 75-g 2-h
OGTT, and lipid profile were assessed. Waist and hip circumference, and systolic and diastolic blood pressures (BP)
were measured at postpartum. Clinical, paraclinical, and obstetric data were recorded from registry offices. The prevalence of MetS and glucose intolerance were determined. Predictors of MetS and glucose intolerance were evaluated
by logistic regression.
Results: The prevalence of postpartum MetS was 20.8% in ART-GDM women and 10.9% in SC-GDM (P=0.123).
Mean postpartum BMI and systolic BP were significantly higher in the ART-GDM group (P=0.016 and P=0.027
respectively). Adverse pregnancy outcomes were significantly higher in the ART-GDM group. Postpartum glucose
intolerance prevalence did not vary significantly between the groups. Family history of diabetes was a predictive factor
for postpartum MetS and glucose intolerance 6-12 weeks after delivery.
Conclusion: Early postpartum MetS and glucose intolerance prevalence after assisted conception did not vary significantly; however, postpartum body mass index (BMI) and systolic BP were significantly higher in the ART-GDM group. Lifestyle modification programs and long-term health care of ART women with GDM diagnosis can be recommended. Further studies with larger sample size and longer follow-up are necessary to verify our findings.

Keywords

References

  1. American Diabetes Association. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes-2019. Diabetes Care. 2019; 42 Suppl 1: S13-S28.
  2. Nouhjah S, Shahbazian H, Shahbazian N, Jahanfar S, Jahanshahi A, Cheraghian B, et al. Early postpartum metabolic syndrome in women with or without gestational diabetes: results from life after gestational diabetes Ahvaz cohort study. Diabetes Metab Syndr. 2018; 12(3): 317-323.
  3. Anna V, van der Ploeg HP, Cheung NW, Huxley RR, Bauman AE. Sociodemographic correlates of the increasing trend in prevalence of gestational diabetes mellitus in a large population of women between 1995 and 2005. Diabetes Care. 2008; 31(12): 2288-2293.
  4. Barquiel B, Herranz L, Hillman N, Burgos MÁ, Pallardo LF. Prepregnancy body mass index and prenatal fasting glucose are effective predictors of early postpartum metabolic syndrome in Spanish mothers with gestational diabetes. Metab Syndr Relat Disord. 2014; 12(9): 457-463.
  5. Retnakaran R, Qi Y, Connelly PW, Sermer M, Zinman B, Hanley AJ. Glucose intolerance in pregnancy and postpartum risk of metabolic syndrome in young women. J Clin Endocrinol Metab. 2010; 95(2): 670-677.
  6. Malcolm J. Through the looking glass: gestational diabetes as a predictor of maternal and offspring long-term health. Diabetes Metab Res Rev. 2012; 28(4): 307-311.
  7. Baliutavičienė D, Buinauskienė JB, Petrenko V, Danytė E, Žalinkevičius R. Gestational diabetes, obesity, and metabolic syndrome diagnosed during pregnancy. Metab Syndr Relat Disord. 2012; 10(3): 214-217.
  8. Cho NH, Ahn CH, Moon JH, Kwak SH, Choi SH, Lim S, et al. Metabolic syndrome independently predicts future diabetes in women with a history of gestational diabetes mellitus. Medicine (Baltimore). 2016; 95(35): e4582.
  9. Lauenborg J, Mathiesen E, Hansen T, Glümer C, Jørgensen T,Borch-Johnsen K, et al. The prevalence of the metabolic syndrome in a danish population of women with previous gestational diabetes mellitus is three-fold higher than in the general population. J Clin Endocrinol Metab. 2005; 90(7): 4004-4010.
  10. Shin JA, Lee JH, Lim SY, Ha HS, Kwon HS, Park YM, et al. Metabolic syndrome as a predictor of type 2 diabetes, and its clinical interpretations and usefulness. J Diabetes Investig. 2013; 4(4): 334-343.
  11. Gunderson EP, Chiang V, Pletcher MJ, Jacobs DR, Quesenberry CP, Sidney S, et al. History of gestational diabetes mellitus and future risk of atherosclerosis in mid-life: the coronary artery risk development in young adults study. J Am Heart Assoc. 2014; 3(2): e000490.
  12. Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. Harmonizing the metabolic syndrome: a joint interim statement of the international diabetes federation task force on epidemiology and prevention; national heart, lung, and blood institute; american heart association; world heart federation; international atherosclerosis society; and international association for the study of obesity. Circulation. 2009; 120(16): 16405.
  13. Ashrafi M, Gosili R, Hosseini R, Arabipoor A, Ahmadi J, Chehrazi M. Risk of gestational diabetes mellitus in patients undergoing assisted reproductive techniques. Eur J Obstet Gynecol Reprod Biol. 2014; 176: 149-152.
  14. Kouhkan A, Khamseh ME, Pirjani R, Moini A, Arabipoor A, Maroufizadeh S, et al. Obstetric and perinatal outcomes of singleton pregnancies conceived via assisted reproductive technology complicated by gestational diabetes mellitus: a prospective cohort study. BMC Pregnancy Childbirth. 2018; 18(1): 495.
  15. Kouhkan A, Khamseh ME, Moini A, Pirjani R, Valojerdi AE, Arabipoor A, et al. Predictive factors of gestational diabetes in pregnancies following assisted reproductive technology: a nested case-control study. Arch Gynecol Obstet. 2018; 298(1): 199-206.
  16. Tobias DK, Chavarro JE, Williams MA, Buck Louis GM, Hu FB, Rich-Edwards J, et al. History of infertility and risk of gestational diabetes mellitus: a prospective analysis of 40,773 pregnancies. Am J Epidemiol. 2013; 178(8): 1219-1225.
  17. American Diabetes Association. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes-2018. Diabetes Care. 2018; 41(Suppl 1): S13-S27.
  18. Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005; 112(17): 2735-2752.
  19. Vilmi-Kerälä T, Palomäki O, Vainio M, Uotila J, Palomäki A. The risk of metabolic syndrome after gestational diabetes mellitus – a hospital-based cohort study. Diabetol Metab Syndr. 2015; 7: 43.
  20. Parikh RM, Mohan V. Changing definitions of metabolic syndrome. Indian J Endocrinol Metab. 2012; 16(1): 7-12.
  21. Xu Y, Shen S, Sun L, Yang H, Jin B, Cao X. Metabolic syndrome risk after gestational diabetes: a systematic review and metaanalysis. PLoS One. 2014; 9(1): e87863.
  22. Nouhjah S, Shahbazian H, Amoori N, Jahanfar S, Shahbazian N, Jahanshahi A, et al. Postpartum screening practices, progression to abnormal glucose tolerance and its related risk factors in Asian women with a known history of gestational diabetes: a systematic review and meta-analysis. Diabetes Metab Syndr. 2017; 11 Suppl 2: S703-S712.
  23. Retnakaran R, Qi Y, Sermer M, Connelly PW, Hanley AJ, Zinman B. Beta-cell function declines within the first year postpartum in women with recent glucose intolerance in pregnancy. Diabetes Care. 2010; 33(8): 1798-1804.
  24. Pallardo F, Herranz L, Garcia-Ingelmo T, Grande C, Martin- Vaquero P, Jañez M, et al. Early postpartum metabolic assessment in women with prior gestational diabetes. Diabetes Care. 1999; 22(7): 1053-1058.
  25. Kramer CK, Swaminathan B, Hanley AJ, Connelly PW, Sermer M, Zinman B, et al. Each degree of glucose intolerance in pregnancy predicts distinct trajectories of β-cell function, insulin sensitivity, and glycemia in the first 3 years postpartum. Diabetes Care. 2014; 37(12): 3262-3269.
  26. Inoue H, Ishikawa K, Takeda K, Kobayashi A, Kurita K, Kumagai J, et al. Postpartum risk of diabetes and predictive factors for glucose intolerance in East Asian women with gestational diabetes. Diabetes Res Clin Pract. 2018; 140: 1-8.
  27. Wahabi H, Fayed A, Tunkar SMS, Bakhsh H, Al-Hazmi AM, Esmaeil S, et al. Incidence and contributing factors of glucose intolerance in Saudi postpartum women: sub-group analysis from RAHMA study. PLoS One. 2019; 14(1): e0210024.
  28. Youngwanichsetha S, Phumdoung S. Factors related to prediabetes among postpartum Thai women with a history of gestational diabetes mellitus. Nurs Health Sci. 2013; 15(4): 449-453.
  29. Coetzee A, Mason D, Hall DR, Conradie M. Prevalence and predictive factors of early postpartum diabetes among women with gestational diabetes in a single-center cohort. Int J Gynaecol Obstet. 2018; 142(1): 54-60.
  30. Nouhjah S, Shahbazian H, Shahbazian N, Jahanshahi A, Jahanfar S, Cheraghian B. Incidence and contributing factors of persistent hyperglycemia at 6-12 weeks postpartum in iranian women with gestational diabetes: results from LAGA cohort study. J Diabetes Res. 2017; 2017: 9786436.
  31. Guo XY, Liu XM, Jin L, Wang TT, Ullah K, Sheng JZ, et al. Cardiovascular and metabolic profiles of offspring conceived by assisted reproductive technologies: a systematic review and metaanalysis. Fertil Steril. 2017; 107(3): 622-631.
  32. Catford SR, McLachlan RI, O'Bryan MK, Halliday JL. Longterm follow-up of ICSI-conceived offspring compared with spontaneously conceived offspring: a systematic review of health outcomes beyond the neonatal period. Andrology. 2018; 6(5): 635-653.
  33. Pontesilli M, Painter RC, Grooten IJ, van der Post JA, Mol BW, Vrijkotte TG, et al. Subfertility and assisted reproduction techniques are associated with poorer cardiometabolic profiles in childhood. Reprod Biomed Online. 2015; 30(3): 258-267.
  34. Vannuccini S, Clifton VL, Fraser IS, Taylor HS, Critchley H, Giudice LC, et al. Infertility and reproductive disorders: impact of hormonal and inflammatory mechanisms on pregnancy outcome. Hum Reprod Update. 2016; 22(1): 104-115.
  35. Chen M, Wu L, Zhao J, Wu F, Davies MJ, Wittert GA, et al. Altered glucose metabolism in mouse and humans conceived by IVF. Diabetes. 2014; 63(10): 3189-3198.
  36. Qin JB, Sheng XQ, Wu D, Gao SY, You YP, Yang TB, et al. Worldwide prevalence of adverse pregnancy outcomes among singleton pregnancies after in vitro fertilization/intracytoplasmic sperm injection: a systematic review and meta-analysis. Arch Gynecol Obstet. 2017; 295(2): 285-301.

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