Gestational diabetes (GDM) diagnosis may receive a makeover thanks to new research. According to a recent systemic review, triglycerides, insulin, and maternal weight have the potential to act as diagnostic biomarkers.
GDM treatment outcomes vary between patients. Even with proper treatment, some patients still experience pregnancy complications. This suggests that GDM subtypes exist. The authors sifted through several studies to pinpoint potential biomarkers for GDM subtypes. The systemic review included 137 studies and twenty-three of them underwent a post-hoc meta-analysis.
A common GDM concern is delivering newborns with macrosomia or LGA (large for gestational age). Macrosomia refers to infants weighing > 4,000 gm (8.82 lbs.) while LGA refers to infants weighing ≥ 90th percentile for gestational age. The meta-analysis calculated LGA/macrosomia risk by comparing normal-weight and obese/overweight GDM patients. Obese/overweight patients were 2-3 times more likely to deliver larger infants.
Most studies reviewed included lipid and insulin levels as non-glucose biomarkers. Prior studies have associated elevated triglycerides and insulin resistance with larger newborn weights. High LDL and low HDL cholesterol levels lack a similar impact on infant weight.
Fetal macrosomia leads to many maternal and neonatal risks. Higher fetal weights complicate vaginal deliveries. In some cases, deliveries need forceps, vacuums, or a C-section. Postpartum issues include low blood glucose, which is more common in larger newborns. Later in life, these children have an increased risk for obesity. These complications make proper GDM treatment vital for public health.
The authors noted they reviewed only observational studies due to strict inclusion/exclusion criteria. Observational studies yield lower quality evidence, which highlights the need for better research on this topic. Either way, the evidence surrounding triglycerides, insulin resistance, and maternal weight is intriguing.
Sources
- Francis EC, Powe CE, Lowe WL Jr, et al. Refining the diagnosis of gestational diabetes mellitus: a systematic review and meta-analysis. Commun Med (Lond). December 18, 2023;3(1):185. doi: 10.1038/s43856-023-00393-8.
- Mayo Clinic Staff. Fetal macrosomia: symptoms and causes. Mayo Clinic. Updated June 3, 2022. Accessed January 4, 2023. https://www.mayoclinic.org/diseases-conditions/fetal-macrosomia/symptoms-causes/syc-20372579
- Hong YH, Lee JE. Large for Gestational Age and Obesity-Related Comorbidities. J Obes Metab Syndr. 2021 Jun 30;30(2):124-131. doi: 10.7570/jomes20130.
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