A new study by researchers from Denmark, Australia, Hong Kong and the USA feeds in to an important debate on how to target our resources where the need is greatest without neglecting pregnant women at risk of complications from gestational diabetes.

The overall conclusion is that, if we combine continuous data on insulin secretion and insulin sensitivity with easily available details such as BMI, age, ethnicity, smoking and weight gain during pregnancy, that is the most accurate way of predicting complications, says postdoc Lene Ring Madsen MD, PhD, the first author of the study, which has just been published in Diabetologia.

Gestational diabetes can be due to either reduced insulin secretion or reduced insulin sensitivity in the mother, and studies in recent years have shown a greater risk of complications if diabetes is caused by reduced insulin sensitivity rather than reduced insulin secretion. These studies have led to consideration being given to dividing pregnant women with gestational diabetes into high complication risk and low complication risk categories to enable the pathway and treatment to be tailored to the individual woman.

‘Our work shows that we are not there yet. We need to know more before we can group pregnant women in such a categorical way’, says Lene Ring Madsen.

The study, which is based on data from 6,337 women and their babies, argues that reduced insulin sensitivity and reduced insulin secretion in pregnancy should be regarded to a greater extent as a continuum.

The study is based on data from Australia, the USA and Hong Kong, and the idea for it emerged during a PhD research visit to Brisbane in Queensland, Australia hosted by Danish Diabetes Academy visiting professor David McIntyre.

FACTS
Gestational diabetes is observed in approximately 3% of pregnant Danish women, but has an incidence of up to 20% in other parts of the world.

Gestational diabetes raises the risk to both mother and baby of complications during pregnancy such as oversized babies, increased risk of caesarean section, pre-eclampsia and premature birth.

CONTACT
Lene Ring Madsen PhD, staff specialist, postdoc
Hospital Unit West & Steno Diabetes Center Aarhus, Aarhus University Hospital

Mob. +45 2244 1924
leemas@rm.dk

The article: Do variations in insulin sensitivity and insulin secretion in pregnancy predict differences in obstetric and neonatal outcomes? was published in Diabetologia in January 2021.