Gestational Diabetes Mellitus Subtypes Classified by Oral Glucose Tolerance Test and Maternal and Perinatal Outcomes: Results of a Mexican Multicenter Prospective Cohort Study “Cuido Mi Embarazo”
Janinne Ortega-Montiel, Luis Alberto Martínez‐Juárez, Alejandra Montoya, Linda Morales‐Juárez, Héctor Gallardo‐Rincón, Victoria Galicia-Hernández, Rodrigo García-Cerde, María Jesús Ríos-Blancas, Diego-Abelardo Álvarez-Hernández, Julieta Lomelín‐Gascón, Gisela Martínez-Silva, Lucía Marcela Illescas-Correa, Daniel Diaz Martinez, Francisco Magos Vázquez, Edwin Vargas Ávila, MA. CONCEPCIÓN CARMONA-RAMOS, Ricardo Mújica‐Rosales, Enrique Reyes-Muñoz, Roberto Tapia‐Conyer
Abstract
Purpose: This study explores the impact of gestational diabetes mellitus (GDM) subtypes classified by oral glucose tolerance test (OGTT) values on maternal and perinatal outcomes. Patients and Methods: This multicenter prospective cohort study (May 2019–December 2022) included participants from the Mexican multicenter cohort study Cuido mi Embarazo (CME). Women were classified into four groups per 75-g 2-h OGTT: 1) normal glucose tolerance (normal OGTT), 2) GDM-Sensitivity (isolated abnormal fasting or abnormal fasting in combination with 1-h or 2-h abnormal results), 3) GDM-Secretion (isolated abnormal values at 1-h or 2-h or their combination), and 4) GDM-Mixed (three abnormal values). Cesarean delivery, neonates large for gestational age (LGA), and pre-term birth rates were among the outcomes compared. Between-group comparisons were analyzed using either the t -test, chi-square test, or Fisher’s exact test. Results: Of 2,056 Mexican pregnant women in the CME cohort, 294 (14.3%) had GDM; 53.7%, 34.4%, and 11.9% were classified as GDM-Sensitivity, GDM-Secretion, and GDM-Mixed subtypes, respectively. Women with GDM were older (p = 0.0001) and more often multiparous (p = 0.119) vs without GDM. Cesarean delivery (63.3%; p = 0.02) and neonate LGA (10.7%; p = 0.078) were higher in the GDM-Mixed group than the overall GDM group (55.6% and 8.4%, respectively). Pre-term birth was more common in the GDM-Sensitivity group than in the overall GDM group (10.2% vs 8.5%, respectively; p=0.022). At 6 months postpartum, prediabetes was more frequent in the GDM-Sensitivity group than in the overall GDM group (31.6% vs 25.5%). Type 2 diabetes was more common in the GDM-Mixed group than in the overall GDM group (10.0% vs 3.3%). Conclusion: GDM subtypes effectively stratified maternal and perinatal risks. GDM-Mixed subtype increased the risk of cesarean delivery, LGA, and type 2 diabetes postpartum. GDM subtypes may help personalize clinical interventions and optimize maternal and perinatal outcomes. Keywords: Gestational Diabetes, GDM-Mixed, GDM-Secretion, GDM-Sensitivity, macrosomia, cesarean delivery, pre-term delivery