Risk Assesssment for Gestational Diabetes Mellitus at Early Gestation by Use of Risk Prediction Models and Glucometabolic Parameters with Particular Focus on Recurrence and Heterogeneity
Gestational diabetes mellitus (GDM) is a growing problem in today’s world with its increasing prevalence and potential short- and long-term complications for mother and child. GDM is diagnosed during the late second to early third trimester through an oral glucose tolerance test (OGTT). However, risk stratification at early pregnancy could be beneficial to reduce GDM associated comorbidities by allowing for timely lifestyle interventions. For this purpose, several early risk prediction models for GDM have been developed over the last decade, their clinical benefit when applied to the recent diagnostic criteria is not well investigated yet. Furthermore, recent studies have suggested that the diagnosis of GDM possibly comprises different metabolic entities with diverse pathophysiological mechanisms, but a clear understanding as how to differentiate potential subtypes of GDM in the clinical setting is lacking. One practical approach could be to classify GDM entities according to the presence of fasting and/or post-load hyperglycemia in the diagnostic oral glucose tolerance test. Yet, this concept is less well established in pregnancy and their specific characteristics and risk factors at early gestation are not investigated until now. Lastly, women with a history of gestational diabetes mellitus are predisposed to develop hyperglycemia in a subsequent pregnancy. Subtle defects in glucose metabolism can persist even after pregnancy and be unmasked in a subsequent pregnancy, leading to a recurrence of GDM. The characterization of glucose metabolism at the beginning of a subsequent pregnancy could be of clinical importance in order to identify subgroups at high risk for recurrence of GDM.
The primary objective of this project is to assess the performance of published early risk prediction models for the later development of GDM as defined by the recent WHO recommendations.
The second objective of this project is to assess early pregnancy characteristics of GDM entities classified according to the presence of fasting and/or post-load hyperglycemia during the diagnostic OGTT.
The third objective of this project is to assess metabolic characteristics including laboratory parameters and indices of glucose metabolism at the beginning of a subsequent pregnancy of women with a history of GDM.
Methods and Skills:
Kotzaeridi G, Blätter J, Eppel D, Rosicky I, Linder T, Geissler F, Huhn EA, Hösli I, Tura A, Göbl CS. Characteristics of gestational diabetes subtypes classified by oral glucose tolerance test values. Eur J Clin Invest 51: e13628, 2021
Kotzaeridi G, Blätter J, Eppel D, Rosicky I, Mittlböck M, Yerlikaya-Schatten G, Schatten C, Husslein P, Eppel W, Huhn EA, Tura A, Göbl CS. Performance of early risk assessment tools to predict the later development of gestational diabetes. Eur J Clin Invest Jun 18: e13630, 2021 (online ahead of print)