Liang et al. Diabetol Metab Syndr (2021) 13:73 https://doi.org/10.1186/s13098-021-00694-9 Diabetology & Metabolic Syndrome RESEARCH Open Access Clinical characteristics, gestational weight gain and pregnancy outcomes in women with a history of gestational diabetes mellitus Xin Liang, Wei Zheng, Cheng Liu, Lirui Zhang, Li Zhang, Zhihong Tian and Guanghui Li* Abstract Background: Pregnant women with a history of gestational diabetes mellitus (GDM) are at high risk of GDM. It is unclear whether this population has pregnancy characteristics diferent from the general population. Whether these features afect the perinatal outcome has not yet been elucidated. Methods: A retrospective study was conducted, including baseline characteristics, laboratory data, gestational weight gain (GWG), and pregnancy outcomes of 441 pregnant women with prior GDM. Besides, 1637 women with- out a history of GDM treated in the same period were randomly selected as the control group. The above indicators of the two groups were compared. Multivariable logistic regression analysis was performed to investigate how GWG was associated with perinatal outcomes for previous GDM women. Results: Among women with GDM history, triglycerides (TG) and fasting plasma glucose (FPG) in the 1st trimester were higher than those without GDM history. GWG was lower in women with prior GDM relative to the control group at various pregnancy stages. However, women with GDM history had a higher risk of developing GDM (OR 3.25, 95% CI 2.26–4.68) and pregnancy-induced hypertension (OR 1.50, 95% CI 1.05–2.45). In women with previous GDM, excessive GWG before OGTT exhibited a positive correlation with pregnancy-induced hypertension (OR 1.47, 95% CI 1.05–3.32), while inadequate GWG was not a protective factor for GDM and pregnancy-induced hypertension. Conclusion: Women with prior GDM have glucose and lipid metabolism disorders in the 1st trimester. Limited reduction of GWG before oral glucose tolerance test (OGTT) was insufcient to ofset the adverse efects of glucose and lipid metabolism disorders in women with previous GDM. Relevant interventions may be required at early stage or even before pregnancy. Keywords: A history of gestational diabetes mellitus, Glucose and lipid profles, Gestational weight gain, Pregnancy outcomes Background long-term health of mothers and their ofspring [3]. Gestational diabetes mellitus (GDM) is a prevalent preg- In recent years, the incidence of GDM in CHINA has nancy metabolic disorder characterized by insulin resist- reached 17.5–18.9% [4]. Te promotion of “two-child” ance and impaired pancreatic β-cell function [1, 2]. It policy in China has recently signifcantly increased the can lead to adverse perinatal outcomes and infuence rates of high-risk pregnancy and adverse pregnancy out- comes [5, 6]. Particularly, the number of pregnant women *Correspondence: [email protected] with GDM history has increased, and previous studies Division of Endocrinology and Metabolism, Department of Obstetrics, suggest that GDM history is a risk factor for the recur- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, rence of GDM and type 2 diabetes [7, 8]. It was reported No 251, Yaojiayuan Road, Chaoyang District, Beijing 100026, China that women with prior GDM had a tenfold increased © The Author(s) 2021. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http:// creat iveco mmons. org/ licen ses/ by/4. 0/. The Creative Commons Public Domain Dedication waiver (http:// creat iveco mmons. org/ publi cdoma in/ zero/1. 0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Liang et al. Diabetol Metab Syndr (2021) 13:73 Page 2 of 8 risk for type 2 diabetes compared to those without GDM Study design history [9]. Tere was a higher likelihood of develop- All pregnant women with previous GDM underwent ing type 2 diabetes in women who were overweight or fasting plasma glucose (FPG) test at 6–8 weeks of gesta- obese before pregnancy with a history of GDM compared tion unless insulin or metformin treatment was initiated to their counterparts without a history of GDM [10]. earlier. FPG ≥ 7.0 mmol/L indicates pre-gestational dia- Women with GDM history are at high risk for recurrence betes mellitus. Tese women were managed according to of GDM and the development of type 2 diabetes, how- the standard of pre-pregnancy diabetes. Te rest of preg- ever, the general condition of their subsequent pregnancy nant women with prior GDM underwent a 75-g OGTT remains unclear. Most articles have focused on postpar- at 24–28 weeks of gestation, FPG ≥ 5.1 mmol/L, 1-h tum metabolic characteristics of women with GDM his- value ≥ 10.0 mmol/L, or 2-h value ≥ 8.5 mmol/L indicate tory, but less attention has been given to the diferences GDM. Height and weight were recorded without shoes between women with previous GDM and the general at the outpatient clinic or subject’s home. Pre-pregnancy pregnant women during a subsequent pregnancy. In this BMI was calculated as weight divided by height squared regard, our study attempted to elucidate diferent clinical (kg/m2) using self-reported pre-pregnancy weight. Each characteristics, glucose metabolism, lipid metabolism, subject in the study group received individualized coun- gestational weight gain (GWG) at various stages of preg- seling on diet, physical activity and weight control from nancy, and pregnancy outcomes of women with GDM trained study nurses and doctors in the frst visit (usu- history and those without GDM history. Meanwhile, ally from 8–12 weeks of gestation). A follow-up was we investigated GWG efect before oral glucose toler- performed every 2–4 weeks included formulating diet ance test (OGTT) on pregnancy outcomes of women prescription according to pre-pregnancy body mass with prior GDM, aiming to produce relevant informa- index (BMI) and physical activities. Te control group tion to guide proper management methods during preg- received standard antenatal care. We used the electronic nancy and reduce related adverse maternal and infant medical record system of hospital to collect patient-level outcomes. variables, such as standard demographic information (age, pre-pregnancy height and weight, GWG, number Materials and methods of prior pregnancies, parity, family history, previous his- Study subjects tory, history of pregnancy and childbirth and education We conducted a retrospective cohort study comprising level) and laboratory data (glucose and lipid metabo- pregnant women who established a medical record for lism indexes at various stages of pregnancy), as well as receiving healthcare and delivered singleton gestations relevant maternal and infant outcomes. Ten, the above at Beijing Obstetrics and Gynecology Hospital afliated indicators of the two groups were compared statistically. to Capital Medical University from January 1, 2017 until Meanwhile, in women with previous GDM, we discussed December 31, 2018. On the one hand, participants were the infuence of GDM history on the risk of GDM and included in the study if they; (i) were multipara; (ii) were pregnancy-induced hypertension (included gestational women who used to diagnosed with GDM after 2011. On hypertension and pre-eclampsia). We also investigated the other hand, subjects were excluded if they; (i) were the association between GDM, pregnancy-induced aged > 45 or < 18 years old; (ii) were females with multiple hypertension and GWG before OGTT in the study pregnancies; (iii) had pre-existing diabetes, hypertension, group. Maternal GWG before OGTT was used to group acute and chronic heart, liver, kidney disease, or other the subjects within or above the target as recommended serious diseases; (iv) exhibited fetal chromosomal abnor- by the Institute of Medicine (IOM). GWG below or malities or major birth defects and; (v) did not have com- above the recommended threshold was defned as inad- plete clinical data. According to the above criteria, 441 equate or excessive weight gains, respectively. Te risk of pregnant women with a history of GDM were included GDM and pregnancy-induced hypertension in diferent as the study group. At the same time, the mechanical subgroups was analyzed. sampling methods was used to sort every 40 pregnant women with no history of GDM as a list according to Laboratory test indicators and pregnancy outcome the medical record number. Te odd-numbered preg- Blood lipid levels were determined at various stages nant women were selected. Finally, 1637 women without of pregnancy using a full-automatic biochemical GDM history treated in the same period were randomly analyzer. Te analysis included quantifcation of tri- recruited as the control group. Te study received ethical glycerides (TG), total cholesterol (TC), high-density approval from the ethics committee of Beijing Obstetrics lipoprotein-cholesterol (HDL-C), and low-density lipo- and Gynecology Hospital afliated with Capital Medical protein-cholesterol (LDL-C) levels. Blood glucose lev- University(2018-KY-030-01). els were determined using the oxidase method during Liang et al. Diabetol Metab Syndr (2021) 13:73 Page 3 of 8 pregnancy. Gestational hypertension (GH) was defned Results as de novo hypertension if an individual exhibited a Women with previous GDM had a signifcantly higher systolic blood pressure ≥ 140 mmHg and, or diastolic maternal age (34.8 ± 3.5 vs.