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| |  Risk Factors Identified For Diabetes During Pregnancy CHICAGO, IL. -- Women who are at risk for the most common form of diabetes are also at risk for developing diabetes during pregnancy, according to an article in tomorrow's issue of Caren G. Solomon, M.D., M.P.H., and colleagues from Brigham and Women's Hospital and Harvard Medical School in Boston studied 14,613 women who became pregnant between 1990 and 1994. None of the women had a history of gestational diabetes mellitus (GDM) before they enrolled in a larger study, the Nurses' Health Study II. The researchers found the risk for gestational diabetes increased with advancing age, history of diabetes in a first-degree relative such as a mother or father, non-white ethnicity, high body mass index (BMI) before pregnancy, weight gain in early adulthood and cigarette smoking. While previous studies have identified maternal age and BMI as risk factors for GDM, most have not assessed the effects of BMI independent of age. The effect of weight gain in the years before pregnancy on risk of GDM has also not been previously evaluated, according to the researchers. Non-insulin-dependent diabetes mellitus (NIDDM) is the most common form of diabetes. GDM affects three to five percent of all pregnant women. The researchers found that: --- women over the age of 40 have more than a two-fold increased risk (2.24) for GDM compared with women age 25 to 29 years. --- women with a family history of diabetes had more than one-and-a-half times the risk (1.68) for GDM, with the risk rising to nearly double (1.90) when it came from the mother and nearly triple (2.87) when it came from both parents. --- women who are African-American had 1.75 times the risk for GDM, while Hispanic women had 1.45 times the risk and Asian women had 2.32 times the risk for GDM when compared with white women. --- women who had a BMI of 25.0-29.9 kg/m2 or more prior to pregnancy had double the risk (2.13) for GDM, while the risk rose to nearly three times (2.90) for women with a BMI of 30 kg/m2 or more. BMI is the ratio of body fat to lean muscle mass expressed as weight in kilograms divided by height in meters squared (kg/m2). A BMI of 25.0 could represent a woman who is five-foot-six, weighing 154 pounds. A BMI of 30 could represent a woman who is five-foot-six weighing 186 pounds. --- the risk for GDM also increased significantly with a higher BMI at age 18 years and weight gain of as little as 5.0-9.9 kg (11-22 pounds) between age 18 years and pregnancy. --- current smoking also increased the risk for GDM by nearly one-and-a-half times (1.43). "These findings suggest the potential for interventions to reduce GDM risk in pregnancy, including [pre-pregnancy] counseling about weight gain, smoking and possibly exercise," the researchers write. "These data underscore the close link between GDM and NIDDM, as well as the need to identify and to address, where possible, modifiable risk factors for these disorders." In this study, 722 of the women, or 4.9 percent of the total, reported a new diagnosis of GDM. Among women who were considered to be at low risk for the condition -- white women under the age of 30, with no family history of diabetes and without the other risk factors of smoking, early adult weight gain or high BMI -- the researchers found a 2.9 percent rate of GDM. "Our observations of a nearly three percent incidence of GDM among those with no identifiable risk factors for this disorder ...provides further justification for universal screening as presently advocated," the researchers write.
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