The pre-pregnancy fasting blood glucose, glycated hemoglobin and lipid profiles as blood biomarkers for gestational diabetes mellitus: evidence from a multigenerational cohort study

Figures & data

Figure 1. Flowchart demonstrates the study exposures, outcome and the number (%) of G1, G2 and G3 retained in MUSP study at each phase (age) of data collection [29].

Table 1. Generation 2 participants’ characteristics at 30-year follow-up by GDM at 34-year follow-up.

	34-year follow-up
Participants’ characteristics at 30-year follow-up	GDM	Non- GDM	p-value
	N(%)	N(%)
Age^Table Footnotea (years)/mean ± SD	30.2(1.2)	30.1(1.0)	.49
Marital status
Single	2.0(5.41)	48(10.21)	.3*
Married	29(78.38)	293(62.34)
Living together	4.0(10.81)	100(21.28)
Sep-Div-Wid	2.0(5.41)	29(6.17)
Gross family income (per year)
$0–$50k	10(27.03)	93(19.83)	.3
$50k+	27(72.97)	376(80.17)
Smoking status
Nonsmoker	31(83.78)	390(82.45)	.84
Smoker	6.0(16.22)	83(17.55)
Alcohol consumption
Abstainer	10(27.03)	51(10.78)
Light-moderate drinker	9.0(24.32)	98(20.72)	.02
Moderate-heavy drinker	12(32.43)	223(47.15)
Heavy drinker	6.0(16.22)	101(21.35)
IPAQ categorical
Low	2.0(7.41)	26(7.2)	.4*
Moderate	7.0(25.93)	142(39.34)
High	18(66.67)	193(53.46)
BMI (kg/m^2)/Self-reported
Normal	9.0(25.71)	232(50.11)	<.001
Overweight	6.0(17.14)	131(28.29)
Obese	20(57.14)	100(21.60)
BMI (kg/m^2)/Measured
Normal	7.0(26.92)	187(47.70)	.006
Overweight	6.0(23.08)	117(29.85)
Obese	13(50.00)	88(22.45)

p-value indicates the level of significant. We used x² test for the exposure variables. BMI: body mass index; GDM: gestational diabetes mellitus; N: the total number; SD: standard deviation.

^aF-test used.

*Fisher’s exact test was used.

Table 2. Generation 2 participants’ pre-pregnancy blood biomarkers (continuous variables) level in GDM-group and non-GDM group.

	34-year follow-up
Blood biomarkers at 30-year follow-up	GDM	Non-GDM	p-value
	Mean ± SD)	Mean ± SD
FBG (mmol/L) (n = 525)	4.6 ± 0.5	4.4 ± 0.5	<.001*
HbA1c (%) (n = 430)	5.3 ± 0.4	5.2 ± 0.3	.13
Insulin (mIU/L) (n = 518)	13.0 ± 11.5	8.3 ± 6.3	<.001*
HOMA-IR (n = 518)	2.8 ± 2.9	1.7 ± 1.8	<.001*
HDL (mmol/L) (n = 519)	1.3 ± 0.3	1.5 ± 0.4	.007*
LDL (mmol/L) (n = 517)	2.9 ± 1.3	2.7 ± 0.8	.14
Total cholesterol: HDL ratio (n = 518)	3.9 ± 1.2	3.3 ± 1.0	.001

* p-value indicates the level of significant. We used F-test for the exposure variables. SD: standard deviation; GDM: gestational diabetes mellitus; FBG: fasting blood glucose; HbA1c: hemoglobin A1c; HOMA-IR: Homeostatic Model Assessment of Insulin Resistance score; HDL: high-density lipoproteins; LDL: low-density lipoproteins; n: the total number.

Table 3. Associations between pre-pregnancy blood biomarkers (continuous variables) and GDM.

	Unadjusted odds ratio	Adjusted odds ratio*
	(95% CI)	(95% CI)
FBG (mmol/L)	2.2(1.3–3.8)	2.1(1.1–3.9)
HbA1c (%)	2.5(0.9–7.0)	2.2(0.7–7.5)
Insulin (mIU/L)	1.1(1.0–1.2)	1.1(1.0–1.2)
HOMA-IR	1.2(1.0–1.3)
HDL (mmol/L)	0.2(0.1–0.7)	0.4(0.1–0.9)
LDL (mmol/L)	1.3(0.9–1.8)	1.2(1.0–1.8)
Total cholesterol: HDL ratio	1.5(1.2–2.0)	1.3(1.0–1.8)

* Variables included in the adjusted model: age, marital status, family income, smoking, alcohol, physical activity, BMI (self-reported) at 30-year follow-up. CI: confidence interval; FBG: fasting blood glucose; HbA1c: hemoglobin A1c; HOMA-IR: Homeostatic Model Assessment of Insulin Resistance; LDL: low-density lipoproteins; HDL: high-density lipoproteins.

Table 4. Generation 2 participants’ pre-pregnancy blood biomarkers level (categorical variables) in GDM-group and non-GDM group.

	34-year follow-up
	GDM	Non-GDM
Blood biomarkers at 30-year follow-up	N(%)	N(%)	p-value
FBG (mmol/L) (n = 524)
Normal <5.6	35(89.7)	478(98.6)
Pre-diabetes 5.6–6.9	4(10.3)	7(1.4)	.006*
HbA1c (%) (n = 428)
Normal <5.7%	26(86.7)	355(89.2)
Pre-diabetes 5.7–6.4%	4(13.3)	43(10.8)	.56*
Insulin (mIU/L) (n = 518)
Normal ≤10	21(53.9)	380(79.3)	<.001
Insulin resistance >10	18(46.1)	99(20.7)
HOMA-IR (n = 518)
≤2	16(41.0)	372(77.7)	<.001
>2	23(59.0)	107(22.3)
HDL (mmol/L) (n = 519)
≤1.0	6(15.8)	54(11.2)	.4
>1.0	32(84.2)	427(88.8)
LDL (mmol/L) (n = 517)
<2	7(18.9)	88(18.3)	.9
≥2	30(81.1)	392(81.7)
Total cholesterol: HDL ratio (n = 518)
<5.5	34(89.5)	463(96.5)	.06*
≥5.5	4(10.5)	17(3.5)

p-value indicates the level of significant. We used x² test for the exposure variables. SD: standard deviation; GDM: gestational diabetes mellitus; FBG: fasting blood glucose; HbA1c: hemoglobin A1c; HOMA-IR: Homeostatic Model Assessment of Insulin Resistance score; HDL: high-density lipoproteins; LDL: low-density lipoproteins; n: the total number.

* Fisher’s exact test was used.

Table 5. Associations between pre-pregnancy blood biomarkers (categorical variables) and GDM.

	Unadjusted odds ratio	Adjusted odds ratio*
	(95% CI)	(95% CI)
FBG (mmol/L)
Normal <5.6	1.00	1.00
Pre-diabetes 5.6–6.9	7.8(2.2–28.0)	6.4(2.0–36.6)
HbA1c (%)
Normal <5.7%	1.00	1.00
Pre-diabetes 5.7–6.4%	1.9(0.5–6.9)	1.2(0.2–6.2)
Insulin (mIU/L)
Normal ≤10	1.00	1.00
Insulin resistance >10	3.3(1.7–6.4)	1.4(1.1–3.4)
HOMA-IR
≤2	1.00	1.00
>2	5.0(2.6–9.9)	3.0(1.2–7.3)
HDL (mmol/L)
≤1.0	1.00	1.00
>1.0	0.7(0.3–1.7)	1.2(1.0–3.3)
LDL (mmol/L)
<2	1.00	1.00
≥2	1.0(0.4–2.3)	0.9(0.3–1.0)
Total cholesterol: HDL ratio
<5.5	1.00	1.00
≥5.5	3.1(1.0–9.8)	1.5(1.1–5.6)

*Variables included in the adjusted model: age, marital status, family income, smoking, alcohol, physical activity, BMI (self-reported) at 30-year follow-up. CI: confidence interval; FBG: fasting blood glucose; HbA1c: hemoglobin A1c; HOMA-IR: Homeostatic Model Assessment of Insulin Resistance; LDL: low-density lipoproteins; HDL: high-density lipoproteins.

Najman J, Alati R, Bor W, et al. Cohort profile update: the Mater-University of Queensland study of pregnancy (MUSP). Int J Epidemiol. 2015;44(1):78.

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