Early predictors of gestational diabetes mellitus in IVF-conceived pregnancies

Objective Gestational diabetes mellitus (GDM) associates with adverse maternal and foetal outcomes. The aim of our study was to identify early and reliable GDM predictors, which will enable implementation of preventive and management measures. Methodology 28-week prospective cohort of IVF-conceived pregnant women (≤39years, BMI 18.5-38kg/m2) without known history of diabetes mellitus. Fasting blood samples were analysed at baseline (pre-IVF) and 12-week gestation for reproductive hormones, glucose, serum insulin, lipids, thyroid function, adiponectin and LBP. At 28 weeks, 75-gram OGTT was used to screen for GDM. Results For the pregnant group overall at baseline, 22% had a BMI≥30kg/m2, 45% with PCOS, 16% with HbA1c of 5.7–6.1% and 14% with a past history of GDM. At 28-week gestation (n=158): 34 women developed GDM and 124 did not. Significant baseline predictors of GDM onset included: greater BMI (29.0 vs. 25.8kg/m2), older age (34 vs. 32years) and higher levels of FSH/LH ratio (1.2 vs. 1.0), HbA1C (5.5 vs. 5.2%), insulin (10.6 vs. 7.1μIU/mL), HOMA-IR (2.2 vs. 1.7), T-Chol (199 vs. 171mg/dL) and LDL-C (123 vs. 105mg/dL), and lower TG levels (74 vs. 76mg/dL). Significant 12-week GDM predictors included: greater maternal weight gain (delta: 3.4 vs. 1.5kg) and higher levels of insulin (11.3 vs. 7.6μIU/mL), TG (178 vs. 120mg/dL) and HOMA-IR (2.3 vs. 1.5). 12-week BMI is a predictor of GDM following adjustment for PCOS status and maternal age. Conclusion While preconception maternal BMI, age and FSH/LH ratio are predictors for subsequent development of GDM, early IVF-conceived gestational weight gain predicted best GDM onset