ArticleFrontiers in endocrinology2026
Glycometabolic profiles and pregnancy outcomes across pathophysiological subtypes of gestational diabetes mellitus.
Article in Frontiers in endocrinology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Gestational diabetes mellitus (GDM) exhibits profound pathophysiological heterogeneity, but current management fails to account for subtype-specific differences in clinical features and pregnancy prognoses. This study aimed to characterize the glycometabolic profiles and pregnancy outcomes of GDM subtypes defined by insulin resistance and β-cell function, and provide a foundation for precision medicine in GDM. Methods: In this 1:1 case-control study, 330 singleton women with GDM and 330 healthy singleton controls were enrolled. Using control-derived quartiles of HOMA-IR and HOMA-β, GDM patients were classified into four subtypes: insulin resistance (GDM-IR), insulin secretory defect (GDM-IS), combined defect (GDM-M), and unclassified (GDM-N). Clinical characteristics, glycometabolic parameters, and pregnancy outcomes were compared across groups, and multivariate logistic regression identified independent risk factors for adverse pregnancy outcomes. Results: Subtype distribution was: GDM-IR 36.4% (120/330), GDM-IS 22.7% (75/330), GDM-M 17.9% (59/330), GDM-N 23.0% (76/330). GDM-M showed the most severe glycometabolic derangements: highest first-trimester fasting glucose, all OGTT glucose values, HbA1c, insulin use rate (18.6%, 11/59), and poor glycemic control rate (22.0%, 13/59). It also had the highest rates of cesarean delivery (72.9%, 43/59), postpartum hemorrhage (8.5%, 5/59), preterm birth (18.6%, 11/59), macrosomia (17.0%, 10/59), and neonatal hypoglycemia (11.9%, 7/59) (all P < 0.05). Multivariate regression identified age (OR = 1.067, 95% CI: 1.028-1.108), pre-pregnancy BMI (OR = 1.073, 95% CI: 1.014-1.136), GDM-IS (OR = 2.013, 95% CI: 1.134-3.574), GDM-M (OR = 8.417, 95% CI: 2.661-26.627), and GDM-N (OR = 1.831, 95% CI: 1.076-3.115) as independent risk factors for adverse pregnancy outcomes, with GDM-M conferring the highest risk. Conclusions: GDM subtypes defined by insulin resistance and β-cell function exhibit marked heterogeneity in glycometabolic profiles and pregnancy outcomes. The combined defect subtype (GDM-M) carries the highest risk of adverse maternal-neonatal events and may warrant the most intensive monitoring. These findings support pathophysiological subtyping for risk stratification, but causal inference is limited by the observational, single-center design; validation in multicenter, multi-ethnic prospective cohorts is required.
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