EB Research: Gestational Diabetes Mellitus (GDM) - Epidemiology, Etiology, and Health Consequences

Gestational diabetes mellitus (GDM), one of the most common complications of pregnancy, is related to substantial short-term and long-term adverse health outcomes for both women and their offspring. Understanding the epidemiology and etiology of GDM is critical for the development of effective and targeted intervention strategies to prevent GDM and to interrupt the vicious cycle across generations involving maternal GDM, childhood obesity and impaired glucose metabolism, and adulthood onset diabetes. Along this line of research, a series of studies have been conducted and are under study. These include:

  • Identification of risk factors, for instance, diet and lifestyle factors, reproductive factors, early life risk factors, and genetic factors, for the development of GDM and its recurrence. In collaboration with investigators at the Harvard School of Public Health and other institutes, a number of novel risk factors have been identified and additional risk factors are currently under study based on data from the Nurses' Health Study II and the Consortium on Safe Labor.
  • Investigation of the pathogenesis of GDM using prospectively and longitudinally collected biospecimens from pregnancy cohorts, such as the NICHD Fetal Growth Study. Currently, this line of research focuses on a comprehensive panel of biochemical markers that are putatively implicated in glucose homeostasis, fetal growth, or both. Targeted and non-targeted metabolomics are being analyzed for the discovery of new pathways and/or biochemical markers related to glucose intolerance and subsequent adverse fetal outcomes.
  • Investigation of the impact and underlying mechanisms of how a hyperglycemic intrauterine environment affects short-term and long-term health outcomes in the offspring based on multiple datasets, for instance, the Consortium on Safe Labor.

Principal Investigator

Zhen Chen, Ph.D.

Division Collaborator

Aiyi Liu, Ph.D.

Publications

  • Bowers K, Tobias DK, Yeung E, Hu FB, Zhang C. A prospective study of prepregnancy dietary fat intake and risk for gestational diabetes. The American Journal of Clinical Nutrition. 2012; 95(2):446-453. PMID: 22218158. PMCID: PMC3260071
  • Chen L, Hu FB, Yeung E, Tobias DK, Willett WC, Zhang C. Prepregnancy consumption of fruits and fruit juices and the risk of gestational diabetes mellitus: A prospective cohort study. Diabetes Care. 2012; 35(5):1079-1082. PMID: 22446174. PMCID: PMC3329813 
  • Tobias DK, Zhang C, Chavarro J, Bowers K, Rich-Edwards J, Rosner B, Mozaffarian D, Hu FB. Prepregnancy adherence to dietary patterns and lower risk of gestational diabetes mellitus. The American Journal of Clinical Nutrition. 2012; 96(2):289-295. PMID: 22760563. PMCID: PMC3396443
  • Bao W, Bowers K, Tobias DK, Hu FB, Zhang C. Prepregnancy dietary protein intake, major dietary protein sources, and the risk of gestational diabetes mellitus: A prospective cohort study. Diabetes Care. 2013; 36(7):2001-2008. PMID: 23378620. PMCID: PMC3687314
  • Bowers K, Laughon SK, Kiely M, Brite J, Chen Z, Zhang C. Gestational diabetes, pre-pregnancy obesity and pregnancy weight gain in relation to excess fetal growth: Variations by race/ethnicity. Diabetologia. 2013; 56(6):1263-1271. PMID: 23571827
  • Bowers K, Laughon SK, Kim S, Mumford SL, Brite J, Kiely M, Zhang C. The association between a medical history of depression and gestational diabetes in a large multi-ethnic cohort of the United States. Paediatric and Perinatal Epidemiology. 2013; 27(4):323-328. PMID: 23772933. PMCID: PMC4123954
  • Zhang C, Bao W, Rong Y, Yang H, Bowers K, Yeung E, Kiely M. Genetic variants and the risk of gestational diabetes mellitus: A systematic review. Human Reproduction Update. 2013; 19(4):376-390. PMID: 23690305. PMCID: PMC3682671
  • Tobias DK, Chavarro JE, Williams MA, Buck Louis GM, Hu FB, Rich-Edwards J, Missmer SA, Zhang C. History of infertility and risk of gestational diabetes mellitus: A prospective analysis of 40,773 pregnancies. American Journal of Epidemiology. 2013; 178(8):1219-1225. PMID: 23956097. PMCID: PMC3792729
  • Bao W, Bowers K, Tobias DK, Olsen SF, Chavarro J, Vaag A, Kiely M, Zhang C. Prepregnancy low-carbohydrate dietary pattern and risk of gestational diabetes mellitus: A prospective cohort study. The American Journal of Clinical Nutrition. 2014; 99(6):1378-1384. PMID: 24717341. PMCID: PMC4021782
  • Bao W, Tobias DK, Olsen SF, Zhang C. Pre-pregnancy fried food consumption and the risk of gestational diabetes mellitus: a prospective cohort study. Diabetologia. 2014; 57(12):2485-2491. PMID: 25303998. PMCID: PMC4221538
  • Hao C, Zhang C, Chen W, Shi Z. Prevalence and risk factors of diabetes and impaired fasting glucose among university applicants in Eastern China: Findings from a population-based study. Diabetic Medicine. 2014; 31(10):1194-1198. PMID: 24766092. PMCID: PMC4167969
  • Zhang C, Tobias DK, Chavarro JE, Bao W, Wang D, Ley SH, Hu FB. Adherence to healthy lifestyle and risk of gestational diabetes: prospective cohort study. BMJ. 2014; 349:g5450. PMID: 25269649. PMCID: PMC4180295
  • Mason SM, Tobias DK, Clark CJ, Zhang C, Hu FB, Rich-Edwards JW. Abuse in childhood or adolescence and gestational diabetes: A retrospective cohort study. American Journal of Preventive Medicine. 2015; 50(4):436-444. PMID: 26547539. PMCID: PMC4801767
  • Zhang C, Sundaram R, Maisog J, Calafat AM, Barr DB, Buck Louis GM. A prospective study of prepregnancy serum concentrations of perfluorochemicals and the risk of gestational diabetes. Fertility and Sterility. 2015; 103(1):184-189. PMID: 25450302. PMCID: PMC4282598
  • Bao W, Li S, Chavarro JE, Tobias DK, Bowers K, Li S, Hu FB, Zhang C. Long-term risk of type 2 diabetes in relation to habitual iron intake in women with a history of gestational diabetes: a prospective cohort study. The American Journal of Clinical Nutrition. 2016; 103(2):375-381. PMID: 26762369. PMCID: PMC4733253
  • Bao W, Li S, Chavarro JE, Tobias DK, Zhu Y, Hu FB, Zhang C. Low carbohydrate-diet scores and long-term risk of type 2 diabetes among women with a history of gestational diabetes mellitus: a prospective cohort study. Diabetes Care. 2016; 39(1):43-49. PMID: 26577416. PMCID: PMC4686844
  • Bao W, Michels KB, Tobias DK, Li S, Chavarro JE, Gaskins AJ, Vaag AA, Hu FB, Zhang C. Parental smoking during pregnancy and the risk of gestational diabetes in the daughter. International Journal of Epidemiology. 2016; 45(1):160-169. PMID: 26748845. PMCID: PMC4881834
  • Bao W, Tobias DK, Hu FB, Chavarro JE, Zhang C. Pre-pregnancy potato consumption and risk of gestational diabetes mellitus: prospective cohort study. BMJ. 2016; 352:h6898. PMID: 26759275. PMCID: PMC5115165
  • Chen L, Li S, He C, Zhu Y, Buck Louis GM, Yeung E, Hu FB, Zhang C. Age at menarche and risk of gestational diabetes mellitus: A prospective cohort study among 27,482 women. Diabetes Care. 2016; 39(3):469-471. PMID: 26813668. PMCID: PMCID4764040
  • Hinkle SN, Buck Louis GM, Rawal S, Zhu Y, Albert PS, Zhang C. A longitudinal study of depression and gestational diabetes in pregnancy and the postpartum period. Diabetologia. 2016; 59(12):2594-2602. PMID: 27640810. PMCID: PMC5101167  
  • Rawal S, Hinkle SN, Zhu Y, Albert PS, Zhang C. A longitudinal study of sleep duration in pregnancy and subsequent risk of gestational diabetes: Findings from a prospective, multiracial cohort. American Journal of Obstetrics and Gynecology. 2016; 216(4):399.e1-399.e8. PMID: 27939328
  • Jaacks LM, Barr DB, Sundaram R, Maisog JM, Zhang C, Buck Louis GM. Pre-pregnancy maternal exposure to polybrominated and polychlorinated biphenyls and gestational diabetes: A prospective cohort study. Environmental Health. 2016; 15:11. PMID: 26792546. PMCID: PMC4721055
  • Zhang C, Rawal S, Chong YS. Risk factors for gestational diabetes: Is prevention possible? Diabetologia. 2016; 59(7):1385-1390. PMID: 27165093
  • Zhu Y, Mendola P, Albert PS, Bao W, Hinkle SN, Tsai MY, Zhang C. Insulin-like growth factor axis and gestational diabetes mellitus: A longitudinal study in a multiracial cohort. Diabetes. 2016; 65(11):3495-3504. PMID: 27468747. PMCID: PMC5079637
  • Bowers KA, Olsen SF, Bao W, Halldorsson TI, Strom M, Zhang C. Plasma concentrations of ferritin in early pregnancy are associated with risk of gestational diabetes mellitus in women in the Danish national birth cohort. The Journal of Nutrition. 2016; 146(9):1756-1761. PMID: 27511926. PMCID: PMC4997275
  • Rawal S, Hinkle SN, Bao W, Zhu Y, Grewal J, Albert PS, Weir NL, Tsai MY, Zhang C. A longitudinal study of iron status during pregnancy and the risk of gestational diabetes: Findings from a prospective, multiracial cohort. Diabetologia. 2017; 60(2):249-257. PMID: 27830277. PMCID: PMC6331052.
  • Li S, Zhu Y, Yeung E, Chavarro JE, Yuan C, Field AE, Missmer SA, Mills JL, Hu FB, Zhang C. Offspring risk of obesity in childhood, adolescence and adulthood in relation to gestational diabetes mellitus: A sex-specific association. International Journal of Epidemiology. 2017; 46(5):1533-1541. PMID: 29024955. PMCID: PMC5837775
  • Zhang C, Rawal S. Dietary iron intake, iron status, and gestational diabetes. The American Journal of Clinical Nutrition. 2017; 106(Suppl 6):1672S-1680S. PMID: 29070554. PMCID: PMC5701716
  • Hinkle SN, Rawal S, Zhu Y, Grewal J, Albert PS, Zhang C. Validation of self-reported diagnosis of gestational diabetes at 6-weeks postpartum. Epidemiology. 2017; 28(5):747-752. PMID: 28570385. PMCID: PMC5538910
  • Zhu Y, Tsai MY, Sun Q, Hinkle SN, Rawal S, Mendola P, Ferrara A, Albert PS, Zhang C. A prospective and longitudinal study of plasma phospholipid saturated fatty acid profile in relation to cardiometabolic biomarkers and the risk of gestational diabetes. American Journal of Clinical Nutrition. 2018; 107 (6): 1017-1026. PMID: 29868913. PMCID: PMC6248709
  • Rawal S, Tsai MY, Hinkle SN, Zhu Y, Bao W, Lin Y, Panuganti P, Albert PS, Ma RCW, Zhang C. A longitudinal study of thyroid markers across pregnancy and risk of gestational diabetes. Journal of Clinical Endocrinology and Metabolism. 2018 Jul 1;103(7):2447-2456. PMID: 29889229. PMCID: PMC6276672
  • Hinkle SN, Tsai MY, Rawal S, Albert PS, Zhang C. HbA1c measured in the first trimester of pregnancy and the association with gestational diabetes. Scientific Reports. 2018 Aug 16;8(1):12249. PMID: 30116010. PMCID: PMC6095876
  • Hinkle SN, Rawal S, Liu D, Chen J, Tsai MY, Zhang C. Maternal adipokines longitudinally measured across pregnancy and their associations with neonatal size, length, and adiposity. International Journal of Obesity. 2018 Nov 21. [Epub ahead of print]. PMID: 30464233
  • Francis EF, Hinkle SN, Song Y, Rawal S, Donnelly SR, Zhu Y, Chen L, Zhang C. Longitudinal maternal vitamin D status during pregnancy is associated with neonatal anthropometric measures. Nutrients. 2018 Nov 2;10(11). pii: E1631. PMID: 30400155. PMCID: PMC6265933
  • Li M, Li SS, Chavarro JE, Gaskins AJ, Ley SH, Hinkle SN, Wang XB, Ding M, Bell G, Bjerregaard AA, Olsen SF, Mills JL, Hu FB, Zhang C. Pre-pregnancy habitual intakes of total, supplemental, and food folate and risk of gestational diabetes: A prospective cohort study. Diabetes Care. 2019; 42(6):1034-41. PMID: 31010874. PMCID: PMC6609948 
  • McIntyre HD, Catalano P, Zhang C, Desoye G, Mathiesen ER, Damm P. Gestational diabetes mellitus. Nature Reviews Disease Primers. 2019;5(1):47. PMID: 31296866
  • Rahman ML, Zhang C, Smarr MM, Lee S, Honda M, Kannan K, Tekola-Ayele F, Louis GMB. Persistent organic pollutants and gestational diabetes: A multi-center prospective cohort study of healthy US women. Environment International. 2019;124:249-58. PMID: 30660025
  • Williams AD, Grantz KL, Zhang C, Nobles C, Sherman S, Mendola P. Ambient volatile organic compounds and racial/ethnic disparities in gestational diabetes mellitus: Are Asian/Pacific Islander women at greater risk? American Journal of Epidemiology. 2019;188(2):389-97. PMID: 30452528 PMCID: PMC6357797
  • Lin Y, Zhu Y, Wu J, Hinkle SN, Rawal S, Han J, Weir NL, Tsai MY, Zhang C. A prospective study of leukocyte telomere length and risk of gestational diabetes in a multiracial cohort. Epidemiology. 2019;30 Suppl 2:S10-S6. PMID: 31569148
  • Xia J, Song YQ, Rawal S, Wu J, Hinkle SN, Tsai MY, Zhang C. Vitamin D status during pregnancy and the risk of gestational diabetes mellitus: A longitudinal study in a multiracial cohort. Diabetes, Obesity, and Metabolism. 2019;21(8):1895-905. PMID: 30993847 PMCID: PMC6701861
  • Zhu YY, Li M, Rahman ML, Hinkle SN, Wu J, Weir NL, Lin Y, Yang HX, Tsai MY, Ferrara A, Zhang C. Plasma phospholipid n-3 and n-6 polyunsaturated fatty acids in relation to cardiometabolic markers and gestational diabetes: A longitudinal study within the prospective NICHD Fetal Growth Studies. PLoS Medicine. 2019;16(9):e1002910. PMID: 31518348 PMCID: PMC6743768
  • Li M, Song Y, Rawal S, Hinkle SN, Zhu Y, Tekola-Ayele F, Ferrara A, Tsai MY, Zhang C. Plasma prolactin and progesterone levels and the risk of gestational diabetes: A prospective and longitudinal study in a multiracial cohort. Frontiers in Endocrinology. 2020;11:83. PMID: 32180760 PMCID: PMC7058109
  • Li M, Rawal S, Hinkle SN, Zhu Y, Tekola-Ayele F, Tsai MY, Liu S, Zhang C. Sex hormone-binding globulin, cardiometabolic biomarkers, and gestational diabetes. Journal of Maternal-Fetal Medicine. Accepted.
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