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EB Research - Perinatal Epidemiology

Gestational Diabetes Mellitus - 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 Diabetes & Women's Health Study and the Consortium on Safe Labor.

Principal Investigator

Cuilin Zhang, M.D., M.P.H., Ph.D.

DIPHR Collaborators

Publications

  • Bowers K, Tobias DK, Yeung E, Hu FB, Zhang C. A prospective study of prepregnancy dietary fat intake and risk for gestational diabetes. Am J Clin Nutr. 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. Am J Clin Nutr. 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. Paediatr Perinat Epidemiol. 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. Hum Reprod Update. 2013;19(4):376-90. 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. Am J Epidemiol. 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. Low-carbohydrate dietary pattern and risk of gestational diabetes mellitus: a prospective cohort study. Am J Clin Nutr. 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. 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. Diabet Med. 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: a 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. Am J Prev Med. 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. Fert Steril. 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. Am J Clin Nutr. 2016;103(2): 375-381. PMID: 26762369. PMCID: PMC4733253.
  • Bao W, Li S, Chavarro JE, Tobias K, Zhu Y, 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;16(1):7. 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. Int J Epidemiol. 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, 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: PMC4764040
  • 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 [Available on 2017-12-01].
  • 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. Am J Obstet Gynecol. 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. Environ 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 [Available on 2017-11-01].
  • 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.
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Contact Information

Name: Dr Enrique Fabian Schisterman
Chief and Senior Investigator
Epidemiology Branch
Phone: 301-435-6893
Fax: 301-402-2084
E-mail: schistee@mail.nih.gov

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