Gestational diabetes is a disease that develops during pregnancy and affects how the body turns food into energy. In the U.S., about 6% to 9% of pregnant women develop gestational diabetes. Women who develop it are at increased risk for type 2 diabetes later in life.
Cuilin Zhang, M.D., Ph.D., is a clinical epidemiologist at the National Institute of Child Health and Human Development researching the genetic and environmental factors that cause gestational diabetes. She shares more about the disease's lasting effects, its link to type 2 diabetes, and her research into prevention.
How did you become interested in studying gestational diabetes?
I was interested in gestational diabetes because it's not just a pregnancy complication, but it can impact the fetus and the child. Children born from pregnancies complicated by gestational diabetes have an increased risk for cardiometabolic disorders, such as childhood obesity. After the pregnancy, women, too, can have exceptionally high risk of developing type 2 diabetes and a greater risk of cardiovascular diseases.
I began my research on gestational diabetes with a particular focus on factors women can change that could prevent the disease. We have also researched potential biomarkers [which can help predict disease] you can change for early prediction of gestational diabetes and to better inform prevention and intervention.
Can you share some findings from your research?
Our research has looked at gestational diabetes before pregnancy, during pregnancy, and after pregnancy. We discovered that pre-pregnancy is a critical time for gestational diabetes risk. We identified a number of pre-pregnancy factors that can impact this risk, including smoking, a sedentary lifestyle, unhealthy eating, and a body mass index over 25. Not smoking, exercising for more than 150 minutes per week, eating a healthy diet, and maintaining a healthy weight prior to pregnancy was associated with an 83% lower risk of gestational diabetes.
Some of our current research is looking into how gestational diabetes can be predicted around week 10 instead of around week 28 based on omics research tools such as women's metabolome profiles. This could allow us more time for prevention and intervention.
Postpartum, we have identified a number of healthful diet and lifestyle factors that can help reduce the risk of type 2 diabetes in women who have had gestational diabetes. Some of these include lactation [or breastfeeding] and following a low carbohydrate, high protein and high fat diet mainly from plant-sourced foods. Reducing the risk of type 2 diabetes in women who have had gestational diabetes is important, as research has found that up to 25% of women with gestational diabetes ultimately develop type 2 diabetes.
What do you wish more people knew about gestational diabetes?
Some people don't think that gestational diabetes is a severe disease because, for a majority of women, their glucose levels go back to normal after pregnancy. Still, it can have this long-term and lasting impact on women's health and on the offspring's health. It's important to think about the health impacts of gestational diabetes over their lifespan and the implications it can have on children.
What are your hopes about research in the future?
I hope that more research focuses on understanding the etiology, determinants, and health consequences of gestational diabetes in minority populations, as much of the research has been done among Caucasian populations. Minorities, particularly Asian or Hispanic women, are at much greater risk of gestational diabetes. The conversion rate from gestational diabetes to type 2 diabetes is also higher among the minority population. There are huge data gaps, especially for the postpartum and preconception time windows. There's lots of work still to be done.