{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T01:07:34Z","timestamp":1792026454052,"version":"4.4.0"},"reference-count":34,"publisher":"American Diabetes Association","issue":"12","license":[{"start":{"date-parts":[[2023,5,4]],"date-time":"2023-05-04T00:00:00Z","timestamp":1683158400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.diabetesjournals.org\/journals\/pages\/license"}],"funder":[{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["R01HD094150"],"award-info":[{"award-number":["R01HD094150"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["UL1 TR000170"],"award-info":[{"award-number":["UL1 TR000170"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["UL1TR001102"],"award-info":[{"award-number":["UL1TR001102"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000867","name":"Robert Wood Johnson Foundation","doi-asserted-by":"publisher","award":["Harold Amos Medical Faculty Development Program"],"award-info":[{"award-number":["Harold Amos Medical Faculty Development Program"]}],"id":[{"id":"10.13039\/100000867","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["K23DK113218"],"award-info":[{"award-number":["K23DK113218"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100005294","name":"Massachusetts General Hospital","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005294","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,12,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To evaluate changes in insulin physiology in euglycemic pregnancy and gestational diabetes mellitus (GDM).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                    <jats:p>Participants underwent oral glucose tolerance tests at \u226415 weeks\u2019 gestation (early pregnancy), 24\u201332 weeks\u2019 gestation (mid-late pregnancy), and 6\u201324 weeks postpartum. We evaluated longitudinal changes in insulin secretory response (log Stumvoll first-phase estimate) and insulin sensitivity (log Matsuda index) using linear mixed models. We then evaluated participants who met GDM criteria in early pregnancy (early GDM) and mid-late pregnancy (classic GDM) separately from those without GDM. We derived the pregnancy insulin physiology (PIP) index to quantify \u03b2-cell compensation for insulin resistance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Among 166 participants, 21 had early GDM and 24 developed classic GDM. Insulin sensitivity was reduced slightly in early pregnancy (\u03b2 = \u22120.20, P &amp;lt; 0.001) and substantially in mid-late pregnancy (\u03b2 = \u22120.47, P &amp;lt; 0.001) compared with postpartum. Insulin secretory response (adjusted for insulin sensitivity) was augmented in early pregnancy (\u03b2 = 0.16, P &amp;lt; 0.001) and mid-late pregnancy (\u03b2 = 0.16, P = 0.001) compared with postpartum. Compared with postpartum, the PIP index was augmented in early pregnancy (\u03b2 = 215, P = 0.04) but not mid-late pregnancy (\u03b2 = 55, P = 0.64). Early GDM was distinguished by a substantial reduction in early pregnancy insulin sensitivity (\u03b2 = \u22120.59, P &amp;lt; 0.001) compared with postpartum. Both early and classic GDM lacked evidence of early pregnancy augmentation of insulin secretory response (adjusted for insulin sensitivity) and the PIP index (P &amp;gt; 0.1 vs. postpartum). Early pregnancy PIP index predicted GDM independent of participant characteristics (area under the curve without PIP index 0.70 [95% CI 0.61\u20130.79], area under the curve with PIP index 0.87 [95% CI 0.80\u20130.93]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>\u03b2-Cell function is enhanced in early pregnancy. Deficient first-trimester \u03b2-cell function predicts GDM.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2337\/dc22-2226","type":"journal-article","created":{"date-parts":[[2023,5,1]],"date-time":"2023-05-01T17:06:55Z","timestamp":1682960815000},"page":"2137-2146","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":50,"title":["Distinct Insulin Physiology Trajectories in Euglycemic Pregnancy and Gestational Diabetes Mellitus"],"prefix":"10.2337","volume":"46","author":[{"given":"Tanayott","family":"Thaweethai","sequence":"first","affiliation":[{"name":"1Biostatistics, Massachusetts General Hospital, Boston, MA"},{"name":"2Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zainab","family":"Soetan","sequence":"additional","affiliation":[{"name":"1Biostatistics, Massachusetts General Hospital, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaitlyn","family":"James","sequence":"additional","affiliation":[{"name":"2Harvard Medical School, Boston, MA"},{"name":"3Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose C.","family":"Florez","sequence":"additional","affiliation":[{"name":"2Harvard Medical School, Boston, MA"},{"name":"4Diabetes Unit, Endocrine Division, Department of Medicine, Massachusetts General Hospital, Boston, MA"},{"name":"5Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA"},{"name":"6Broad Institute of MIT and Harvard, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7060-7778","authenticated-orcid":false,"given":"Camille E.","family":"Powe","sequence":"additional","affiliation":[{"name":"2Harvard Medical School, Boston, MA"},{"name":"3Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA"},{"name":"4Diabetes Unit, Endocrine Division, Department of Medicine, Massachusetts General Hospital, Boston, MA"},{"name":"6Broad Institute of MIT and Harvard, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","published-online":{"date-parts":[[2023,5,4]]},"reference":[{"key":"2023112719550227600_B1","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1111\/dme.12381","article-title":"Trying to understand gestational diabetes","volume":"31","author":"Catalano","year":"2014","journal-title":"Diabet Med"},{"key":"2023112719550227600_B2","doi-asserted-by":"crossref","first-page":"380","DOI":"10.2337\/diab.34.4.380","article-title":"Insulin action during pregnancy. 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