Follow‐up of women with gestational diabetes in the Tehran Lipid and Glucose Study (TLGS): A population‐based cohort study

Tehrani, Fahimeh Ramezani; Hashemi, Somayeh; Hasheminia, Mitra; Azizi, Fereidoun

doi:10.1111/j.1447-0756.2011.01767.x

Cited by 18 publications

(11 citation statements)

References 26 publications

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“…These results are in agreement with a previous 18-years follow-up study showing that waist circumference and fasting glucose were the only significant components of MetS in mothers with LGA infants with or without GDM during their pregnancies [ 8 ]. In agreement with our results, no difference was observed in waist circumference in women with macrosomic (> 4 kg) or stillborn newborns as compared to age- and BMI-matched women without macrosomic deliveries in a 9-year follow-up study in women without previous GDM [ 19 ].…”

Section: Discussionsupporting

confidence: 91%

“…This is in agreement with a previous 2-year follow-up study, where fasting glucose levels did not differ between the non-GDM women with previous LGA and AGA deliveries [ 20 ]. Moreover, a 9-year follow-up study did not find any differences in fasting glucose concentrations in women with and without previous macrosomic newborns with absence of GDM during pregnancy [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

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Future risk of metabolic syndrome in women with a previous LGA delivery stratified by gestational glucose tolerance: a prospective cohort study

Hakkarainen

Huopio

Cederberg

et al. 2018

BMC Pregnancy Childbirth

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BackgroundWhether the delivery of a large-for-gestational-age (LGA) infant predicts future maternal metabolic syndrome (MetS) is not known. To this aim, we investigated the incidence of MetS and its components in women with or without a history of gestational diabetes mellitus (GDM) with a view to the birth weight of the offspring.MethodsEight hundred seventy six women treated for their pregnancies in Kuopio University Hospital in 1989–2009 underwent a follow-up study (mean follow-up time 7.3 (SD 5.1) years), of whom 489 women with GDM and 385 normoglycemic controls. The women were stratified into two groups according to the newborn’s birth weight: 10-90th percentile (appropriate-for-gestational-age; AGA) (n = 662) and > 90th percentile (LGA) (n = 116). MetS and its components were evaluated in the follow-up study according to the International Diabetes Federation criteria.ResultsLGA vs. AGA delivery was associated with a higher incidence of MetS at follow-up in women with a background of GDM (54.4% vs. 43.6%), but not in women without GDM.ConclusionAn LGA delivery in women with GDM is associated with a higher risk of future MetS and this group is optimal to study preventive measures for MetS. In contrast, an LGA delivery after a normoglycemic pregnancy was not associated with an increased future maternal MetS risk.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Future risk of metabolic syndrome in women with a previous LGA delivery stratified by gestational glucose tolerance: a prospective cohort study

Hakkarainen

Huopio

Cederberg

et al. 2018

BMC Pregnancy Childbirth

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“…This investigation reported a higher rate of T2DM in women with a history of GDM (27.3%) than women in control group (9.5%) (P < 0.001). However, number of women with a history of GDM was small (29 women) compared with control group (628 women) ( 32 ).…”

Section: Discussionmentioning

confidence: 94%

The Risk Factors and Incidence of Type 2 Diabetes Mellitus and Metabolic Syndrome in Women With Previous Gestational Diabetes

Alavi

Mazloomzadeh

Piri

et al. 2015

Int J Endocrinol Metab

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Background:Gestational diabetes mellitus (GDM) affects nearly 5% of pregnancies. Significant proportion of the women with previous GDM develops type 2 diabetes mellitus (T2DM) in the next years, which indicates a higher risk in them than in the general population.Objectives:We conducted this study to determine the risk factors and incidence of abnormal glucose level and metabolic syndrome (MetS) in women with a history of GDM in a long period after delivery in our region.Patients and Methods:We extracted the demographic characteristics of 110 women with GDM who had delivered during 2004 - 2010 in three main hospitals of Zanjan City, Iran. The patients were recalled to perform oral glucose tolerance test (OGTT) and other necessary tests for MetS diagnosis. Anthropometric measurements were recorded of all the participants.Results:In this study, 110 women with a history of GDM were studied at one to six years since delivery. Among these women, 36 (32.7%) developed T2DM and 11 (10%) had impaired fasting glucose (IFG) or impaired glucose tolerance (IGT). Moreover, 22 women (20%) had developed MetS. among those with abnormal results in glycemic test, 93.6% had fasting blood sugar (FBS) ≥ 95 mg/dL (≥ 5.27 mmol/L)at the time of GDM diagnosis in the index pregnancy that was significantly higher than the normal glycemic test (NGT) group with 42.9% being affected (OR, 19.55; P < 0.0001). There was a significant difference between those with abnormal results and NGT group in interval between delivery and performing laboratory tests (27 ± 18.8 and 18.5 ± 17.7 months, respectively; OR, 1.02; P = 0.02). No insulin use during pregnancy was discovered as a protective factor in women with a history of GDM (OR, 0.35; P = 0.01). Those with abnormal results were significantly different from NGT group in the number of parities (2.61 ± 1.4 vs. 2.05 ± 1.1, respectively; OR, 1.4; P = 0.03). The most common component of MetS among women with a history of GDM was FBS > 100 mg/dL (> 5.55 mmol/L).Conclusions:Regarding the high incidence of the T2DM and MetS among women with a history of GDM, they should be screened at a regular interval for diabetes and other cardiovascular risk factors.

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“…Of these, 119 were conference proceedings, 72 did not explore outcomes in a group with GDM and a healthy control group, 24 reported postpartum follow-up for a period shorter than 12 months, 15 were not relevant to the research question, 6 did not report the incidence of T2DM, 10 were cross sectional studies, 8 included patients with a self-reported diagnosis of diabetes (either GDM or T2DM or both), 5 were letters and commentaries, 2 were systematic reviews, 2 reported screening in patients already diagnosed with impaired glucose tolerance after GDM, 1 did not compare patients with GDM with a healthy population, and 1 reported information about screening but not progression. Tehrani et al25 and Hakkarainen et al26 assessed the same cohorts as Minooee et al27 and Huopio et al,28 respectively. We included the last two studies because these reported the most relevant data for the meta-analysis.…”

Section: Resultsmentioning

confidence: 99%

Progression to type 2 diabetes in women with a known history of gestational diabetes: systematic review and meta-analysis

Vounzoulaki

Khunti

Abner

et al. 2020

BMJ

691

476

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ObjectiveTo estimate and compare progression rates to type 2 diabetes mellitus (T2DM) in women with gestational diabetes mellitus (GDM) and healthy controls.DesignSystematic review and meta-analysis.Data sourcesMedline and Embase between January 2000 and December 2019, studies published in English and conducted on humans.Eligibility criteria for selecting studiesObservational studies investigating progression to T2DM. Inclusion criteria were postpartum follow-up for at least 12 months, incident physician based diagnosis of diabetes, T2DM reported as a separate outcome rather than combined with impaired fasting glucose or impaired glucose tolerance, and studies with both a group of patients with GDM and a control group.ResultsThis meta-analysis of 20 studies assessed a total of 1 332 373 individuals (67 956 women with GDM and 1 264 417 controls). Data were pooled by random effects meta-analysis models, and heterogeneity was assessed by use of the I2 statistic. The pooled relative risk for the incidence of T2DM between participants with GDM and controls was estimated. Reasons for heterogeneity between studies were investigated by prespecified subgroup and meta-regression analyses. Publication bias was assessed by funnel plots and, overall, studies were deemed to have a low risk of bias (P=0.58 and P=0.90). The overall relative risk for T2DM was almost 10 times higher in women with previous GDM than in healthy controls (9.51, 95% confidence interval 7.14 to 12.67, P<0.001). In populations of women with previous GDM, the cumulative incidence of T2DM was 16.46% (95% confidence interval 16.16% to 16.77%) in women of mixed ethnicity, 15.58% (13.30% to 17.86%) in a predominantly non-white population, and 9.91% (9.39% to 10.42%) in a white population. These differences were not statistically significant between subgroups (white v mixed populations, P=0.26; white v non-white populations, P=0.54). Meta-regression analyses showed that the study effect size was not significantly associated with mean study age, body mass index, publication year, and length of follow-up.ConclusionsWomen with a history of GDM appear to have a nearly 10-fold higher risk of developing T2DM than those with a normoglycaemic pregnancy. The magnitude of this risk highlights the importance of intervening to prevent the onset of T2DM, particularly in the early years after pregnancy.Systematic review registrationPROSPERO CRD42019123079.

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Follow‐up of women with gestational diabetes in the Tehran Lipid and Glucose Study (TLGS): A population‐based cohort study

Abstract: Women with a history of GDM are at higher risk for developing T2DM later in life. The timely recognition of GDM may provide a 'teachable moment' during which women could be motivated to implement lifestyle modifications to reduce their T2DM risk.

Cited by 18 publications

References 26 publications

Future risk of metabolic syndrome in women with a previous LGA delivery stratified by gestational glucose tolerance: a prospective cohort study

Future risk of metabolic syndrome in women with a previous LGA delivery stratified by gestational glucose tolerance: a prospective cohort study

The Risk Factors and Incidence of Type 2 Diabetes Mellitus and Metabolic Syndrome in Women With Previous Gestational Diabetes

Progression to type 2 diabetes in women with a known history of gestational diabetes: systematic review and meta-analysis

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