Glucose Intolerance after a Recent History of Gestational Diabetes Based on the 2013 WHO Criteria

Abstract

AimsUncertainty exists on the prevalence of glucose intolerance in women with a recent diagnosis of gestational diabetes (GDM) based on a two-step screening strategy and the 2013 World Health Organization (WHO) criteria. Our aim was to evaluate the uptake of postpartum screening, the prevalence and the risk factors for glucose intolerance in women with a recent history of GDM.MethodsRetrospective analysis of the medical records of women with a recent history of GDM diagnosed in a universal two-step screening strategy with the 2013 WHO criteria. All women with a history of GDM are advised to undergo a 75g oral glucose tolerance test (OGTT) around 12 weeks postpartum. Indices of insulin sensitivity (the Matsuda index and the reciprocal of the homeostasis model assessment of insulin resistance, 1/HOMA-IR) and an index of beta-cell function, the Insulin Secretion-Sensitivity Index-2 (ISSI-2) were calculated based on the OGTT postpartum. Multivariable logistic regression was used to adjust for confounders such as age, BMI, ethnicity and breastfeeding.ResultsOf the 191 women with GDM, 29.3% (56) did not attend the scheduled postpartum OGTT. These women had a higher BMI (28.6 ±6.8 vs. 26.2 ± 5.6, p = 0.015), were more often from an ethnic minority (EM) background (41.1% vs. 25.2%, p = 0.029) and smoked more often during pregnancy (14.3% vs. 2.2%, p = 0.001) than women who attended the OGTT postpartum. Of all women (135) who received an OGTT postpartum, 42.2% (57) had prediabetes (11.9% impaired fasting glucose, 24.4% impaired glucose tolerance and 5.9% both impaired fasting and impaired glucose tolerance) and 1.5% (2) had overt diabetes. Compared to women with a normal OGTT postpartum, women with glucose intolerance were older (32.5±4.3 vs. 30.8±4.8 years, p = 0.049), were more often obese (34.5% vs. 17.3%, p = 0.023), were more often from an EM background (33.9% vs. 18.4%, p = 0.040), less often breastfed (69.5% vs. 84.2%, p = 0.041) and had more often an abnormal fasting glycaemia at the time of the OGTT in pregnancy (55.6% vs. 37.3%, p = 0.040). In the multivariable logistic regression, an EM background [OR = 2.76 (1.15–6.62), p = 0.023] and the HbA1c level at the time of the OGTT in pregnancy [OR = 4.78 (1.19–19.20), p = 0.028] remained significant predictors for glucose intolerance postpartum. Women with glucose intolerance postpartum had a similar insulin sensitivity [Matsuda index 0.656 (0.386–1.224) vs. 0.778 (0.532–1.067), p = 0.709; 1/HOMA-IR 0.004 (0.002–0.009) vs. (0.004–0.003–0.007), p = 0.384] but a lower beta-cell function compared to women with a normal OGTT postpartum, remaining significant after adjustment for confounders [ISSI-2 1.6 (1.2–2.1) vs. 1.9 (1.7–2.4),p = 0.002].ConclusionsGlucose intolerance is very frequent in early postpartum in women with GDM based on the 2013 WHO criteria in a two-step screening strategy and these women have an impaired beta-cell function. Nearly one third of women did not attend the scheduled OGTT postpartum and these women have an adverse risk profile. More efforts are...

Metabolic effects of breastfeed in women with prior gestational diabetes mellitus: A systematic review and meta‐analysis

“…A total of 16 studies evaluated the risk of pre‐DM, IGT, or IFG in 4266 women after GDM pregnancy. Meta‐analyses (Figure ) indicated that longer BF was significantly associated with a lower probability of pre‐DM ( I 2 = 41.1%; OR = 0.66; 95% CI, 0.51‐0.86; P = 0.002), which was identified in the subgroup analyses stratified by follow‐up period (OR = 0.65; 95% CI, 0.49‐0.86; P = 0.003 for 1‐6 months; OR = 0.55; 95% CI, 0.33‐0.91; P = 0.020 for 1‐5 years).…”

“…Characteristics of included studies are shown in Table 1. All the included women had a history of GDM, while the diagnostic criteria were various, involving the International Association of Diabetes and Pregnancy Study Group criteria, 20,21,27,31 the American Diabetes Association criteria, 28,41 the World Health Organization criteria, 25 Carpenter-Coustan criteria, 26,[29][30][31]33,37 the National Diabetes Data Group criteria, 43,45 and some local criteria. 24,35,44,46 Two kinds of BF measure (status, intensity) were used to describe and group the exposure in each study, with different distinction points, ranged from BF initiation to 12 months.…”

“…The duration of follow-up varied from 6 weeks to 24 years post partum, which was divided into three periods (1-6 months, 1-5 years, >5 years) during the subgroup analyses. A total of 21 studies 20,21,[23][24][25][26][27][28][29][31][32][33]35,37,[39][40][41][43][44][45][46] evaluated the risk of developing T2DM or pre-DM (IGT and/or IFG), and 10 20,21,26-30,34,41,45 reported the results of detailed metabolic parameters, including body mass index (BMI), fasting glucose, 2-hour post load glucose, fasting insulin, homeostasis model of assessment of insulin resistance (HOMA-IR), insulin sensitivity index (ISI), triglyceride, and cholesterol in women with prior GDM.…”

“…Quality assessments using RoBANS are summarized in Table S2. A total of 12 studies 23,26,27,[30][31][32]34,35,37,[43][44][45] with diabetes-free at baseline had a low risk of selection bias caused by selection of participants. Meanwhile, seven studies 20,[23][24][25]35,40,43 had a low risk of confounding bias caused by confounding variables, due to the adequate adjustment for covariates. Performance bias indicating measurement of BF were judged to be "high" in 10 studies 25,31,[33][34][35]37,39,40,44,46 with self-administered questionnaire or without definition, and "unclear" for seven studies.…”

“…Meanwhile, seven studies 20,[23][24][25]35,40,43 had a low risk of confounding bias caused by confounding variables, due to the adequate adjustment for covariates. Performance bias indicating measurement of BF were judged to be "high" in 10 studies 25,31,[33][34][35]37,39,40,44,46 with self-administered questionnaire or without definition, and "unclear" for seven studies. 21,28,29,32,41,43,45 Since the selected outcomes could not be influenced by the blinding of assessment, all the studies had a low risk of detection bias.…”