Long term prognosis of women with gestational diabetes in a multiethnic population

Abstract

GDM represents a significant risk factor for future DM development regardless of ethnicity. Glycated haemoglobin values at GDM diagnosis have value in predicting future diabetes mellitus.

Impact of gestational diabetes on the risk of diabetes following pregnancy among Chinese and South Asian women

“…Similarly, a smaller study in New York City demonstrated an increased risk of GDM among virtually all minority populations compared with whites, including an adjusted relative risk of 2.3 for Chinese women and 4.7 for South Asian women [28]. The high risk of subsequent diabetes after GDM among South Asians has been previously described in a small UK study, where the cumulative diabetes incidence at 4.4 years after pregnancy was 49% among South Asians but only 25% among whites [17]. Other studies have similarly described ethnic variation in the risk of subsequent diabetes after GDM [6,18,29], but have not shown effect modification of Asian ethnicities on the relationship between GDM and subsequent diabetes risk.…”

“…The possible explanations for this observation and the greater prevalence of GDM among minority women are uncertain, but lifestyle, dietary or cultural factors may contribute. Alternatively, Chinese and South Asian women may have metabolic differences from white women that reflect higher degrees of antenatal insulin resistance and therefore relatively greater degrees of glucose intolerance in pregnancy [17,28,30], but that do not necessarily lead to similar degrees of insulin resistance postpartum. The original diagnostic thresholds for GDM described by O'Sullivan, which were shown to predict postpartum diabetes incidence, were derived from a predominantly white population in New England [31].…”

“…More recent data have corroborated this observation [12][13][14]. Furthermore, there are data suggesting that women from some minority groups may be at increased risk of glucose intolerance or diabetes following pregnancy complicated by GDM [15][16][17]. However, these earlier studies were small, and they did not include patients without GDM, so whether the observed ethnic differences in diabetes risk after GDM differed from baseline ethnic differences in diabetes risk could not be evaluated.…”

GDM: Postpartum management to reduce long-term risks

“…Women with gestational diabetes mellitus (GDM) are known to be at increased risk for developing DM later in life [5][6][7][8][9]. In addition, offspring exposed to the diabetic environment in utero are at increased risk for long-term effects, including obesity, glucose intolerance, and overt DM [ 10 , 11 ].…”

SUGAR: Spotting Undiagnosed Glucose Abnormal Results—A New Protocol To Increase Postpartum Testing Among Women With Gestational Diabetes Mellitus

“…6%. 29,36,63,64 This lower diagnostic threshold is in line with our goal of capturing all women at risk for future obstetric or medical morbidity. The possibility that the insulin resistance of a recent pregnancy could cause overdiagnosis via a "false positive" HbA 1c is unlikely based on three studies demonstrating an isolated postpartum HbA 1c has a lower sensitivity for dysglycemia than an OGTT or FPG/ HbA 1c combination.…”