Predictors of Postpartum Diabetes in Women With Gestational Diabetes Mellitus

Abstract

The aim of this study was to stratify risk for postpartum diabetes in women who have gestational diabetes. Women with gestational diabetes were recruited between 1989 and 1999, and 302 were followed with oral glucose tolerance tests at 9 months and 2, 5, 8, and 11 years postpregnancy. The 8-year postpartum diabetes risk was 52.7% (130 diabetic cases). Risk was increased in women with autoantibodies to GAD and/or insulinoma antigen-2 (adjusted hazard ratio 4.1; P < 0.0001), women who required insulin during pregnancy (4.7; P < 0.0001), women with BMI >30 kg/m 2 (1.5; P ‫؍‬ 0.04), and women with more than two prior pregnancies (2.5; P ‫؍‬ 0.02). Women without these risk factors had a postpartum diabetes risk of 14% by 8 years, and risk rose incrementally to 96% by 8 years in autoantibody-positive women. Parity status, C-reactive protein concentration, a diabetes family history, maternal age, weeks of gestation, and the child's birth weight did not significantly affect risk in multivariate analysis. Prospective diabetes assessment is indicated and intervention should be considered in women with gestational diabetes who are autoantibody positive, require insulin treatment during pregnancy, or are obese. Diabetes 55:792-797, 2006 G estational diabetes mellitus (GDM) complicates ϳ4% of pregnancies and is defined as glucose intolerance with onset or first diagnosis during pregnancy (1). GDM substantially increases the risk to develop postpartum diabetes and thus identifies a high-risk population for the development of both type 1 and type 2 diabetes. Risk estimates of type 2 diabetes after GDM vary from 17 to 63% within 5-16 years after pregnancy, depending upon the ethnic background of the study population and the detection method for GDM and glucose intolerance (2-4). Like type 2 diabetes, the incidence of postpartum diabetes appears to be increasing (5). Reported risk factors for postpartum diabetes include the detection of islet autoantibodies (6,7), insulin treatment during pregnancy, BMI, and age at delivery (3).The German GDM study has prospectively followed patients with GDM for up to 11 years for the purpose of estimating diabetes risk and identifying factors that modify risk. Here we report diabetes risk with respect to anthropometric markers such as BMI, insulin requirement during pregnancy, family history of diabetes, the number of previous pregnancies, age at delivery, duration of gestation, or birth weight of child and serological markers such as the presence of islet autoantibodies and serum concentrations of C-reactive protein (CRP) in this cohort. RESEARCH DESIGN AND METHODSThe German GDM prospective study follows women with GDM from delivery (6,8). Between 1989 and 1999, 302 patients with GDM were recruited from hospitals in Germany and participated in at least one follow-up contact after delivery. GDM was diagnosed following the criteria of the German Diabetes Association using an oral glucose tolerance test (OGTT) with 75-g glucose load. Women were considered to have GDM if two of three capillary bl...

Atlantic DIP: high prevalence of abnormal glucose tolerance post partum is reduced by breast-feeding in women with prior gestational diabetes mellitus

“…Raised BMI at booking visit (20-24 weeks) was associated with subsequent post partum hyperglycemia, particularly in non-European women; this corroborates some but not all previous studies (27,28). Glucosetolerant overweight and obese women also need to be targeted aggressively, however, as recent data show that these women have greater adverse fetal and maternal outcomes compared with controls, independent of pregnancy glucose status (29).…”

Can we really diagnose diabetes during pregnancy?

“…Our local population in Hawaii has diverse mix ethnicity, with a high percentage of Asian, Polynesian, Micronesian and mixed ethnicities. In addition, the importance of obesity with GDM in the development of metabolic syndrome cannot be understated [7,25,26]. If obesity and ethnicity are factored into future diagnostic or predictive criteria, the specificity of an antepartum HbA 1c may be improved upon.…”

“…Prior research shows that women with gestational diabetes are at increased risk for developing type II diabetes later in life [4][5][6][7][8]. Some women diagnosed with overt diabetes in the postpartum period entered the pregnancy with pre-gestational diabetes but were not diagnosed with hyperglycemia until they were enrolled in prenatal care.…”

The Effectiveness of D-Chiro Inositol Treatment in Gestational Diabetes

“…GDM is a major concern because of the various short-and longterm health consequences it poses for both the mother and the child. Women with GDM are more likely to experience further pregnancy complications, such as pre-eclampsia [15], and to develop T2DM later in life [5,6]. Babies born from pregnancies complicated by GDM are more likely to be large for gestational age (LGA), and to be affected by obesity and T2DM in the future [4].…”

“…Incidence of GDM varies from 2% to 14% worldwide and is growing [2] and hyperglycaemia has been independently associated with a risk for mother, foetus and neonate, both in the short and long term [3,4]. Although GDM usually disappears after delivery, women who have been previously diagnosed with GDM are at a greater risk of developing gestational diabetes in subsequent pregnancies, and type 2 diabetes (T2DM) later in life [5,6].…”