Prevention of type 2 diabetes mellitus in women with previous gestational diabetes mellitus

Abstract

Gestational diabetes mellitus (GDM), defined as any degree of glucose intolerance with onset or first recognition during pregnancy, is characterized by underlying maternal defects in the β-cell response to insulin during pregnancy. Women with a previous history of GDM have a greater than 7-fold higher risk of developing postpartum diabetes compared with women without GDM. Various risk factors for postpartum diabetes have been identified, including maternal age, glucose levels in pregnancy, family history of diabetes, pre-pregnancy and postpartum body mass index, dietary patterns, physical activity, and breastfeeding. Genetic studies revealed that GDM shares common genetic variants with type 2 diabetes. A number of lifestyle interventional trials that aimed to ameliorate modifiable risk factors, including diet, exercise, and breastfeeding, succeeded in reducing the incidence of postpartum diabetes, weight retention, and other obesity-related morbidities. The present review summarizes the findings of previous studies on the incidence and risk factors of postpartum diabetes and discusses recent lifestyle interventional trials that attempted to prevent postpartum diabetes.

Postpartum risk of diabetes and predictive factors for glucose intolerance in East Asian women with gestational diabetes

“…East Asians have a relatively low BMI and a weak insulin secretion capacity that cannot be compensated for by an increase in insulin resistance, due to the prevalence of limited obesity. The underlying pathophysiology of DM in this population is thought to differ from that in other ethnicities [32]. Additionally, East Asian patients with type 2 DM show a higher risk of developing DM-related complications than Europeans [33].…”

Physical activity level in women with gestational diabetes mellitus: Lifestyle INtervention for Diabetes prevention After pregnancy (LINDA‐Brasil) study

“…Approximately one‐third of this sample of the LINDA‐Brasil study was physically active; this is worrying considering the potential of this behavior to prevent development of T2D after delivery. In addition, physical activity improves glycemic control and contributes to a reduction in weight gain in women diagnosed with GDM . Among those with a history of GDM or with a high BMI (≥30 kg/m 2 ), simple advice to undertake physical activity, as well as dietary changes and weight control, can reduce the incidence of GDM by almost40% .…”

“…In addition, physical activity improves glycemic control 8,10 and contributes to a reduction in weight gain in women diagnosed with GDM. 10,28,29 Among those with a history of GDM or with a high BMI (≥30 kg/m 2 ), simple advice to undertake physical activity, as well as dietary changes and weight control, can reduce Abbreviations: GDM, gestational diabetes mellitus. Data are given as n (%).…”

“…Charts were reviewed to collect data on prepregnancy weight, gestational weight, gestational age at recruitment, plasma glucose levels at diagnosis of GDM, treatment for GDM, and reproductive history. 21,23 For descriptive analyses, age was classified into three categories (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39), and ≥40 years). Self-declared skin color was categorized as white, black, brown, or other, according to the Brazilian census bureau.…”

The low‐risk perception of developing type 2 diabetes among women with a previous history of gestational diabetes: a qualitative study

“…It is vital that women are provided with clear and timely information about their future diabetes risk, and offered a feasible and tailored intervention that fits with women's multiple roles . NICE recommends that women with GDM should be offered lifestyle advice (weight control, diet and exercise) and a fasting plasma glucose measurement at the six‐week postnatal check and annually after that .…”