Risk of gestational diabetes recurrence and the development of type 2 diabetes among women with a history of gestational diabetes and risk factors: a study among 18 clinical centers in China

Abstract

Background:Gestational diabetes mellitus (GDM) brings health issues for both mothers and offspring, and GDM prevention is as important as GDM management. It was shown that a history of GDM was significantly associated with a higher maternal risk for GDM recurrence. The incidence of GDM recurrence was unclear because of the incidence of second-child was low before 2016 in China. We aim to investigate the prevalence of GDM recurrence and its associated high-risk factors which may be useful for the prediction of GDM recurrence in China.Methods:A retrospective study was conducted which enrolled participants who underwent regular prenatal examination and delivered twice in the same hospital of 18 research centers. All participants were enrolled from January 2018 to October 2018, where they delivered the second baby during this period. A total of 6204 women were enrolled in this study, and 1002 women with a history of GDM were analyzed further. All participants enrolled in the study had an oral glucose tolerance test (OGTT) result at 24 to 28 weeks and were diagnosed as GDM in the first pregnancy according to the OGTT value (when any one of the following values is met or exceeded to the 75-g OGTT: 0 h [fasting], ≥5.10 mmol/L; 1 h, ≥10.00 mmol/L; and 2 h, ≥8.50 mmol/L). The prevalence of GDM recurrence and development of type 2 diabetes mellitus were calculated, and its related risk factors were analyzed.Results:In 6204 participants, there are 1002 women (1002/6204,16.15%) with a history of GDM and 5202 women (5202/6204, 83.85%) without a history of GDM. There are significant differences in age (32.43 ± 4.03 years vs. 33.00 ± 3.34 years vs. 32.19 ± 3.37 years, P < 0.001), pregnancy interval (4.06 ± 1.44 years vs. 3.52 ± 1.43 years vs. 3.38 ± 1.35 years, P = 0.004), prepregnancy body mass index (BMI) (27.40 ± 4.62 kg/m2vs. 23.50 ± 3.52 kg/m2vs. 22.55 ± 3.47 kg/m2, P < 0.001), history of delivered macrosomia (22.7% vs. 11.0% vs. 6.2%, P < 0.001) among the development of diabetes mellitus (DM), recurrence of GDM, and normal women. Moreover, it seems so important in the degree of abnormal glucose metabolism in the first pregnancy to the recurrence of GDM and the development of DM. There are significant differences in OGTT levels of the first pregnancy such as area under the curve of OGTT value (18.31 ± 1.90 mmol/L vs. 16.27 ± 1.93 mmol/L vs. 15.55 ± 1.92 mmol/L, P < 0.001), OGTT fasting value (5.43 ± 0.48 mmol/L vs. 5.16 ± 0.49 mmol/L vs. 5.02 ± 0.47 mmol/L, P < 0.001), OGTT 1-hour value (10.93 ± 1.34 mmol/L vs. 9.69 ± 1.53 mmol/L vs. 9.15 ± 1.58 mmol/L, P < 0.001), OGTT 2-hour value (9.30 ± 1.66 mmol/L vs. 8.01 ± 1.32 mmol/L vs. 7.79 ± 1.38 mmol/L, P < 0.001), incidence of impaired fasting glucose (IFG) (fasting plasma glucose ≥5.6 mmol/L) (31.3% vs. 14.6% vs. 8.8%, P < 0.001), and incidence of two or more abnormal OGTT values (68.8% vs. 39.7% vs. 23.9%, P < 0.001) among the three groups. Using multivariate analysis, the factors, such as age (1.07 [1.02–1.12], P = 0.006), prepregnancy BMI (1.07 [1.02, 1.12], P = 0.0...

Association of interpregnancy interval and risk of adverse pregnancy outcomes in woman by different previous gestational ages

“…[46] And the degree of abnormal glucose metabolism in previous pregnancy was important in the recurrence of diabetes mellitus in pregnancy. [35] Our result was consistent with another meta-analysis that concluded that shorter intervals (less than 2 years) are not associated with an increased risk of recurrent preeclampsia, but longer intervals appear to increase the risk. [7] We further found that the estimated risk of preeclampsia or eclampsia, gestational hypertension, and diabetes mellitus in pregnancy for women with long IPIs increased more among women with a previous term birth than among those with a previous preterm birth or an infant with a gestational age less than 28 weeks.…”

“…However, gestational diabetes mellitus took account of approximately 90% of diabetes mellitus in pregnancy. [ 34 , 35 ] Thus, we defined diabetes mellitus in pregnancy in this research, which refers to pre-existing diabetes mellitus and diabetes mellitus arising in pregnancy.…”

Relationship between sexual function and marital satisfaction with quality of life-related gestational diabetes mellitus: a cross-sectional study

“…A history of GDM is associated with a higher risk of GDM recurrence in subsequent pregnancies. Also, these people have a higher chance of developing type 2 diabetes in the future [72,73]. Further, it is widely accepted that women with a history of GDM are at increased risk of other metabolic diseases and also developing cardiovascular diseases [74].…”

Insulin sensitivity, β cell function, and adverse pregnancy outcomes in women with gestational diabetes

“…Gestational diabetes mellitus (GDM) is a specific type of diabetes that affects women during pregnancy who were not diagnosed with diabetes before pregnancy [1] . Women with prior GDM will have a high risk of recurrent GDM after the first pregnancy and postpartum metabolic disorders [2–5] . GDM itself may be associated with a series of adverse pregnancy outcomes including preeclampsia, macrosomia, preterm delivery, and primary cesarean section [6,7] .…”

“…[1] Women with prior GDM will have a high risk of recurrent GDM after the first pregnancy and postpartum metabolic disorders. [2][3][4][5] GDM itself may be associated with a series of adverse pregnancy outcomes including preeclampsia, macrosomia, preterm delivery, and primary cesarean section. [6,7] Previous studies have shown that both b cell function and insulin sensitivity may be involved in the pathogenesis of GDM.…”