Risk stratification of women with gestational diabetes mellitus using mutually exclusive categories based on the International Association of Diabetes and Pregnancy Study Groups criteria for the development of postpartum dysglycaemia: a retrospective cohort study

Abstract

ObjectivesWomen with gestational diabetes mellitus (GDM) are more predisposed to develop postpartum diabetes mellitus (DM). This study aimed to estimate the relative risk (RR) of postpartum dysglycaemia (prediabetes and DM) using mutually exclusive categories according to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria cut-off points in patients with GDM, so as to establish a risk-stratification method for developing GDM management strategies.Design, setting and participantsIn this retrospective cohort study, 942 women who had been diagnosed with GDM (IADPSG criteria) at 24–28 weeks of gestation from November 2016 to April 2018 underwent a 75 g oral glucose tolerance test (OGTT) at 6–12 weeks postpartum in a tertiary hospital of Singapore. Seven mutually exclusive categories (three one timepoint positive categories (fasting, 1 hour and 2 hours), three two timepoint positive categories (fasting+1 hour, fasting+2 hours and 1 hour+2 hours) and one three timepoint positive category (fasting+1 hour+2 hours)) were derived from the three timepoint antenatal OGTT according to the IADPSG criteria. To calculate the RRs of postpartum dysglyceamia of each mutually exclusive group, logistic regression was applied.Results924 mothers with GDM, whose mean age was 32.7±4.7 years, were mainly composed of Chinese (45.4%), Malay (21.7%) and Indian (14.3%) ethnicity. The total prevalence of postnatal dysglycaemia was 16.7% at 6–12 weeks postpartum. Stratifying subjects into seven mutually exclusive categories, the RRs of the one-time, two-time and three-time positive groups of the antenatal OGTT test were 1.0 (Ref.), 2.0 (95% CI=1.3 to 3.1; p=0.001) and 6.7 (95% CI=4.1 to 10.9; p<0.001), respectively, which could be used to categorise patients with GDM into low-risk, intermediate-risk and high-risk group.ConclusionsMutually exclusive categories could be useful for risk stratification and early management of patients with prenatal GDM. It is plausible and can be easily translated into clinical practice.

Antenatal oral glucose tolerance test abnormalities in the prediction of future risk of postpartum diabetes in women with gestational diabetes: Results from the LIVING study

“…Two recent additional studies, from Canada ( n = 20 513 with GDM; median follow‐up of 4.4 years) and Singapore ( N = 942 with GDM, evaluated at 6–12 weeks postpartum), explored the relationship between the OGTT type and the future risk of diabetes for women diagnosed using IADPSG criteria. 8 , 9 Both studies found significant differences in future risk of diabetes based on OGTT type. Given that GDM diagnosed using IADPSG criteria is milder with a lower risk of future diabetes than that with other criteria, identifying high‐risk women with a history of IADPSG criteria becomes even more crucial for judicious use of limited resources.…”

“…Further, the meta‐analysis was not possible for 1‐h values due to inadequate data. Two recent additional studies, from Canada ( n = 20 513 with GDM; median follow‐up of 4.4 years) and Singapore ( N = 942 with GDM, evaluated at 6–12 weeks postpartum), explored the relationship between the OGTT type and the future risk of diabetes for women diagnosed using IADPSG criteria 8,9 . Both studies found significant differences in future risk of diabetes based on OGTT type.…”