199 Postpartum glucose tolerance following early gestational diabetes

Abstract

Women with GDM are at increased risk for type 2 diabetes (T2DM) or glucose intolerance postpartum. We aimed to compare the risk of postpartum dysglycemia in women with early GDM compared to those with GDM diagnosed in the third trimester. Secondary analysis of a multicenter, randomized controlled trial of obese women with singleton, non-anomalous gestations comparing early GDM screening at 14-20wk to routine screening at 24-28wk. Women were included in this analysis if they were diagnosed with GDM at the primary study site. The primary outcome was postpartum dysglycemia, defined as any abnormality on 2-hour oral glucose tolerance test (GTT) 6 weeks postpartum or clinical diagnosis based on hyperglycemia requiring pharmacotherapy after delivery with deferred GTT. Maternal characteristics and outcomes were compared in bivariable analysis, and logistic regression estimated the association between early GDM and postpartum dysglycemia. Of 119 women included in this analysis, 30 had early GDM and 89 had third trimester GDM. Women with early GDM were more likely to be non-Hispanic Black or White, but other characteristics were similar (Table 1). Women with early GDM were more likely to have clinical diagnosis of dysglycemia with deferred GTT (Table 2). Among the remaining women, GTT completion was low but similar between groups (n=4/23, 17.4% early GDM vs n=29/89, 33% third trimester GDM, p=0.15). All women with early GDM who completed GTT had evidence of dysglycemia compared to 45% of women with third trimester GDM (Table 2). When considering both clinical and laboratory criteria, women with early GDM were more likely to have postpartum dysglycemia compared to women with third trimester GDM (Table 2; OR 3.38, 95% CI 1.31-8.73). While postpartum GTT completion is low, women with early GDM appear to be at higher risk for postpartum dysglycemia compared to women with third trimester GDM. Larger studies are needed to confirm these findings, but postpartum follow-up and diabetes testing may be even more important to impact long-term health in women with early GDM.View Large Image Figure ViewerDownload Hi-res image Download (PPT)