Gestational Diabetes in High-Risk Populations

Abstract

G estational diabetes mellitus (GDM) is defined as glucose intolerance first recognized during pregnancy. Asian-American, Native Hawaiian, Pacific Islander, Hispanic, and African-American women are at a disparately higher risk for GDM or its long-term effects than non-Hispanic white women. Women with a history of GDM have a higher risk for subsequent type 2 diabetes. Therefore, diagnostic testing and prevention measures should be undertaken during postnatal follow-up. The former is necessary to diagnose persistent postnatal glucose intolerance, and the latter is supported by several studies showing that treating insulin resistance reduces the risk of type 2 diabetes in women who have had GDM.1–3 GDM is associated with significant complications during pregnancy, including an increased need for Cesarean sections; higher risks of ketonemia, preeclampsia, and urinary tract infection in both mothers and infants; increased perinatal morbidity (e.g., macrosomia, neonatal hypoglycemia, and neonatal jaundice); and possibly mortality. GDM also identifies women with a high risk for future GDM and type 2 diabetes. In a systematic review of 13 studies,4 recurrence rates for GDM after the index pregnancy varied widely, with lower rates observed in non-Hispanic white populations (30–37%) and higher rates in minority populations (52–69%). In a systematic review of 28 studies, Kim et al.5 found the subsequent incidence of type 2 diabetes to also vary widely, but after adjusting for many of the differences among these studies, women from mixed (non-Hispanic white plus non-white) as well as non-white cohorts seemed to progress to diabetes at similar rates, with progression increasing steeply within the first 5 years after delivery and then reaching a plateau. The Diabetes Prevention Program1 showed that women who had a history of GDM had a 74% increased age-adjusted risk for diabetes compared to women who had no history of GDM. Similar to their …