Glucose levels during gestational diabetes pregnancy and the risk of developing postpartum diabetes or prediabetes

Chadakarn Phaloprakarn,Siriwan Tangjitgamol

doi:10.1186/s12884-021-04352-w

Chadakarn Phaloprakarn, Siriwan Tangjitgamol

Open Access

https://doi.org/10.1186/s12884-021-04352-w

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Abstract

BackgroundBlood glucose levels during pregnancy may reflect the severity of insulin secretory defects and/or insulin resistance during gestational diabetes mellitus (GDM) pregnancy. We hypothesized that suboptimal glycemic control in women with GDM could increase the risk of postpartum type 2 diabetes mellitus (T2DM) or prediabetes. Our objective was to evaluate the impact of plasma glucose levels throughout GDM pregnancy on the risk of postpartum T2DM or prediabetes.MethodsThe medical records of 706 women with GDM who underwent a postpartum 75-g, 2-hour oral glucose tolerance test at our institution between January 2011 and December 2018 were reviewed. These women were classified into 2 groups according to glycemic control during pregnancy: ≤ 1 occasion of either fasting glucose ≥ 95 mg/dL or 2-hour postprandial glucose ≥ 120 mg/dL was defined as optimal glycemic control or else was classified as suboptimal glycemic control. Rates of postpartum T2DM and prediabetes were compared between women with optimal (n = 505) and suboptimal (n = 201) glycemic control.ResultsThe rates of postpartum T2DM and prediabetes were significantly higher in the suboptimal glycemic control group than in the optimal glycemic control group: 22.4% vs. 3.0%, P < 0.001 for T2DM and 45.3% vs. 23.5%, P < 0.001 for prediabetes. In a multivariate analysis, suboptimal glucose control during pregnancy was an independent risk factor for developing either postpartum T2DM or prediabetes. The adjusted odds ratios were 8.4 (95% confidence interval, 3.5–20.3) for T2DM and 3.9 (95% confidence interval, 2.5–6.1) for prediabetes.ConclusionOur findings suggest that blood glucose levels during GDM pregnancy have an impact on the risk of postpartum T2DM and prediabetes.

Highlights

Blood glucose levels during pregnancy may reflect the severity of insulin secretory defects and/or insulin resistance during gestational diabetes mellitus (GDM) pregnancy
Given that the levels of blood glucose during pregnancy may reflect the severity of insulin secretory defects and/ or insulin resistance during GDM pregnancy [11], we hypothesized that suboptimal glycemic control in women with GDM would impart an increased risk of postpartum type 2 diabetes mellitus (T2DM) or prediabetes
Characteristics of the study population A total of 706 women with GDM who had available data on plasma glucose levels during pregnancy and measurements of postpartum fasting plasma glucose (FPG) and 75-g, 2-hour oral glucose tolerance test (OGTT) were included for analysis

Summary

Introduction

Blood glucose levels during pregnancy may reflect the severity of insulin secretory defects and/or insulin resistance during gestational diabetes mellitus (GDM) pregnancy. Gestational diabetes mellitus (GDM) is a common metabolic disorder in pregnancy that affects 20% to 25% of Southeast Asian pregnant women [1]. This metabolic derangement is characterized by insufficient insulin. Given that the levels of blood glucose during pregnancy may reflect the severity of insulin secretory defects and/ or insulin resistance during GDM pregnancy [11], we hypothesized that suboptimal glycemic control in women with GDM would impart an increased risk of postpartum T2DM or prediabetes. The criteria for optimal and suboptimal glycemic control were based on the standard recommendations of the American Diabetes Association (ADA) and the American College of Obstetricians and Gynecologists (ACOG) that the fasting plasma glucose (FPG) in GDM pregnancy should be maintained below 95 mg/dL and the 1-hour or 2-hour postprandial glucose below 140 mg/dL or 120 mg/dL, respectively [12, 13]

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