Abstract
Objective To investigate the long-term outcome of postpartum glucose metabolism and predictive factors in patients with gestational diabetes mellitus (GDM). Methods A total of 1 191 patients diagnosed with GDM in the First Hospital of Peking University between November 2006 and October 2013, 320 (26.9%) patients were followed up and glucose metabolic data were collected during pregnancy, short-term postpartum (6-12 weeks) and long-term postpartum (1-6 years) periods. With type 2 diabetes mellitus (T2DM) as the end point event, the survival curve was drawn by Kaplan-Meier method to analyze the incidence of postpartum T2DM year by year, and Cox multivariate regression was used to analyze the predictive factors of postpartum T2DM. Results In 1-6 years of postpartum period, 9 (2.8%) cases had impaired fasting glucose (IFG), 71 (22.2%) had impaired glucose tolerance (IGT) and 14 (4.3%) had T2DM. Both of fasting plasma glucose (FPG) and 2 hour postprandial glucose (2hPG) elevated year by year in postpartum period. Kaplan-Meier survival curve indicated the cumulative incidence of T2DM were 0, 0.9%, 2.7%, 4.6%, 7.0% and 18.8% in 1-6 years of postpartum period, respectively. Early pregnancy weight, FPG/2hPG during pregnancy, FPG/2hPG/waist/hip ratio in early postpartum period were risk factors of long-term postpartum T2DM (all P<0.05). Body weight ≥72 kg in early pregnancy and FPG ≥5.2 mmol/L in early postpartum period were independent predictive factors, hazard ratio (HR) were 14.9 [95% confidence interval (CI) 2.3-96.1] and 18.2 (1.9-173.0) , respectively. Conclusions The cumulative incidence of T2DM in GDM patients increases annually, especially in the 5th-6th year of postpartum period. High body weight in early pregnancy and postpartum short-term FPG ≥5.2 mmol/L have important significance to predict the long-term outcome of postpartum glucose metabolism. Key words: Diabetes mellitus, gestational; Diabetes mellitus, type 2; Postpartum
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