Most Women with Previous Gestational Diabetes Mellitus Have Impaired Glucose Metabolism after a Decade.

Wahlberg Jeanette,Arnqvist Hans,Ekman Bertil

doi:10.3390/ijms19123724

Wahlberg Jeanette, Arnqvist Hans + Show 1 more

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https://doi.org/10.3390/ijms19123724

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Abstract

Of 1324 women diagnosed with gestational diabetes mellitus (GDM) in Sweden, 25% reported >10 years after the delivery that they had developed diabetes mellitus. We assessed the long-term risk of all glucose metabolic abnormalities in a subgroup of these women. Women (n = 51) previously diagnosed with GDM by capillary blood glucose ≥9.0 mmol/L (≈plasma glucose ≥10.0 mmol/L) after a 2 h 75 g oral glucose tolerance test (OGTT) were included. All underwent a clinical and biochemical evaluation, including a second 2 h 75 g OGTT. Individuals with known type 1 diabetes were excluded. At the follow-up, 12/51 (24%) reported previously diagnosed type 2 diabetes. Another four cases were diagnosed after the second OGTT, increasing the prevalence to 16/51 cases (31%). Impaired fasting plasma glucose (IFG) was diagnosed in 13/51 women and impaired glucose tolerance (IGT) in 10/51 women, leaving only 12 women (24%) with normal glucose tolerance. In addition, 2/51 women had high levels of glutamic acid decarboxylase (GAD) antibodies; of these, one woman classified as type 2 diabetes was reclassified as type 1 diabetes, and the second GAD-positive woman was diagnosed with IGT. Of the women diagnosed with GDM by a 2 h 75 g OGTT, a large proportion had impaired glucose metabolism a decade later, including type 1 and type 2 diabetes.

Highlights

Women with gestational diabetes (GDM) have a high risk of developing manifest diabetes mellitus [1,2,3,4,5], and a meta-analysis in 2009 reported a 7.5-fold increased risk of developing diabetes in women who were diagnosed with gestational diabetes mellitus (GDM) during pregnancy [6]
This study shows a very high prevalence of glucose metabolic abnormalities manifesting in the long run after GDM diagnosis with a 2 h 75 g oral glucose tolerance test (OGTT) and using capillary blood glucose ≥9.0 mmol/L (≈plasma glucose ≥10.0 mmol/L) as a cut-off for diagnosis
Several studies suggest that most women with GDM will have diabetes or glucose intolerance at a long-term follow-up

Summary

Introduction

Women with gestational diabetes (GDM) have a high risk of developing manifest diabetes mellitus [1,2,3,4,5], and a meta-analysis in 2009 reported a 7.5-fold increased risk of developing diabetes in women who were diagnosed with GDM during pregnancy [6]. The prevalence of GDM is generally proportional to the prevalence of underlying type 2 diabetes, and the risk for women with GDM to develop diabetes mellitus later in life depends on several factors, like follow-up time, insulin need during pregnancy, and ethnicity [7]. GDM is an independent risk factor for long-term cardiovascular morbidity [10]. Very long-term follow-up studies, which have been influenced by the obesity epidemic during recent years, are scarce [11]. We recently reported a prevalence of 25% of manifest diabetes mellitus in a large Swedish cohort of GDM women when followed up by a questionnaire

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