Nutritional risk factors of early development of postpartum prediabetes and diabetes in women with gestational diabetes mellitus

Abstract

Objective Early detection of prediabetes and diabetes after delivery helps prevent and delay the development of overt type 2 diabetes in women with gestational diabetes mellitus (GDM). We sought to identify modifiable risk factors for the early development of postpartum type 2 diabetes in women with GDM that may help establish interventions for preventing or delaying the subsequent onset of type 2 diabetes. Methods Three hundred eighty-one women who developed GDM during pregnancy were tested for 1) antepartum anthropometric and biochemical measurements, 2) pregnancy outcome, 3) oral glucose tolerance test at 6 to 12 wk after delivery, and 4) postpartum anthropometric, biochemical, and nutritional measurements. The subjects were divided into three groups on the basis of the postpartum oral glucose tolerance test results: normal glucose tolerance group ( n = 193), prediabetes ( n = 161), and diabetes ( n = 27). Results The incidences of postpartum prediabetes and diabetes at 6 to 12 wk follow-up in Korean women with GDM were 44.8% and 5.2%, respectively. Antepartum modifiable risk factors for developing type 2 diabetes at early postpartum included higher body mass index, lower β-cell function, insulin dosage during late pregnancy, and the non-modifiable risk factor of family history of diabetes ( R 2 = 0.14). Postpartum risk factors included higher body mass index, serum triacylglycerols, hemoglobin A 1c, and energy intake and lower insulin secretion capacity ( R 2 = 0.43). Animal fat intake was higher in the prediabetes and diabetes groups than in the normal glucose tolerance group, whereas breast-feeding did not alter the risk for the development of postpartum diabetes. Conclusion This study strongly suggests that the development of postpartum type 2 diabetes in women with GDM can be prevented and/or delayed by lifestyle and nutritional intervention during antepartum and postpartum.