Post-partum weight loss and glucose metabolism in women with gestational diabetes: the DEBI Study.

Abstract

Women with gestational diabetes are at high risk for developing diabetes; post-partum weight loss may reduce the risk of diabetes. We evaluated the association of post-partum weight change with changes in glucose, insulin and homeostasis model assessment of insulin resistance in a subsample (n=72) of participants from Diet Exercise and Breastfeeding Intervention (DEBI), a randomized pilot trial of lifestyle intervention for women with gestational diabetes. Glucose and insulin were measured fasting and 2h after an oral glucose tolerance test at 6weeks and 12months post-partum. Women were categorized by weight change (lost >2kg vs. maintained/gained) between 6weeks and 12months post-partum. Compared with women who maintained or gained weight, women who lost >2kg experienced significantly lower increases in fasting glucose [age-adjusted means: 0.1mmol/l (95%CI -0.03 to 0.3) vs. 0.4mmol/l (95%CI 0.3-0.6); P<0.01] and 2-h insulin [10.0pmol/l (95%CI -56.9 to 76.9) vs. 181.2pmol/l (95%CI 108.3-506.9); P<0.01] and a significant reduction in 2-h glucose [-0.9mmol/l (95%CI -1.4 to -0.3) vs. 0.3mmol/l (95%CI -0.3 to 0.9); P<0.01]. In multiple linear regression models adjusted for age, Hispanic ethnicity, medication use, meeting the Institute of Medicine's recommendations for gestational weight gain, breastfeeding and randomized group, a 1-kg increase in weight was significantly associated with increases in fasting and 2-h glucose (P<0.05), but was not associated with insulin or homeostasis model assessment of insulin resistance. In women with gestational diabetes, modest post-partum weight loss may be associated with improvements in glucose metabolism.