Abstract
Objective The aims of the study were to evaluate, after pregnancy, the glycemic status of women with history of gestational diabetes mellitus (GDM) and to identify clinical variables associated with the development of type 2 diabetes mellitus (T2DM), impaired fasting glucose (IFG), and impaired glucose tolerance (IGT). Methods Retrospective cohort of 279 women with GDM who were reevaluated with an oral glucose tolerance test (OGTT) after pregnancy. Characteristics of the index pregnancy were analyzed as risk factors for the future development of prediabetes (IFG or IGT), and T2DM. T2DM was diagnosed in 34 (12.2%) patients, IFG in 58 (20.8%), and IGT in 35 (12.5%). Women with postpartum T2DM showed more frequently a family history of T2DM, higher pre-pregnancy body mass index (BMI), lower gestational age, higher fasting and 2-hour plasma glucose levels on the OGTT at the diagnosis of GDM, higher levels of hemoglobin A1c, and a more frequent insulin requirement during pregnancy. Paternal history of T2DM (odds ratio [OR] = 5.67; 95% confidence interval [95%CI] = 1.64-19.59; p = 0.006), first trimester fasting glucose value (OR = 1.07; 95%CI = 1.03-1.11; p = 0.001), and insulin treatment during pregnancy (OR = 15.92; 95%CI = 5.54-45.71; p < 0.001) were significant independent risk factors for the development of T2DM. Conclusion A high rate of abnormal glucose tolerance was found in women with previous GDM. Family history of T2DM, higher pre-pregnancy BMI, early onset of GDM, higher glucose levels, and insulin requirement during pregnancy were important risk factors for the early identification of women at high risk of developing T2DM. These findings may be useful for developing preventive strategies.
Highlights
Gestational diabetes mellitus (GDM) is historically defined as “any degree of glucose intolerance with onset or first recognition during pregnancy”, and may or may not persist after labor.[1]
Patients who returned after labor for reevaluation of glucose tolerance status were divided into four subgroups: type 2 diabetes mellitus (T2DM), impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and normal glucose tolerance (NGT)
Among the 279 patients reevaluated in the postpartum period, 127 (45.5%) showed some rate of abnormal glucose tolerance: 34 (12.2%) were diagnosed with T2DM; 93 (33.3%) were considered pre-diabetic (IFG and/or IGT): 58 (20.8%) showed isolated IFG, and 35 (12.5%) showed IGT; and 152 women (54.5%) sustained NGT (►Fig. 1)
Summary
Gestational diabetes mellitus (GDM) is historically defined as “any degree of glucose intolerance with onset or first recognition during pregnancy”, and may or may not persist after labor.[1] This concept had limitations, considering the inclusion of pregnant women with type 2 diabetes mellitus (T2DM) not previously diagnosed It was modified after the study Hyperglycemia and Adverse Pregnancy Outcome (HAPO), which evaluated more than 25,000 pregnant women and intended to find the cutoff point of the maternal plasma glucose associated to the increase of adverse perinatal events.[2] The diagnostic patterns for GDM were revised, and the recommendation according to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) since 2010 is that pregnant women who fit the diagnosis of T2DM at the first prenatal appointment be diagnosed as having overt diabetes. After the alterations in the diagnostic criteria, the global prevalence of gestational hyperglycemia increased and was estimated at $ 17%, with some regional variations.[5,6] The study of Trujillo et al[7] applied such parameters to a cohort of more than 5,000 pregnant women of the Brazilian Gestational Diabetes Study, conducted between 1991 and 1995, finding an estimated prevalence of 18% of GDM
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