Prevalence of glucose intolerance and metabolic syndrome within one year following delivery of a pregnancy complicated by gestational diabetes

Neetu K. Sodhi,Anita L. Nelson

doi:10.1186/s40834-018-0080-y

Abstract

BackgroundWomen with a history of gestational diabetes (GDM) are at risk for development of both overt Type 2 diabetes (T2DM) and cardiovascular disease (CVD) at higher rates and at earlier ages than control women. Current guidelines recommend longitudinal testing of glucose tolerance for women with prior GDM, but no formal assessments of cardiovascular disease are suggested. This study estimated the prevalence of metabolic syndrome in women with GDM in recent pregnancy who were followed for at least 1 year postpartum to quantify their cardiovascular risks.MethodsThis is a retrospective study of women who were diagnosed with GDM in a public hospital and followed for at least 1 year after delivery and who had tests performed at a minimum 4–12 weeks postpartum and 6 and 12 months postpartum. Primary outcomes were prevalence of glucose tolerance abnormalities and metabolic syndrome (MetS) defined by two prevailing sets of diagnostic criteria.ResultsOne hundred fifty-one indigent, primarily Latina women who had been diagnosed in their last pregnancy with GDM comprised the study population. At the first visit postpartum, 4.7% were found to have overt diabetes and between 24 and 31% met the criteria for MetS. By the end of 12 months, another 14.5% were diagnosed with overt diabetes, and 38.5% had prediabetes. An additional 12–25% of the woman who had not had MetS at baseline developed MetS by the end of the 1-year follow-up.ConclusionsGiven the high prevalence of MetS among women with recent history of GDM immediately postpartum and its rapid development in the following year, further research is needed to enable the development of practice guidelines that will define appropriate short and long-term evaluations needed to assess risk for cardiovascular disease in these women.

Highlights

Women with a history of gestational diabetes (GDM) are at risk for development of both overt Type 2 diabetes (T2DM) and cardiovascular disease (CVD) at higher rates and at earlier ages than control women
This is a retrospective study of the medical records of women cared for in a clinic at Harbor-UCLA Medical Center, which provided gynecological care to women, who in their last pregnancy had been diagnosed with gestational diabetes using prevailing National Diabetes Data Group criteria at the time of diagnosis
At the initial 6 weeks postpartum evaluation, 44.4% had prediabetes and 4.7% were excluded from later analysis because they were diagnosed with overt diabetes

Summary

Introduction

Women with a history of gestational diabetes (GDM) are at risk for development of both overt Type 2 diabetes (T2DM) and cardiovascular disease (CVD) at higher rates and at earlier ages than control women. This study estimated the prevalence of metabolic syndrome in women with GDM in recent pregnancy who were followed for at least 1 year postpartum to quantify their cardiovascular risks. Sodhi and Nelson Contraception and Reproductive Medicine (2018) 3:27 women who had undiagnosed pre-existing diabetes from those who only had gestational diabetes [9]. For those with normal oral glucose tolerance test results postpartum, the American College of Obstetricians and Gynecologists (ACOG) recommends assessment of glycemic status every 1–3 years [9]. The American Diabetes Association (ADA) recommends repeat testing of glucose metabolism every 3 years [14].The Endocrine Society calls for “periodic glucose assessment” at unspecified intervals [15].In Sweden, England and other countries, annual repeat testing is recommended [7]

Methods

Results

Discussion

Conclusion