Glucose Intolerance In Women Research Articles

One-year postpartum weight retention and glucose intolerance in women with prediabetes after gestational diabetes.

To determine risk factors for 1-year postpartum weight retention (PPWR) and glucose intolerance (prediabetes + diabetes) in women with a previous history of gestational diabetes (GDM) and prediabetes in early postpartum. In this exploratory analysis of the MELINDA randomized controlled trial, we report data of 167 women with prediabetes at the 6-16 weeks (early) postpartum oral glucose tolerance test after a recent history of GDM. Of all participants, 45% (75) had PPWR >0 kg at 1-year postpartum. Compared to women without PPWR, women with PPWR had higher gestational weight gain [10.5 ± 6.4 vs. 6.5 ± 4.5 kg, p < 0.001], higher BMI (p < 0.01) and a worse metabolic profile (higher waist circumference, worse lipid profile and more insulin resistance) (all p < 0.05) both in early and late postpartum. Of all women with PPWR, 40.0% developed metabolic syndrome, compared to 18.9% of women without late PPWR (p = 0.003). The only independent predictor for late PPWR was weight retention in early postpartum (p < 0.001). Of all participants, 55.1% (92) had glucose intolerance (84 prediabetes, 8 diabetes) 1-year postpartum. Independent predictors for late postpartum glucose intolerance were lower gestational age at start insulin therapy in pregnancy and delivery by caesarean section (resp. p = 0.044 and 0.014). In women with a previous history of GDM and prediabetes in early postpartum, PPWR in early postpartum was a strong independent predictor for late PPWR, while earlier start of insulin therapy during pregnancy and delivery by caesarean section were independent predictors of glucose intolerance in late postpartum.

Impact of breastfeeding on risk of glucose intolerance in early postpartum after gestational diabetes.

To determine the impact of breastfeeding on the risk of postpartum glucose intolerance in women with gestational diabetes. Sub-analysis of two multi-centric prospective cohort studies (BEDIP-N and MELINDA) in 1008 women with gestational diabetes. Data were collected during pregnancy and at a mean of 12 weeks postpartum. Multivariate logistic regression was used to estimate the effect of breastfeeding on glucose intolerance, with adjustment for ethnicity, education, income, professional activity and BMI. Of all participants, 56.3% (567) breastfed exclusively, 10.1% (102) gave mixed milk feeding and 33.6% (339) did not breastfeed. Mean breastfeeding duration was 3.8 ± 2.4 and 3.7 ± 2.1 months in the breastfeeding and mixed milk feeding groups (p=0.496). The rate of glucose intolerance was lower in both the breastfeeding [22.3% (126)] and mixed milk feeding [25.5% (26)] groups compared to the no breastfeeding group [29.5% (100)], with an adjusted OR of 0.7 (95% CI 0.5-1.0) for glucose intolerance in the breastfeeding group compared to no breastfeeding group and an adjusted OR of 0.7 (95% CI 0.4-1.2) for the mixed milk feeding group compared to the no breastfeeding group. Postpartum, breastfeeding women had a lower BMI, less often postpartum weight retention, lower fasting triglycerides, less insulin resistance and a higher insulin secretion-sensitivity index-2 than the mixed milk feeding and no breastfeeding group. The mixed milk feeding group was more often from an non-White background, had a lower blood pressure and lower fasting triglycerides compared to the no breastfeeding group. Breastfeeding (exclusive and mixed milk feeding) is associated with less glucose intolerance and a better metabolic profile in early postpartum in women with gestational diabetes.

Risk prediction models for postpartum glucose intolerance in women with a history of gestational diabetes mellitus: a scoping review.

The objective of this scoping review was to investigate the effectiveness and limitations of risk prediction models for postpartum glucose intolerance in women with gestational diabetes mellitus (GDM). The aim was to provide valuable insights for healthcare professionals in the development of robust risk prediction models. A comprehensive literature search was conducted across multiple databases, including PubMed, EBSCO, Web of Science Core Collection, Ovid Full-Text Medical Journal Database, ProQuest, Elsevier ClinicalKey, China National Knowledge Infrastructure, China Biology Medicine, and WanFang Database, spanning from January 1990 to July 2023. To assess the quality of the included models, the Predictive Model Risk of Bias Assessment Tool (PROBAST) was employed. Fourteen relevant studies were identified and included in the final review, all focusing on model development. The discrimination ability of the included models ranged from 0.725 to 0.940, indicating satisfactory prediction accuracy. However, a notable limitation was that nine of these models (64.3%) did not provide clear guidelines on the selection of potential predictors. Furthermore, only six models (42.86%) underwent internal validation, with none undergoing external validation. A high risk of bias was observed across the included models. Logistic regression, Cox regression, and machine learning were the primary methods employed in the construction of these models. The risk prediction models included in this review demonstrated favorable prediction accuracy. However, due to variations in construction methodologies, direct comparison of their performance is challenging. These models exhibited certain shortcomings, such as inadequate handling of missing data and a lack of internal and external validation, resulting in a high risk of bias. Therefore, it is recommended that these models be updated and externally validated. The development of prospective, multi-center studies is encouraged to construct predictive models with low risk of bias and high clinical applicability, ultimately guiding evidence-based clinical practice. The online version contains supplementary material available at 10.1007/s40200-023-01330-1.

Risk factors associated with early postpartum glucose intolerance in women with a history of gestational diabetes mellitus: a systematic review and meta-analysis.

This meta-analysis was aimed at exploring the incidence and risk factors of glucose intolerance in women with gestational diabetes mellitus (GDM) at 6-12 weeks postpartum to inform the development of preventive strategies. We searched Pubmed, Embase, Web of Science, the Cochrane Library, Ovid, China Knowledge Resource Integrated Database (CNKI), Wanfang Database and China Biology Medicine Database for entries between January 1990 and September 2022. The search terms included gestational diabetes mellitus, postpartum, glucose intolerance and type 2 diabetes. The meta-analysis was conducted using Stata 14.0. We included 37 studies, with 21 and 16 having low and medium risk of bias, respectively. The incidence of glucose intolerance in women with GDM 6-12 weeks postpartum was 27% (95% CI: 0.22-0.33). The following risk factors for GDM 6-12 weeks postpartum were identified: insulin use during pregnancy (OR = 3.23; 95% CI: 2.35-4.44), family history of diabetes (OR = 2.94; 95% CI: 1.98-4.33), abnormal fasting glucose levels at 24-28 weeks of gestation (OR = 1.15; 95% CI: 1.07-1.25), high pre-pregnancy BMI (OR = 1.63; 95% CI: 1.23-2.15), abnormal triglyceride levels during 28-40 weeks of gestation (OR = 2.18; 95% CI: 1.18-4.03), abnormal HbA1c levels at 28-40 weeks of gestation (OR = 6.62; 95% CI: 4.71-9.30), history of previous GDM (OR = 2.11; 95% CI: 1.27-3.49), and high 1-h glucose levels at 24-28 weeks of gestation (OR = 1.16; 95% CI:1.06-1.28). The incidence of glucose intolerance in GDM patients at 6-12 weeks postpartum was high. To prevent early postpartum glucose intolerance, healthcare providers should develop individualized interventions for GDM patients, depending on existing risk factors.

Interaction of Iron Homeostasis and Fatty Acid Metabolism in the Development of Glucose Intolerance in Women with Previous Gestational Diabetes Mellitus.

A gestational diabetes mellitus (GDM) diagnosis during pregnancy means an increased risk of developing type 2 diabetes later in life. By following up with women after GDM we aimed to examine the relationship between iron parameters, individual fatty acids (FAs) and desaturases in the development of impaired glucose metabolism (IGM). Based on an oral glucose tolerance test (OGTT), six years after GDM, 157 women were grouped as having normal glucose tolerance (NGT) or IGM. Fasting serum FAs, activity of desaturases and iron parameters (ferritin, transferrin, iron, soluble transferrin receptor, total iron binding capacity, hepcidin) were measured, and clinical and anthropometric measurements taken. Soluble transferrin receptor was higher in the IGM group compared to the NGT group (3.87 vs. 3.29 mg/L, p-value = 0.023) and associated positively with saturated FAs and negatively with monounsaturated FAs in the IGM group (adjusted for BMI, age and high sensitivity C-reactive protein; p-value < 0.05). Iron, as well as transferrin saturation, showed a positive association with MUFAs and desaturase activity. These associations were not seen in the NGT group. These results suggest that iron homeostasis and FA metabolism interact in the development of glucose intolerance in women with previous GDM.

Machine-learning prediction of early postpartum glucose intolerance in women with gestational diabetes mellitus

Machine-learning prediction of early postpartum glucose intolerance in women with gestational diabetes mellitus

Maternal height as a predictor of glucose intolerance in the postpartum and its relationship with maternal pre-gestational weight.

Short stature predicts higher risk of developing type 2 diabetes. We studied the association between height and glucose intolerance in women with gestational diabetes mellitus (GDM) and whether this association differed according to body mass index (BMI). Retrospective study of the Portuguese GDM registry. missing data on postpartum oral glucose tolerance test (OGTT) or BMI. postpartum glucose intolerance (diabetes mellitus or prediabetes on the 6-8weeks postpartum OGTT). Women were divided by mean height and compared. A multivariate logistic regression was used, and the analysis was stratified by BMI (cut-off: 30kg/m2) and interaction was tested. We included 7402 women; mean height was 161.9 ± 6.2cm. Taller women had lower BMI and lower rates of glucose intolerance (6.8 vs. 8.8%, p = 0.002). Women with BMI < 30kg/m2 were taller than those with obesity. Height associated with glucose intolerance. The multivariate adjusted OR of glucose intolerance was 0.98 (95% CI 0.96-0.99), p = 0.001, per 1cm increase in height. This association was only observed in women with BMI < 30kg/m2: OR 0.97 (95% CI 0.95-0.99), < 0.001. There was no such association in women with BMI ≥ 30kg/m2: OR 0.99 (95% CI 0.97-1.02), p = 0.65. P for interaction between BMI and height was 0.09. In non-obese pre-gestational women, height is inversely associated with postpartum glucose intolerance. Per 1cm increase in height, women present a 3% decrease in the risk of developing diabetes mellitus or prediabetes.

Association between lipid trajectories during pregnancy and risk of postpartum glucose intolerance after gestational diabetes mellitus: a cohort study

AimsTo assess lipid trajectories throughout pregnancy in relation to early postpartum glucose intolerance in women with gestational diabetes mellitus (GDM).MethodsThis prospective cohort study included 221 Chinese women with GDM who completed plasma lipid test in each trimester of pregnancy and oral glucose tolerance test at 6–9 weeks postdelivery between January 1, 2018 and January 8, 2020. Using the group-based trajectory modeling, total cholesterol (TC), triglyceride (TG), low-density lipoprotein-cholesterol (LDL-c), and high-density lipoprotein-cholesterol(HDL-c) were identified separately as three trajectories: low, moderate, and high trajectory. The associations between lipid trajectories and early postpartum glucose intolerance were all evaluated.ResultsSeventy-three participants developed postpartum glucose intolerance. For patients in low, moderate and high trajectory, the incidence of postpartum glucose intolerance was 38.4%, 34.9%, and 17.9%, respectively. GDM women with lower LDL-c trajectories presented a higher risk of postpartum glucose intolerance. The adjusted odds ratio (95% CI) for glucose intolerance was 3.14 (1.17–8.39) in low LDL-c trajectory and 2.68 (1.05–6.85) in moderate trajectory when compared with the high one. However, TC trajectory was not associated with the risk of postpartum glucose intolerance, nor were TG trajectory and HDL-c trajectory. Moreover, a significant difference of insulin sensitivity was observed in participants with different LDL-c trajectories; participants in high LDL-c trajectory had the highest insulin sensitivity, whereas the women in low LDL-c trajectory had the lowest insulin sensitivity (P = 0.02).ConclusionsThe high trajectory of LDL-c during pregnancy may play a protective role on postpartum glucose intolerance in women with GDM. Further studies are warranted to explore the underlying mechanism.Trial registration The study was reviewed and approved by the Institutional Review Board of The First Affiliated Hospital of Sun Yat-sen University (reference number: [2014]No. 93). All participants provided written informed consent forms, and the ethics committee approved this consent procedure.

Predictive factors for postpartum glucose intolerance in women with gestational diabetes mellitus.

The aim of this prospective cohort study was to evaluate the risk factors for postpartum glucose intolerance (GI) in women with gestational diabetes mellitus (GDM). A total of 140 women with GDM were enrolled. Of these, 115 underwent a 75-g oral glucose tolerance test (OGTT) at 12 weeks after delivery. Clinical factors and parameters in the antepartum 75-g OGTT associated with postpartum GI were evaluated by logistic regression analyses. Twenty-two (19.1%) of the 115 women with GDM developed postpartum GI. The univariate and multivariable logistic regression analyses revealed that low oral disposition index (DI) was a risk factor for postpartum GI (OR, 0.2; 95% CI, 0.04-0.7; p < 0.05), and that no clinical factors were associated with postpartum GI. Lower oral DI on the antepartum 75-g OGTT may be a useful marker for identifying GDM women who are at high risk for postpartum GI.

The Modulation of Gut Microbiota Composition in the Pathophysiology of Gestational Diabetes Mellitus: A Systematic Review.

Simple SummaryRecent studies have placed a great deal of emphasis on the importance of the microbiome, especially the link between the alteration of gut microbiota and multiple associated diseases. Gut microbiota changes in pregnancy have a significant impact on metabolic function and may contribute to gestational diabetes mellitus (GDM). Although GDM carries long-term health risks that affect women, there are also significant short- and severe long-term consequences for the offspring. Regardless, there is a notable lack of research focusing on the impact of prominent microorganisms involved in the development of GDM. A comprehensive review was conducted to gather relevant data on the types of microorganisms that have been associated with GDM. The review found that certain microorganisms impact the onset and progression of GDM during pregnancy. Several bacterial strains associated with GDM are influenced by a diet high in fat and low in fiber. Therefore, integrating the idea of a microbiome-based individualized dietary intervention into gestational diabetes management may be incredibly beneficial.General gut microbial dysbiosis in diabetes mellitus, including gestational diabetes mellitus (GDM), has been reported in a large body of literature. However, evidence investigating the association between specific taxonomic classes and GDM is lacking. Thus, we performed a systematic review of peer-reviewed observational studies and trials conducted among women with GDM within the last ten years using standard methodology. The National Institutes of Health (NIH) quality assessment tools were used to assess the quality of the included studies. Fourteen studies investigating microbial interactions with GDM were found to be relevant and included in this review. The synthesis of literature findings demonstrates that Bacteroidetes, Proteobacteria, Firmicutes, and Actinobacteria phyla, such as Desulfovibrio, Ruminococcaceae, P. distasonis, Enterobacteriaceae, Collinsella, and Prevotella, were positively associated with GDM. In contrast, Bifidobacterium and Faecalibacterium, which produce butyrate, are negatively associated with GDM. These bacteria were associated with inflammation, adiposity, and glucose intolerance in women with GDM. Lack of good diet management demonstrated the alteration of gut microbiota and its impact on GDM glucose homeostasis. The majority of the studies were of good quality. Therefore, there is great potential to incorporate personalized medicine targeting microbiome modulation through dietary intervention in the management of GDM.

162-LB: Plasma Glycated CD59 Predicts Postpartum Glucose Intolerance after Gestational Diabetes

pGCD59 is an emerging biomarker for diabetes and GDM. In studies of women undergoing GDM screening either early in pregnancy (week &amp;lt;20) or at pregnancy weeks 24-28, pGCD59 classified GDM subjects with high sensitivity and specificity and was associated with the prevalence of large for gestational age (LGA) babies (Diabetes Care 2017 and JCEM 2020). GDM developed early in pregnancy imparts a seven-fold increased risk of subsequent glucose intolerance and diabetes. Since HbA1c is not sensitivity to detect glucose intolerance in early postpartum, professional organizations including ADA, recommend that women with GDM should undergo OGTT testing 6-12 weeks postpartum. However, the cumbersome nature of OGTT makes compliance with this requirement very low, highlighting the need for alternative biomarkers that can be used postpartum to test women with GDM for potential conversion glucose intolerance. To assess the ability of pGCD59 to identify postpartum conversion to glucose intolerance in women with GDM, levels of pGCD59 were measured in samples from participants in the Belgian Diabetes in Pregnancy (BEDIP-N, Diabetes Care 2018) cohort study who underwent OGTT testing 6-12 weeks postpartum. Among 105 samples from women with GDM, 36 subjects met OGTT criteria for glucose intolerance (cases) and 70 had normal OGTT (matched controls). Maternal age, race/ethnicity, and BMI were similar among Cases and Controls. pGCD59 was significantly higher in cases than in controls (1.5 ±0.6 SPU vs. 1.0 ±0.6 SPU, p &amp;lt; 0.001) and accurately predicted the postpartum conversion to glucose intolerance as indicated by an AUCROC of 0.72 (95% CI 0.62-0.83). A 0.5-unit increase in postpartum pGCD59 was associated with an OR of 2.0 (95% CI 1.34-2.95, p&amp;lt;0.001) for glucose intolerance. Our results indicate that pGCD59 is a simpler biomarker to assess postpartum conversion to glucose intolerance in women with GDM and represents an alternative to improve compliance with postpartum screening for glucose intolerance. Disclosure K. Benhalima: None. D. Ma: None. M. Toth castillo: None. A. Laenen: None. C. Mathieu: Advisory Panel; Self; Novo Nordisk, Sanofi, Merck Sharp and Dohme Ltd., Eli Lilly and Company, Novartis, AstraZeneca, Boehringer Ingelheim, Roche, Medtronic, ActoBio Therapeutics, Pfizer, Insulet and Zealand Pharma, Research Support; Self; Medtronic, Novo Nordisk, Sanofi and ActoBio Therapeutics, Speaker’s Bureau; Self; Novo Nordisk, Sanofi, Eli Lilly and Company, Boehringer Ingelheim, AstraZeneca and Novartis. J. Halperin: Board Member; Self; Mellitus, LLC. Funding National Institutes of Health (R01DK118528, DK101442); Belgian National Lottery; Fund of Academic Studies of UZ Leuven; Yvonne and Jacques François-de Meurs of the King Boudewijn Foundation

Investigation of the progress in the women with gestational diabetes mellitus postpartum

Aims: Our aim was to evaluate the uptake of postpartum screening, the prevalence and the risk factors for glucose intolerance in women with a recent history of gestational diabetes mellitus (GDM). Methods: All women with a history of GDM are advised to undergo a 75g oral glucose tolerance test (OGTT) around 6 - 12 weeks postpartum. Indices of insulin sensitivity (the Matsuda index and the reciprocal of the homeostasis model assessment of insulin resistance, HOMA-IR) and an index of beta-cell function, the Insulin Secretion-Sensitivity Index-2 (ISSI-2) were calculated based on the OGTT postpartum. Multivariable logistic regression was used to some factors. Results: Of all women (135) who received an OGTT postpartum, 42.2% (57) had glucose intolerance (11.8% impaired fasting glucose, 24.4% impaired glucose tolerance and 6.0% both impaired fasting and impaired glucose tolerance) and 1.5% (2) had overt diabetes. Compared to women with a normal OGTT postpartum, women with glucose intolerance and diabetes were older (32.5 ± 4.3 vs. 30.8 ± 4.8 years, p = 0.049), were more often obese (34.5% vs. 17.3%, p = 0.023). In the multivariable logistic regression, an EM background [OR = 2.76 (1.15 - 6.62), p = 0.023] and the HbA1c level at the time of the OGTT in pregnancy [OR = 4.78 (1.19 - 19.20), p = 0.028] remained significant predictors for glucose intolerance postpartum. Women with glucose intolerance and diabetes postpartum had a similar insulin sensitivity [Matsuda index 0.656 (0.386 - 1.224) vs. 0.778 (0.532 - 1.067), p = 0.709; HOMA-IR 0.004 (0.002 - 0.009) vs. 0.064 (0.003 - 0.007), p = 0.384] but a lower beta-cell function compared to women with a normal OGTT postpartum, remaining significant after adjustment for confounders [ISSI-2 1.6 (1.2 - 2.1) vs. 1.9 (1.7 - 2.4), p = 0.002]. Conclusions: Glucose intolerance is very frequent in early postpartum in women with GDM these women have an impaired beta-cell function. Nearly one third of women did not attend the scheduled OGTT postpartum and these women have an adverse risk profile. More efforts are needed to engage and stimulate women with GDM to attend the postpartum OGTT.

Clinical Characteristics, Outcomes, and Progression to Type 2 Diabetes in Women with Hyperglycemia in Pregnancy.

Context:Women with hyperglycemia in pregnancy (HIP) are at increased risk of developing type 2 diabetes (T2D).Aim:The present study intended to study the incidence of postpartum diabetes among HIP women and predict its risk factors.Settings and Design:This was a prospective observational study done on 178 women with HIP diagnosed after the first trimester, attending the tertiary care hospitals between December 2018 and March 2020.Materials and Methods:Demographics, clinical variables, and feto-maternal outcomes were recorded. The postpartum glycemic status was determined using a 75 g oral glucose tolerance test (OGTT) at 1 and 6 months.Statistical Analysis:All analyses were performed with SPSS software (version 21.0).Results:The mean age of women with HIP was 30.2 ± 6.1 years, with 38% having a family history of diabetes. Eighty percent of the women delivered full-term babies and 71.3% underwent a cesarean section. Gestational hypertension was present in 21.9% of patients. Macrosomia was present in 4.6% of the babies, hypoglycemia in 6.7%, and spontaneous abortion occurred in 7.7%. Postpartum OGTT at 6 months was completed by 76.4% of participants. The incidence of diabetes and glucose intolerance postpartum was 11.7 and 16.2%, respectively at 6 months. Logistic regression analysis showed that maternal obesity, diagnosis of HIP at an earlier trimester (<24 weeks), need for insulin treatment during pregnancy, signs of insulin resistance and fasting and 2-h plasma glucose >100 (>5.6 mmol/L) and >195 mg/dL (>10.9 mmol/L), respectively, and glycated hemoglobin > 6.5% (>48 mmol/mol) increased the risk of having postpartum diabetes significantly.Conclusion:The incidence of postpartum glucose intolerance in women with HIP is high. Prospective diabetes evaluation is required and intervention should be considered in women with HIP who have obesity, diagnosis of HIP at an earlier trimester, signs of insulin resistance, and require insulin treatment during pregnancy.

Association between neonatal birthweight and risk of maternal glucose intolerance after gestational diabetes mellitus.

Aims/IntroductionTo evaluate whether the neonatal birthweight (NBW) is associated with early postpartum glucose intolerance in women with gestational diabetes mellitus.Materials and MethodsA total of 1,113 women diagnosed with gestational diabetes mellitus who completed an oral glucose tolerance test at 6–9 weeks postpartum between 1 April 2014 and 8 January 2020 were included in this observational prospective cohort study. They were grouped by neonatal birthweight quartiles, and the odds ratios of postpartum glucose intolerance for different levels of neonatal birthweight were assessed.ResultsA lower NBW quartile was associated with an increased maternal risk of postpartum glucose intolerance after gestational diabetes mellitus. The adjusted odds ratios for maternal glucose intolerance were 1.69 (95% confidence interval 1.13–2.51) in the lowest NBW quartile (NBW 1,980–2,930 g) when compared with the highest NBW quartile (NBW 3,410–4,610 g). The association between lower NBW and maternal glucose intolerance was significantly stronger in women who delivered a girl. Additionally, NBW ≥3,100 g appears to be associated with a lower risk of maternal glucose intolerance postpartum.ConclusionsOur findings suggest that low NBW is a previously unrecognized risk factor for maternal glucose intolerance after gestational diabetes in early postpartum in South China.

Predictors of postpartum glucose intolerance in women with gestational diabetes mellitus: a prospective cohort study in Ethiopia based on the updated diagnostic criteria

ObjectivesTo identify the incidence of postpartum glucose intolerance and develop a prediction model based on antenatal characteristics to predict postpartum glucose intolerance.DesignProspective cohort study.SettingGondar town public health facilities in Northwest...

Vitamin D Deficiency at Mid-Pregnancy Is Associated with a Higher Risk of Postpartum Glucose Intolerance in Women with Gestational Diabetes Mellitus.

BackgroundTo evaluate the association between serum 25-hydroxyvitamin D (25(OH)D) at mid-pregnancy and postpartum glucose intolerance in women with gestational diabetes mellitus (GDM).MethodsWe enrolled 348 pregnant women diagnosed with GDM from August 2012 to October 2016. We measured serum 25(OH)D levels at mid-pregnancy and carried out a 75-g oral glucose tolerance test at 6 to 12 weeks after delivery. Vitamin D deficiency was defined as serum 25(OH)D <20 ng/mL.ResultsThe prevalence of vitamin D deficiency was 76.7% (n=267). Women with vitamin D deficiency had a higher prevalence of postpartum glucose intolerance than did those without vitamin D deficiency (48.7% vs. 32.1%, P=0.011). Serum 25(OH)D level was negatively correlated with hemoglobin A1c at antepartum and postpartum period (antepartum: r=−0.186, P=0.001; postpartum: r=−0.129, P=0.047). Homeostasis model assessment of β-cell function was positively correlated with serum 25(OH)D level only postpartum (r=0.138, P=0.035). The risk of postpartum glucose intolerance was 2.00 times (95% confidence interval, 1.13 to 3.55) higher in women with vitamin D deficiency than in those without vitamin D deficiency (P=0.018).ConclusionIn women with GDM, vitamin D deficiency at mid-pregnancy is associated with an elevated risk of postpartum glucose intolerance.

The effect of breastfeeding on postpartum glucose tolerance and lipid profiles in women with gestational diabetes mellitus

BackgroundWe aimed to investigate the association of breastfeeding on postpartum glucose levels and lipid profiles in women diagnosed with gestational diabetes mellitus (GDM) and women without GDM.MethodsWe performed a secondary analysis of a cohort study of 243 women, 159 women with GDM and 84 normally glucose tolerant women between 2012 and 2017. At approximately 6–10 weeks postpartum, we measured fasting blood glucose and plasma lipid levels. Breastfeeding behaviour was self-defined as exclusive breastfeeding or not exclusive breastfeeding.ResultsThe mean (SD) glucose in the group of women who breastfed exclusively was 4.6 (0.49) mmol/L, compared to 4.9 (0.58) mmol/L (95% CI 0.45, 0.15, p < 0.001) among women who did not exclusively breastfeed. Among women with GDM, the reduction in fasting glucose in women who were breastfeeding was 0.22 mmol/L (95% CI 0.39, 0.05, p = 0.004), and in women who were not GDM, the reduction was 0.14 mmol/L (95% CI 0.37, 0.09, p = 0.24,). After adjustment for GDM status in pregnancy, maternal body mass index (BMI), maternal age and ethnicity, and exclusive breastfeeding was associated with a decreased fasting glucose of 0.19 (95% CI 0.318, 0.061, p = 0.004). After similar adjustment, there was no significant difference in triglycerides, high density lipoprotein cholesterol or low-density lipoprotein cholesterol between women who were breastfeeding and women who were not breastfeeding.ConclusionsBreastfeeding is associated with a reduction in fasting glucose levels postpartum, but not maternal lipid profile. Breastfeeding may play a role in reducing glucose intolerance in women who have had GDM.

Soluble CD163 and TWEAK in early pregnancy gestational diabetes and later glucose intolerance.

Gestational diabetes mellitus (GDM) is today universally diagnosed during late pregnancy. Treating hyperglycaemia during pregnancy reduces the risk of complications, the effect of interventions is however limited due to the late diagnosis. It is thus important to identify biomarkers reaching a high precision for GDM development in early pregnancy. Here we aim to investigate soluble CD163 (sCD163) and soluble tumour necrosis factor-like weak inducer of apoptosis (sTWEAK) in early pregnancy GDM and their association to the development of later glucose intolerance. In this case-control study, women diagnosed with GDM in early pregnancy (n = 70) at Lund University Hospital, Lund, Sweden in 2011–2015 were age- and BMI matched to pregnant volunteers without diabetes (n = 70) recruited in early pregnancy from maternal health care centres in 2014–2015. Plasma levels of sCD163 and sTWEAK were analysed using commercial ELISA. Plasma levels of sCD163 did not differ between patients with and without GDM in early pregnancy (p = 0.86), plasma levels of sTWEAK however was decreased in women with GDM (0.71 [0.4–1.75] ng/ml) compared to controls (1.38 [0.63–4.86] ng/ml; p = 0.003). Women with sTWEAK levels in the lowest tertile had an increased risk of GDM in early pregnancy (p = 0.014). Neither sCD163 nor sTWEAK were associated with later glucose intolerance in women with GDM. This study reports decreased levels of sTWEAK in women with early pregnancy GDM, independent of age and BMI. Neither sCD163 nor sTWEAK were found to be associated to later glucose intolerance.

The Association between Free Fatty Acid Level at Midpregnancy and Postpartum Glucose Intolerance in Women with Gestational Diabetes Mellitus

Free fatty acid (FFA) is correlated with fetal growth during pregnancy and with neonatal fat mass in women with gestational diabetes mellitus (GDM). However, there are few studies between FFA level and postpartum glucose metabolism in women with GDM. The aim of this study was to evaluate the association between FFA level at mid-pregnancy and postpartum glucose intolerance in women with GDM. We enrolled 769 pregnant women diagnosed with GDM from February 2009 to October 2016. FFA levels (fasting and postprandial 2-h) were measured during 24-32 gestational weeks and 75-g OGTT was performed at 6-12 weeks after delivery. High FFA was defined by more than the median level of FFA at mid-pregnancy. Postpartum glucose intolerance was defined as fasting plasma glucose (FPG) ≥ 100 mg/dL or 2-h plasma glucose (2-h PG) ≥ 140 mg/dL. Mean age was 33.1 years and mean pre-pregnancy BMI was 22.4 kg/m2. The prevalence of postpartum glucose intolerance was 48.0% (n = 369). Although postprandial 2-h FFA level and FFA difference (between fasting and postprandial 2-h FFA) were not significantly different between two groups, women with postpartum glucose intolerance had higher fasting FFA level at mid-pregnancy than those with normal glucose tolerance (733.7 μEq/L vs. 700.6 μEq/L, P = 0.049). Compared to women with low fasting FFA, women with high fasting FFA had higher postpartum glucose intolerance (51.8% vs. 44.1%, P = 0.033). After adjustment for maternal age, pre-pregnancy BMI, parity, family history of diabetes, FPG, and lipid measures (total cholesterol, triglyceride, HDL-cholesterol), women with high fasting FFA were 1.47 times (95% CI 1.07-2.01) more likely to have postpartum glucose intolerance than those with low fasting FFA. In women with GDM, high fasting FFA level at mid-pregnancy is associated with elevated risk of postpartum glucose intolerance. Disclosure K. Kim: None. S. Kim: None. Y. Cho: None. S. Park: None.

Routine HbA1c testing in women undergoing major gynecologic surgery to detect prevalence of glucose intolerance

INTRODUCTION:Determine the prevalence of undiagnosed diabetes, prediabetes and overall incidence of glucose intolerance in women undergoing major surgical procedures on the gynecologic oncology service.METHODS:Retrospective review of preoperative HbA1c levels obtained at preadmission testing in wome