Recurrence Rate Of Gestational Diabetes Mellitus Research Articles

The impact of educational attainment on the occurrence of gestational diabetes mellitus in two successive pregnancies of Finnish primiparous women: a population-based cohort study

AimsTo assess the impact of educational attainment on the occurrence and recurrence of gestational diabetes mellitus (GDM) in two successive pregnancies in primiparous women.MethodsThis is a population-based observational cohort study including all 2347 Finnish women without previously diagnosed diabetes, aged ≥ 20 years from the city of Vantaa, Finland, who gave birth to their first and second child between 2009 and 2015. National registries provided data on study participants. We divided the population into four groups according to the presence of GDM in the two pregnancies (GDM−/−, n = 1820; GDM−/+, n = 223; GDM+/−, n = 113; GDM+/+, n = 191).ResultsThe occurrence of GDM in the first pregnancy was 13.0% (n = 304) and 17.6% (n = 414) in the second. The recurrence rate of GDM was 62.8%. The four groups did not differ in relation to educational attainment (p = 0.11). In multinomial regression analysis, educational attainment protected from GDM in the second pregnancy [relative risk ratio 0.93 (95% confidence interval (CI) 0.86–0.99) per year of schooling for being GDM−/+ compared with GDM−/−]. In multivariate logistics models, prepregnancy body mass index at the first pregnancy [odds ratio (OR) 1.53 per 1-standard deviation (SD) (95% CI 1.22–1.91)], first-born birth weight z-score [OR 1.30 per 1-SD (95% CI 1.00–1.67)], and inter-pregnancy weight change [OR 1.66 per 1-SD (95% CI 1.27–2.16)], but not educational attainment, predicted recurrence of GDM.ConclusionsThe recurrence rate of GDM was high. Education protected from novel GDM in the second pregnancy, but was not associated with GDM recurrence.

Effect of lactation on the recurrence rate of gestational diabetes mellitus: a retrospective cohort study.

To examine the impact of lactation on the recurrence rate of gestational diabetes mellitus (GDM). Retrospective cohort study performed in a single teaching hospital on data between 2009 and 2016. The study group consisted of women who had a diagnosis of GDM and breastfed exclusively for ≥ 1month. The control group consisted of women who had a diagnosis of GDM and did not breastfeed or added formula < 1month postpartum. Data regarding breastfeeding duration, timing and amount of formula supplementation were obtained by a telephone questionnaire. We hypothesized that the recurrence of GDM would be lower in women who breastfed exclusively for ≥ 1month. Therefore, to detect a decrease from 50 to 30% in the recurrence rate of GDM with alpha (one-sided) of 0.05 and 80% power, a sample size of 168 (84 per group) was needed. Overall, 229 women were found eligible; 139 and 90 in the study and control groups, respectively. Except for parity, baseline demographic and obstetric variables were not different between the two groups. After adjusting for parity, the incidence of GDM in subsequent pregnancy was significantly lower among the study compared to the control group [48 (34.5%) and 41 (45.6%), respectively; one-tailed p = 0.043; RR 0.56; 95% CI 0.35-0.90)]. The cesarean delivery (CD) rate was significantly lower as well [28 (20.1%) and 31 (34.4%), respectively; two-tailed p = 0.02; RR 0.48, 95% CI 0.26-0.89)]. Exclusive lactation for ≥ 1month reduced the recurrence rate of GDM and possibly the risk of CD in the subsequent pregnancy.

Recurrence of diet-treated gestational diabetes in primiparous women in northern Zhejiang, China: Epidemiology, risk factors and implications.

This study sought to determine the rate of recurrence of gestational diabetes mellitus (GDM) recurrence during the second pregnancies of women who were diagnosed with GDM during their first pregnancies, to identify risk factors associated with the probability of such recurrence and to evaluate the influence of GDM recurrence on pregnancy outcomes in north Zhejiang, China, after the recent adjustment to the nation's childbirth policy. A retrospective longitudinal study was performed in north Zhejiang, China (at Jiaxing Maternal and Child Health Hospital). A total of 128 women who delivered two sequential live singleton infants and were diagnosed with diet-treated GDM during their first pregnancies were included. According to the 2013 World Health Organization diagnostic criteria for diabetes during pregnancy, the prevalence of gestational diabetes was 11.02% in northern Zhejiang. The recurrence rate of GDM in northern Zhejiang was 43.75% (56/128). The age at second pregnancy, weight gain during pregnancy, interpregnancy interval and macrosomia during the index pregnancy were risk factors for GDM recurrence. Among those women with recurrent GDM, GDM developed earlier and caesarean section was more frequently required during the second pregnancy; in addition, the second pregnancy was associated with more premature and low birthweight infants but less macrosomia. The recurrence rate of GDM is high in northern Zhejiang. Glucose monitoring and management are needed during subsequent pregnancies for patients who previously presented with GDM to improve maternal and fetal outcomes.

Recurrence of gestational diabetes in primiparous women.

Gestational diabetes mellitus (GDM) increases the risk for diabetes in the next pregnancy and later in life. Thus, estimating the risk of GDM in further pregnancies provides a time frame for possible preventive measures. We aimed to calculate the recurrence rate of GDM in primiparous women and evaluate the factors involved such as age, body mass index, weight gain, time between pregnancy and postpartum OGTT results. We established a prospective cohort during a 5-year period at the Department of Obstetrics at Kolding Hospital. Women with diet-treated GDM in their first pregnancy and a subsequent pregnancy constituted our study population. Multiparity and insulin-treated GDM were exclusion criteria. Among 15 735 deliveries, 535 women were diagnosed with GDM (3.4%). Of these, 209 (39.1%) were nulliparous women, treated with diet only. Seventy-two of these women had a subsequent pregnancy and they all attended the recommended screening procedure, a 75-g oral glucose tolerance test at 14-20 (early) or 27-30 (late) weeks' gestation. The recurrence rate of GDM was 47.2%. The risk of recurrence was less in women who lost weight between the first and the subsequent pregnancy. Recurrence of diet-treated GDM was 47.2% in primiparous women with previous GDM and the recurrence was associated with weight gain between pregnancies.

Outcomes in women with a history of gestational diabetes. Screening and prevention of type 2 diabetes. Literature review

Women with a history of gestational diabetes mellitus (GDM) are characterized by a high risk of type 2 diabetes mellitus (T2DM) (x 7), metabolic syndrome (x 2 to 5) and cardiovascular diseases (x 1,7). Women with lesser degrees of glucose intolerance share the same risks. T2DM may occur from post-partum (5 to 14%) to several years later, up to 25 years. Some factors associated with T2DM are identified: obesity, early diagnosis of GDM before 24 weeks gestation, high pregnancy OGTT blood glucose or insulin-therapy during GDM. Screening for T2DM only with fasting glucose provides less sensibility than with OGTT; HbA1c may supplant these dosages. The recurrence rate of GDM is between 30 and 84%, non-white ethnicity and insulinotherapy during GDM being the best proven predictors. High risk women need repeated life-long screenings for glycaemic abnormalities, or when another pregnancy is planned. Among obese women with history of GDM who show minor glycoregulation disturbances, modifications of lifestyle in intensive programs or metformin halve the risk of DT2. However, studies analysing practices show low adhesion to screening; without an intensive program, few women implement lifestyle modifications. These intensive programs should be implemented and proposed to high-risk women. Their therapeutic education should also include prevention of cardiovascular risk factors.

Subsequent Pregnancy After Gestational Diabetes Mellitus

OBJECTIVE—The purpose of this study was to determine the frequency of recurrent gestational diabetes mellitus (GDM) and to find risk factors that can predict the recurrence of GDM in Korean women with previous GDM.RESEARCH DESIGN AND METHODS—We evaluated women who had GDM in an index pregnancy (1993–2001) and a subsequent pregnancy by 2003. An oral glucose tolerance test (OGTT) was performed during the index pregnancy and 2 months postpartum. The recurrence rate of GDM was assessed among 111 women who had a subsequent pregnancy. Multivariate logistic regression analysis was used to identify independent predictors of recurrent GDM.RESULTS—The frequency of recurrent GDM in subsequent pregnancies was 45.0% (95% CI 35.6–54.4%). Women with impaired fasting glucose and/or impaired glucose tolerance 2 months postpartum were at increased risk for recurrent GDM (relative risk 2.31, 95% CI 1.24–4.30). Higher BMI before the subsequent pregnancy (P = 0.024), higher fasting glucose concentration (P = 0.007) 2 months postpartum, and lower 1-h insulin concentration (P = 0.004) of the diagnostic OGTT in the index pregnancy were independent risk factors for recurrence of GDM in subsequent pregnancies.CONCLUSIONS—GDM recurred in nearly half of subsequent pregnancies in Korean women. Fasting glucose 2 months postpartum might be a clinically valuable predictor of recurrent GDM risk.

The recurrence rate of gestational diabetes in subsequent pregnancies.

To define the recurrence rate of gestational diabetes mellitus (GDM) in a subsequent pregnancy and to determine what factors could be predictive. The subjects of the index pregnancy were 480 personally cared for women with GDM. One hundred women had had a subsequent pregnancy and had been tested for GDM. The recurrence rate of GDM was 35% (95% CI, 25.5-44.5). An increase in weight between the two pregnancies and a higher maternal age and parity were risk associates for a recurrence. A recurrence of GDM was not associated with a higher glucose level, insulin use, or fetal birth weight in the index pregnancy. GDM occurs in only one-third of subsequent pregnancies. Those women who had a recurrence of their GDM were older, more parous, and also had an increase in weight between the pregnancies.