Postpartum Reclassification of Glycemic Status in Women with Gestational Diabetes Mellitus and Associated Risk Factors

• Published in: Revista Brasileira de ginecologia e obstetrícia Vol. 38; no. 8; pp. 381 - 390
• Main Authors: Alves, Jacy Maria, Stollmeier, Aline, Leite, Isabelle Gasparetto, Pilger, Camilla Gallo, Detsch, Josiane Cristine Melchioretto, Radominski, Rosana Bento, Réa, Rosângela Roginski
• Format: Journal Article
• Language: English
• Published: Rio de Janeiro, Brazil Thieme Publicações Ltda 01.08.2016; Federação Brasileira das Sociedades de Ginecologia e Obstetrícia
• Subjects: Adult; Cohort Studies; Diabetes Mellitus, Type 2 - blood; Diabetes, Gestational - blood; Disease Progression; Female; gestational diabetes; Glucose Intolerance - blood; Glucose Tolerance Test; Humans; OBSTETRICS & GYNECOLOGY; oral glucose tolerance test; Original; Original Article; Postpartum Period - blood; postpartum test; Pregnancy; Retrospective Studies; Risk Factors; type 2 diabetes; reavaliação pós-parto; diabetes tipo 2; risk factors; type 2 diabetes; oral glucose tolerance test; gestational diabetes; diabetes gestacional; postpartum test; teste oral de tolerância à glicose; fatores de risco
• ISSN: 0100-7203; 1806-9339; 1806-9339
• DOI: 10.1055/s-0036-1588008

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. Results: 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.