Gestational Diabetes Mellitus: Clinical Predictors and Long-Term Risk of Developing Type 2 Diabetes: A retrospective cohort study using survival analysis

• Published in: Diabetes care Vol. 30; no. 4; pp. 878 - 883
• Main Authors: Lee, Anna J, Hiscock, Richard J, Wein, Peter, Walker, Susan P, Permezel, Michael
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01.04.2007
• Subjects: Biological and medical sciences; Birth weight; blood; blood glucose; Body Mass Index; Care and treatment; Cohort Studies; Continental Population Groups; cumulative risk; Diabetes; Diabetes in pregnancy; Diabetes Mellitus, Type 2; Diabetes Mellitus, Type 2 - epidemiology; Diabetes Mellitus, Type 2 - mortality; Diabetes, Gestational; Diabetes, Gestational - blood; Diabetes. Impaired glucose tolerance; Diagnosis; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; epidemiology; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Follow-Up Studies; gestational diabetes; Glucose Tolerance Test; Humans; Hyperglycemia; Infant, Newborn; insulin; Medical sciences; mortality; noninsulin-dependent diabetes mellitus; Parity; patients; Pregnancy; Racial Groups; Retrospective Studies; Risk Factors; Studies; Survival Analysis; Type 2 diabetes; women; Australia; Oceania; Endocrinopathy; Type 2 diabetes; Metabolic diseases; Maternal diseases; Epidemiology; Long term; Retrospective; Pregnancy; Cohort study; Risk factor; Gestational diabetes; Predictive factor; Public health
• DOI: 10.2337/dc06-1816
• ISSN: 0149-5992; 1935-5548

OBJECTIVE:--We sought to determine the long-term risk of type 2 diabetes following a pregnancy complicated by gestational diabetes mellitus (GDM) and assess what maternal antepartum, postpartum, and neonatal factors are predictive of later development of type 2 diabetes. RESEARCH DESIGN AND METHODS--This was a retrospective cohort study using survival analysis on 5,470 GDM patients and 783 control subjects who presented for postnatal follow-up at the Mercy Hospital for Women between 1971 and 2003. RESULTS:--Risk of developing diabetes increased with time of follow-up for both groups and was 9.6 times greater for patients with GDM. The cumulative risk of developing type 2 diabetes for the GDM patients was 25.8% at 15 years postdiagnosis. Predictive factors for the development of type 2 diabetes were use of insulin (hazard ratio 3.5), Asian origin compared with Caucasian (2.1), and 1-h blood glucose (1.3 for every 1 mmol increase above 10.1 mmol). BMI was associated with an increased risk of developing type 2 diabetes but did not meet the assumption of proportional hazards required for valid inference when using Cox proportional hazards. CONCLUSIONS:--While specific predictive factors for the later development of type 2 diabetes can be identified in the index pregnancy, women with a history of GDM, as a group, are worthy of long-term follow-up to ameliorate their excess cardiovascular risk.