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

Alves, Jacy Maria; Stollmeier, Aline; Leite, Isabelle Gasparetto; Pilger, Camilla Gallo; Detsch, Josiane Cristine Melchioretto; Radominski, Rosana Bento; Réa, Rosângela Roginski

doi:10.1055/s-0036-1588008

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Revista Brasileira de Ginecologia e Obstetrícia

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Original Articles • Rev. Bras. Ginecol. Obstet. 38 (08) • Aug 2016 • https://doi.org/10.1055/s-0036-1588008 copy

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

Reclassificação pós-parto do estado glicêmico em mulheres com diabetes mellitus gestacional e fatores de risco associados

Authorship SCIMAGO INSTITUTIONS RANKINGS

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.

Keywords:
gestational diabetes; postpartum test; type 2 diabetes; oral glucose tolerance test; risk factors

Baseline characteristics	Postpartum reevaluation(n= 279)	No postpartum reevaluation(n= 1,239)	p
Age at GDM diagnosis (years)	32.1 ± 6.1	31.8 ± 6.4	0.530^*
Father with T2DM	40 (14.3)	175 (14.1)	0.927^**
Mother with T2DM	85 (30.5)	333 (26.9)	0.225^**
Pre-gestational weight (kg)	70.6 ± 14.7	71.7 ± 16.6	0.288^*
BMI 1 (kg/m²)	27.9 ± 5.7	28.2 ± 6.1	0.596^*
History of chronic hypertension or hypertensive pregnancy disorders	75 (26.9)	315 (25.4)	0.615^**
Gestational age at diagnosis of index pregnancy with GDM (weeks)	30.7 ± 4.7	31.7 ± 4.7	0.002^*
First trimester fasting plasma glucose (mg/dL)	89.1 ± 12.5	88.1 ± 12.1	0.240^*
Fasting plasma glucose – OGTT (mg/dL)	95.7 ± 19.3	95.3 ± 18.2	0.744^*
75-g-2-hour glucose – OGTT (mg/dL)	167.8 ± 31.3	168.0 ± 31.1	0.906^*
Gestational weight at diagnosis of GDM (kg)	79.3 ± 14.8	80.1 ± 16.3	0.475^*
BMI 2 (kg/m²)	31.4 ± 5.9	31.4 ± 5.9	0.933^*
Insulin/metformin treatment in pregnancy	84/2(30.1/0.7)	345/8(27.8/0.6)	0.739†

		Glucose tolerance categories
	T2DM(n= 34)	IFG( n = 58)	IGT( n = 35)	NGT( n = 152)	p
Age at GDM diagnosis (years)	33.7 ± 6.2	32.0 ± 6.3	32.3 ± 5.3	31.7 ± 6.1	0.390^*
Father with T2DM	9 (26.5)	5 (8.6)	7 (20.0)	19 (12.5)	0.073^**
Mother with T2DM	16 (47.1)	17 (29.3)	16 (45.7)	36 (23.7)	0.009^**
Pre-gestational weight (kg)	77.4 ± 16.7	70.4 ± 15.7	71.3 ± 15.2	69.0 ± 13.5	0.031^*
BMI 1 (kg/m²)	30.6 ± 6.0	27.6 ± 5.6	28.3 ± 5.9	27.4 ± 5.5	0.028^*
History of chronic hypertension or hypertensive pregnancy disorders	13 (38.2)	20 (34.5)	10 (28.6)	32 (21.0)	0.085^**
Previous GDM	2 (5.9)	4 (6.9)	2 (5.7)	11 (7.4)	0.984^**
Gestational age at diagnosis of index pregnancy with GDM (weeks)	28.3 ± 5.7	30.9 ± 4.8	30.8 ± 5.1	31.1 ± 4.3	0.019^*
First trimester fasting plasma glucose (mg/dL)	98.8 ± 16.5	90.4 ± 12.0	90.9 ± 13.4	86.0 ± 10.1	< 0.001^*
Fasting plasma glucose – OGTT (mg/dL)	113.9 ± 27.4	97.5 ± 13.5	95.3 ± 23.8	91.1 ± 15.1	< 0.001^*
75-g-2-hour glucose – OGTT (mg/dL)	189.6 ± 59.8	169.5 ± 25.9	164.5 ± 27.1	163.4 ± 22.8	< 0.001^*
Median hemoglobin A1c during pregnancy	5.9 ± 1.0	5.6 ± 0.5	5.6 ± 0.8	5.4 ± 0.5	< 0.001^*
Gestational weight at diagnosis of GDM (kg)	85.4 ± 16.6	80.1 ± 15.8	78.3 ± 15.9	77.9 ± 13.3	0.055^*
BMI 2 (kg/m²)	33.9 ± 5.9	31.5 ± 6.4	30.6 ± 6.0	30.9 ± 5.5	0.055^*
Excessive weight gain during pregnancy	5 (15.2)	12 (21.1)	5 (16.1)	29 (20.0)	0.868^**
Insulin/metformin treatment in pregnancy
Yes	27 (79.4)	22 (37.9)	9 (25.7)	28 (18.4)	< 0.001^**
No	7 (20.6)	36 (62.1)	26 (74.3)	124 (81.6)	< 0.001^**
Insulin treatment start in pregnancy (gestational age – weeks)	29.1 ± 4.2	30.9 ± 5.8	27.5 ± 7.9	32.1 ± 4.0	0.070^*
Insulin dose in pregnancy (IU)	19.7 ± 14.9	14.3 ± 10.7	16.9 ± 10.5	9.9 ± 5.3	0.016^*
Elapsed time from first appointment to postpartum OGTT (months)	24.7 ± 26.9median = 15(1.5–110)	12.1 ± 15.5median = 4.9(1.5–90)	16.2 ± 16.8median = 10.8(1.8–63)	9.2 ± 13.8median = 3.8(0.3–90)	< 0.001†

Risk factors for T2DM	p	OR [95%CI]
First trimester fasting plasma glucose (mg/dL)	0.001	1.07 [1.03–1.11]
Father with T2DM	0.006	5.67 [1.64–19.59]
Insulin/metformin treatment in pregnancy	< 0.001	15.92 [5.54–45.71]
Risk factors for IGT
First-trimester fasting plasma glucose (mg/dL)	0.008	1.04 [1.01–1.08]
Mother with T2DM	0.005	3.15 [1.43–6.97]
Risk factors for IFG
First trimester fasting plasma glucose (mg/dL)	0.022	1.04 [1.00–1.07]
Insulin/metformin treatment in pregnancy	0.021	2.29 [1.13–4.64]

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[1] Address for correspondence Jacy Maria Alves, MD, MSc, Hospital de Clínicas, Universidade Federal do Paraná, Avenida Agostinho Leão Junior, 285, 80030-110, Curitiba, PR, Brasil (e-mail: jacy.alves@yahoo.com.br).