Postpartum glucose tolerance status 6 to 12 weeks after gestational diabetes mellitus: a Brazilian cohort

Abstract

Objectives:The aims of this study were to estimate the local rate of postpartum diabetes screening after gestational diabetes mellitus (GDM) pregnancies, and to identify clinical variables associated with retesting rates and with the persistence of decreased glucose tolerance. Subjects and methods:Prospective cohort of GDM women with prenatal delivery at a specialized center, from November 2009 to May 2012. All women were advised to schedule a 6 weeks postpartum 75-g oral glucose tolerance test (OGTT). Results: Of the 209 women included, 108 (51.7%) returned to be tested with fasting plasma glucose (n = 14), OGTT (n = 93) or random glucose (n = 1). Return was associated with lower parity rate (2 vs. 3, p < 0.001) and higher pregnancy 2-h OGTT (165 vs. 155 mg/dL, p = 0.034), but not with socio-demographic characteristics. Four women (3.7%) had diabetes, 22 (20.4%) had impaired fasting glucose or impaired glucose tolerance. Persistent hyperglycemia was associated with a positive family history of diabetes (relative risk -RR 2.41, p = 0.050), diagnostic 2-h OGTT in pregnancy (RR 1.01, p = 0.045), insulin use during pregnancy (RR 2.37, p = 0.014), and cesarean section (RR 2.61, p = 0.015). Conclusions: Even though postpartum abnormalities were frequent in GDM, rates of postpartum diabetes screening were undesirably low. As no specific clinical profile defines who will adhere to postpartum testing, it is essential to encourage all women to reevaluate their glucose status, particularly those with a family history of diabetes and more severe hyperglycemia. Resultados: Das 209 mulheres arroladas na gestação, 108 (51,7%) foram avaliadas após o parto: 14 com glicemia de jejum, 93 com o TOTG e uma com glicemia ao acaso. O retorno para reavaliação foi associado com menor paridade (2 vs. 3, p < 0,001) e com glicemia de 2-h mais elevada no TOTG diagnóstico (165 vs. 155 mg/dL, p = 0,034). Diabetes foi diagnosticado em quatro mulheres (3,7%) e pré-diabetes em 22 (20,4%). Análise multivariada evidenciou que a história familiar de diabetes (risco relativo -RR 2,41, p = 0,050), a glicemia de 2 horas no TOTG da gestação (RR 1,01, p = 0,045), o uso de insulina na gestação (RR 2,37, p = 0,014) e a taxa de cesariana (RR 2,61, p = 0,015) foram os fatores associados à persistência da hiperglicemia. Conclusões: O retorno para reavaliação foi baixo, embora as alterações glicêmicas tenham sido frequentes. Como não houve fatores que indiquem quais mulheres retornarão, estratégias para aumentar a adesão são necessárias, especialmente quando há história familiar ou o DMG foi mais grave. Arq Bras Endocrinol Metab. 2014;58(2):197-204 Descritores Diabetes gestacional; reavaliação pós-parto; DMG; diabetes tipo 2; teste oral de tolerância à glicose ¹ Programa de Pós-graduação em Endocrinologia, Universidade Federal do Rio Grande do Sul

A comparison of the International Association of Diabetes and Pregnancy Study Groups Recommendations with Former Criteria for Diagnosing Gestational Diabetes Mellitus: A Retrospective Cohort Study

“…The same authors showed that both fasting and 2-h OGTT glucose levels at the time of GDM diagnosis significantly predicted abnormal glucose tolerance postpartum. Similarly, Weinert et al [48], using 'mixed' criteria (Brazilian guidelines 2002 and IADPSG recommendations) for GDM diagnosis, found prediabetes in 20 % and diabetes in 4 % of the population studied 6-12 weeks postpartum. The authors identified family history of diabetes, 2-h OGTT result in pregnancy and cesarean section as independent predictors of glucose intolerance early after childbirth.…”

“…The authors identified family history of diabetes, 2-h OGTT result in pregnancy and cesarean section as independent predictors of glucose intolerance early after childbirth. Although insulin treatment during pregnancy also seems to be an important risk factor for glucose intolerance postpartum [45,46,48] we could not take it into account since only a small proportion of the patients who were available after childbirth needed insulin treatment in pregnancy.…”

Risk factors for abnormal postpartum glucose outcome in women with gestational diabetes mellitus diagnosed by modified The International Association of the Diabetes and Pregnancy Study Groups criteria

“…Therefore, identifying risk factors for postpartum glucose abnormalities in women with GDM are essential to screening, monitoring and managing those at risk for developing dysglycemia after delivery. Previously reported predicators of future prediabetes and diabetes in women with GDM include prepregnancy body mass index, different ethnic groups, higher plasma glucose level in pregnancy, earlier diagnosis of GDM, requirement of insulin therapy during pregnancy, HbA1c during pregnancy and advanced maternal age . Most studies were mainly concentrated in White population, with only a few were conducted in Asian population .…”

Return for Postpartum Oral Glucose Tolerance Test Following Gestational Diabetes Mellitus

“…3,4 Weinert et al found that 3.7% of women with GDM had diabetes at 6 weeks postpartum, and another 20.4% of their cohort had impaired glucose tolerance. 1 More worrying is the fact that one third of diabetes cases among parous women were mothers with a history of GDM. 5 Therefore, a screening test for early detection of diabetes after delivery has the potential to benefit the health of women and their future offspring.…”

“…Several studies have shown that the prevalence of women who returned for the repeat postpartum OGTT following GDM is low, ranging from 37% to 57.8%. 1,2,[9][10][11][12] This low return rate for the test is an alarming situation, and the barriers to this postpartum screening test are not well recognized. With the rising prevalence of type 2 diabetes in the local population, 13 there is a need to understand the associated situation in order to develop effective strategies to increase postpartum screening attendance.…”