Abnormal glucose tolerance post-gestational diabetes mellitus as defined by the International Association of Diabetes and Pregnancy Study Groups criteria

Abstract

Objective: An increase in gestational diabetes mellitus (GDM) prevalence has been demonstrated across many countries with adoption of the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) diagnostic criteria. Here, we determine the cumulative incidence of abnormal glucose tolerance among women with previous GDM, and identify clinical risk factors predicting this. Design: Two hundred and seventy women with previous IADPSG-defined GDM were prospectively followed up for 5 years (mean 2.6) post-index pregnancy, and compared with 388 women with normal glucose tolerance (NGT) in pregnancy. Methods: Cumulative incidence of abnormal glucose tolerance (using American Diabetes Association criteria for impaired fasting glucose, impaired glucose tolerance and diabetes) was determined using the Kaplan-Meier method of survival analysis. Cox regression models were constructed to test for factors predicting abnormal glucose tolerance. Results: Twenty-six percent of women with previous GDM had abnormal glucose tolerance vs 4% with NGT, with the log-rank test demonstrating significantly different survival curves (P < 0.001). Women meeting IADPSG, but not the World Health Organization (WHO) 1999 criteria, had a lower cumulative incidence than women meeting both sets of criteria, both in the early post-partum period (4.2% vs 21.7%, P < 0.001) and at longer-term follow-up (13.7% vs 32.6%, P < 0.001). Predictive factors were glucose levels on the pregnancy oral glucose tolerance test, family history of diabetes, gestational week at testing, and BMI at follow-up. Conclusions: The proportion of women developing abnormal glucose tolerance remains high among those with IADPSG-defined GDM. This demonstrates the need for continued close follow-up, although the optimal frequency and method needs further study.

Insulin secretion and action in North Indian women during pregnancy

“…Notably, established environmental risk factors for gestational diabetes influenced insulin resistance and insulin secretion differently in North Indian women. The finding of more severe impairment in insulin secretion using adapted GDM2013 compared with GDM1999 criteria is in agreement with those of Noctor et al [10] suggesting a less-favourable metabolic profile in women meeting the GDM2013 criteria compared with those meeting GDM1999 criteria [10].…”

Heterogeneity of gestational diabetes (GDM) and long-term risk of diabetes and metabolic syndrome: findings from the RADIEL study follow-up

“…The future risk of diabetes among women with a history of GDM varies according to study design, population, ethnicity, and diagnostic criteria. A 5-year follow-up [20] on women with GDM based on IADPSG criteria reported a 26% cumulative incidence of prediabetes or diabetes. The cumulative incidence in our study reached 23% among women with GDM in the index pregnancy.…”

Postpartum risk of diabetes and predictive factors for glucose intolerance in East Asian women with gestational diabetes

“…Eth-nic differences may reflect an underlying variation in maternal insulin sensitivity and secretion. In a study focused on ethnic differences, three months postpartum, 31% of women of non-European ethnicity and 18% of women of European ethnicity were glucose tolerant [31].…”