Abnormalities of Glucose Tolerance Following Gestational Diabetes

Dornhorst, Anne; Bailey, Philippa C.; Anyaoku, V.; Elkeles, R. S.; Johnston, Desmond G.; Beard, R. W.

doi:10.1093/qjmed/77.3.1219

Cited by 81 publications

(60 citation statements)

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“…Diniz & Da Costa have also suggested that breast-feeding women have improved insulin sensitivity that persists after childbirth (22), but further research is needed to understand the associations observed here. Previous studies have shown that the risk of diabetes following GDM increases with the degree of carbohydrate intolerance in pregnancy, the need for insulin therapy and early diagnosis of GDM during the index pregnancy (23). High rates of persistent glucose intolerance in Indo-Asian women may reflect undiagnosed diabetes pre-dating pregnancy (5,24,25).…”

Section: Discussionmentioning

confidence: 99%

Atlantic DIP: high prevalence of abnormal glucose tolerance post partum is reduced by breast-feeding in women with prior gestational diabetes mellitus

O’Reilly

Avalos

Dennedy

et al. 2011

European Journal of Endocrinology

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Objective: Gestational diabetes (GDM) is associated with adverse fetal and maternal outcomes, and identifies women at risk of future type 2 diabetes mellitus (T2DM). Breast-feeding may improve post partum maternal glucose tolerance. Our objective was to identify the prevalence of post partum dysglycemia after GDM, to delineate associated factors and to examine the effect of lactation on post partum glucose tolerance. Design: We compared post partum 75 g oral glucose tolerance test (OGTT) results from 300 women with GDM and 220 controls with normal gestational glucose tolerance (NGT) in five regional centers. Breast-feeding data was collected at time of OGTT. Methods: Post partum OGTT results were classified as normal (fasting plasma glucose (FPG) !5.6 mmol/l, 2 h !7.8 mmol/l) and abnormal (impaired fasting glucose (IFG), FPG 5.6-6.9 mmol/l; impaired glucose tolerance (IGT), 2 h glucose 7.8-11 mmol/l; IFGCIGT; T2DM, FPG R7 mmol/lG2 h glucose R11.1 mmol/l). Binary logistic regression was used to identify factors predictive of persistent hyperglycemia. Results: Five hundred and twenty women were tested; six (2.7%) with NGT in pregnancy had post partum dysglycemia compared with 57 (19%) with GDM in index pregnancy (P!0.001). NonEuropean ethnicity (odds ratio (OR) 3.40; 95% confidence interval (CI) 1.45-8.02, PZ0.005), family history of T2DM (OR 2.14; 95% CI 1.06-4.32, PZ0.034), and gestational insulin use (OR 2.62; 95% CI 1.17-5.87, PZ0.019) were associated with persistent dysglycemia. The prevalence of persistent hyperglycemia was significantly lower in women who breast-fed vs bottle-fed post partum (8.2 vs 18.4%, P!0.001). Conclusions: Non-European ethnicity, gestational insulin use, family history of T2DM, and elevated body mass index were associated with persistent dysglycemia after GDM. Breast-feeding may confer beneficial metabolic effects after GDM and should be encouraged. European Journal of Endocrinology 165 953-959

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Section: Discussionmentioning

confidence: 99%

Atlantic DIP: high prevalence of abnormal glucose tolerance post partum is reduced by breast-feeding in women with prior gestational diabetes mellitus

O’Reilly

Avalos

Dennedy

et al. 2011

European Journal of Endocrinology

View full text Add to dashboard Cite

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“…Since the first study on glucose intolerance in pregnancy was conducted by O'Sullivan and Mahan to identify women at risk of overt diabetes post-partum [33], various potential risk factors have been identified: severity of glucose intolerance during pregnancy, insulin demand during pregnancy, earlier diagnosis of GDM, family history of diabetes, recurrence of GDM, increasing parity, maternal age, prepregnancy BMI, and weight gain during pregnancy or post-partum [34][35][36][37]. In the general population, no data on the insulin resistance or insulin secretion at gestation were available, thus the direct comparison between GDM and general population subjects was not possible.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of type 2 diabetes among women with a previous history of gestational diabetes mellitus

Lee

Jang

Park³

et al. 2008

Diabetes Research and Clinical Practice

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“…Approximately 30 % of women who present with NIDDM in middle age have previously been suspected to have diabetes in pregnancy because of hyperglycaemia or glycosuria [2]. Women who have had gestational diabetes present an opportunity to study diabetes at an early stage in its evolution [3]. They are often overweight, and have both impaired beta-cell function and increased insulin resistance [4,5].…”

mentioning

confidence: 99%

Prevalence of diabetes mellitus and impaired glucose tolerance in parents of women with gestational diabetes

et al. 1995

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Summary Nuclear families of non-insulin-dependent diabetic (NIDDM) patients are uncommon, as usually one or both parents have died. In order to aid identification of complete nuclear families, we have ascertained the disease process at a younger age by studying subjects with previous gestational diabetes. One hundred women who had had gestational diabetes, age (+ SD) 38 (6) years, were screened by fasting plasma glucose (fpg). Sixty-one were found to have either fasting hyperglycaemia (5.5 _< fpg < 7.8 mmol/1) or diabetes. Of these women 35 had both parents alive and the parents of 14 of these women agreed to the assessment of their metabolism by a continuous infusion of glucose with model assessment (CIGMA). Seven probands had impaired glucose tolerance (IGT) and seven were diabetic. They were age 35 (4) years and had body mass index (BMI) 26 (5) kg/m 2. The parents were aged 62 (6) years and had BMI 29 (6) kg/m 2 and their affection status was defined as presence of glucose intolerance (fpg or post-infusion achieved plasma glucose level > 2 SD of an age and obesity matched population). In the 14 families, five probands (36%) had neither parent affected, six (43 %) had one parent affected and three (21%) had both parents affected. Only three probands had a parent with diabetes as defined by World Health Organisation criteria. We concludes that the study of women who have had gestational diabetes allows detection of probands with diabetes or impaired glucose tolerance, who have both parents available for study. A substantial proportion had neither parent affected with impaired glucose tolerance or diabetes, similar to the nuclear families of NIDDM patients. The results are in accord with studies of nuclear families of NIDDM patients in suggesting polygenic inheritance or environmental influences rather than autosomal dominant inheritance with high penetrance. [Diabetologia (1995) 25 years, more than 50 % of the women develop diabetes [1]. Approximately 30 % of women who present with NIDDM in middle age have previously been suspected to have diabetes in pregnancy because of hyperglycaemia or glycosuria [2]. Women who have had gestational diabetes present an opportunity to study diabetes at an early stage in its evolution [3]. They are often overweight, and have both impaired beta-cell function and increased insulin resistance [4,5]. These are similar defects to those found in the first degree relatives of NIDDM patients [5][6][7].Studies of inheritance of NIDDM have been restricted because of the difficulty in identifying two

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Abnormalities of Glucose Tolerance Following Gestational Diabetes

Cited by 81 publications

References 0 publications

Atlantic DIP: high prevalence of abnormal glucose tolerance post partum is reduced by breast-feeding in women with prior gestational diabetes mellitus

Atlantic DIP: high prevalence of abnormal glucose tolerance post partum is reduced by breast-feeding in women with prior gestational diabetes mellitus

Prevalence of type 2 diabetes among women with a previous history of gestational diabetes mellitus

Prevalence of diabetes mellitus and impaired glucose tolerance in parents of women with gestational diabetes

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