An abnormal screening glucose challenge test in pregnancy predicts postpartum metabolic dysfunction, even when the antepartum oral glucose tolerance test is normal

Abstract

An abnormal antepartum GCT, even when followed by a normal OGTT, is associated with postpartum glycaemia and beta-cell dysfunction, factors that may portend an increased future risk of diabetes in this patient population.

Mild glucose intolerance in pregnancy and risk of cardiovascular disease: a population-based cohort study

“…First, because any degree of abnormal glucose homeostasis during pregnancy predicts an increased future risk of prediabetes or diabetes (both of which carry vascular risk), [4][5][6][7][8] it stands to reason that cardiovascular disease may also ensue. Second, similar to postpartum dysglycemia, other cardiometabolic risk factors associated with previous gestational diabetes (e.g., hypertension, dyslipidemia, obesity) are also continuous and hence may also extend to lesser degrees of antepartum glycemia.…”

“…Although the purpose of this screening is to detect gestational diabetes, it has recently emerged that any degree of abnormal glucose homeostasis on antepartum screening (not just gestational diabetes) predicts an increased risk of prediabetes or diabetes at 3-months postpartum and of diabetes in the years after delivery. [4][5][6][7][8] If the long-term risk of diabetes associated with gestational diabetes extends to lesser degrees of antepartum dysglycemia, the cardiovascular risk associated with gestational diabetes may also extend to women with mild glucose intolerance during pregnancy. To test this hypothesis, we used population-based health care data to determine whether pregnant women who have an abnormal glucose challenge test result but not gestational diabetes have an increased risk of subsequent cardiovascular disease.…”

β-cell dysfunction in women with previous gestational diabetes is associated with visceral adipose tissue distribution

“…However, also women with milder glucose intolerance, but without the diagnosis of GDM, have an increased risk of developing prediabetes and type 2 diabetes in the future (2,3). Prediabetes is an intermediate form of dysglycemia and identifies individuals at risk of diabetes, cardiovascular (CV) disease and mortality (4,5,6).…”

Gestational Diabetes and the Metabolic Syndrome

“…It remains to be determined, however, whether these current strategies can effectively reduce long-term risks of metabolic syndrome, T2DM and CVD in affected women (Nolan, 2011). Indeed, women who do not meet the prescribed thresholds for GDM may incur glucose-mediated fetal macrosomia (Mello et al, 1997;Rudge et al, 2000;Scholl et al, 2001;Sermer, et al, 1995), and may be at risk for T2DM and CVD (Retnakaran et al, 2008a(Retnakaran et al, , 2008b(Retnakaran et al, , 2009a(Retnakaran et al, , 2009b(Retnakaran et al, , 2009c(Retnakaran et al, , 2009d(Retnakaran et al, , 2009e, 2010cShah et al, 2008). The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study was undertaken to examine the risks associated with glucose values below traditional thresholds used to diagnose GDM.…”