Gestational diabetes mellitus and risk of type 2 diabetes 10 years after the index pregnancy in Sri Lankan women—A community based retrospective cohort study

Abstract

BackgroundWomen with a history of gestational diabetes mellitus (GDM) have an increased risk of type 2 diabetes mellitus (T2DM) later in life compared to women with no GDM. This study was aimed to determine the risk of developing T2DM 10 years after GDM in Sri Lankan women.MethodsA retrospective cohort study was conducted in the Colombo district, Sri Lanka. 7205 women who delivered a child in 2005 were identified through Public Health Midwives in the field. Women with antenatal records were interviewed and relevant data were extracted from medical records to identify potential participants. One hundred and nineteen women who had GDM and 240 women who did not have GDM were recruited. Current diagnosis of diabetes was based on history, relevant medical records and blood reports within the past 1 year.ResultsThe mean duration of follow up was 10.9 (SD = 0.35) years in the GDM group and 10.8 (SD = 0.31) years in the non-GDM group. The incidence density of diabetes in the GDM group was 56.3 per 1000 person years compared to 5.4 per 1000 person years in non GDM group giving a rate ratio of 10.42 (95% CI: 6.01–19.12). A woman having GDM in the index pregnancy was 10.6 times more likely to develop diabetes within 10 years compared to women with no GDM after controlling for other confounding variables. Delivering a child after 30 years, being treated with insulin during the pregnancy and delivering a baby weighing more than 3.5 Kg were significant predictors of development of T2DM after controlling for family history of diabetes mellitus (DM), GDM in previous pregnancies, parity and gestational age at delivery.ConclusionsWomen with GDM had a 10-fold higher risk of developing T2DM during a 10-year follow up period as compared to women with no GDM after controlling for other confounding variables.

Prevalence of diabetes five years after having gestational diabetes during pregnancy — Croatian national study

“…This result seems to be less compared to previously published studies and similar to only one other study from Sweden where diabetes prevalence was 3.4% among women 3-4 years after childbirth (21). The majority of other studies report higher prevalence rates, ranging from 14% (9) or 20% (13) by 11 or 9 years postpartum and up to 33.3% among women investigated 5-10 years postpartum (15). We believe a longer period of follow up in the latter studies might be the cause of higher diabetes prevalence compared to the one observed in our study.…”

“…On the other hand, women burdened with GD during pregnancy are at risk of developing diabetes later in life. Studies have reported that women with GD during pregnancy have a seven to twelve times (8)(9)(10) higher risk of developing type 2 diabetes compared with women who are normoglycaemic during pregnancy and, according to a systemic literature review by Kim et al (11), the occurrence rate is highest in the first 5 years after pregnancy. This systemic review also revealed a wide range of cumulative incidence of diabetes ranging from 2.6% to over 70%, which is presumably due to different follow-up periods among studies expanding from 6 weeks to 28 years postpartum.…”

A framework for healthcare interventions to address maternal morbidity

“…Common examples include pre-eclampsia (discussed above) and GDM, which increases the risk of future type 2 diabetes, and can be further influenced by ethnicity. 18,19 Combined NCDs are the leading cause of death in women worldwide, accounting for 65% of all deaths. 20 Estimates suggest that, in 2030, a two-thirds reduction in maternal and child deaths, and a one-third reduction in NCD mortality would mean 210 000 fewer maternal deaths and 690 000 fewer NCD deaths in women and girls aged 5-49 years, and 2.4 million fewer NCD deaths in women aged 50-69 years.…”

Intrauterine exposure to hyperglycaemia in pregnancy and risk of adiposity in the offspring at 10 years of age – A community based retrospective cohort study in Sri Lanka

“…A retrospective cohort study was conducted in eight Medical Officer of Health (MOH) areas in Colombo district, Sri Lanka from March 2015 to October 2016 to assess the long term outcomes of HIP on the mother and the offspring. We have previously published the risk of type 2 diabetes in the mothers 10 years after gestational diabetes [39].…”