Gestational Diabetes Mellitus: Clinical Predictors and Long-Term Risk of Developing Type 2 Diabetes

Abstract

OBJECTIVE—We sought to determine the long-term risk of type 2 diabetes following a pregnancy complicated by gestational diabetes mellitus (GDM) and assess what maternal antepartum, postpartum, and neonatal factors are predictive of later development of type 2 diabetes. RESEARCH DESIGN AND METHODS—This was a retrospective cohort study using survival analysis on 5,470 GDM patients and 783 control subjects who presented for postnatal follow-up at the Mercy Hospital for Women between 1971 and 2003. RESULTS—Risk of developing diabetes increased with time of follow-up for both groups and was 9.6 times greater for patients with GDM. The cumulative risk of developing type 2 diabetes for the GDM patients was 25.8% at 15 years postdiagnosis. Predictive factors for the development of type 2 diabetes were use of insulin (hazard ratio 3.5), Asian origin compared with Caucasian (2.1), and 1-h blood glucose (1.3 for every 1 mmol increase above 10.1 mmol). BMI was associated with an increased risk of developing type 2 diabetes but did not meet the assumption of proportional hazards required for valid inference when using Cox proportional hazards. CONCLUSIONS—While specific predictive factors for the later development of type 2 diabetes can be identified in the index pregnancy, women with a history of GDM, as a group, are worthy of long-term follow-up to ameliorate their excess cardiovascular risk.

2D-DIGE to identify proteins associated with gestational diabetes in omental adipose tissue

“…Longterm women and infants are prone to obesity, diabetes and cardiovascular disease (Catalano et al 2003, Lee et al 2007. Thus, increasing our understanding of the aetiology of GDM will provide the best opportunity for early treatment to prevent onset or progression of the disease.…”

“…Importantly, it is considered an important driver for the type 2 diabetes epidemic in many populations. In a recently published retrospective cohort study, the risk of developing diabetes was 9.6 times greater for patients with GDM, with the cumulative risk of developing type 2 diabetes for GDM patients being 25% at 15 years post-diagnosis (Lee et al 2007). Thus, increasing our understanding of the pathophysiology of GDM is essential in order to provide the best opportunity for early treatment to prevent onset or progression of the disease.…”

Hyperemesis gravidarum and long‐term mortality: a population‐based cohort study

“…Gestational hypertension, pre‐eclampsia and placental abruption are all reported to increase the risk of cardiovascular disease (CVD) later in life 3, 4, 5, 6, 7. Moreover, it is well known that gestational diabetes increases the risk of developing type 2 diabetes 6, 8, 9, 10. According to the American Heart Association Guidelines for the prevention of Cardiovascular Disease in Women , taking a history of pregnancy complications is part of the CVD risk evaluation 11…”

Terapia nutricional no diabetes gestacional

“…Lee et al 19 , em estudo de coorte retrospectivo com 5 470 mulheres acometidas previamente por DMG e 783 controles, encontraram risco acumulado de 9,6 (5,9-16,7) vezes maior entre as mulheres com história de DMG. Em recente revisão sistemática da literatura, Kim et al 20 observaram que a recorrência de DMG variou entre 30% e 84% dos estudos avaliados.…”