Screening of postpartum diabetes in women with gestational diabetes: high-risk subgroups and areas for improvements—the STRONG observational study

Abstract

Aims To assess the proportion of women with gestational diabetes (GDM) by performing postpartum Oral Glucose Tolerance Test (OGTT) and to identify GDM phenotypes at high-risk of postpartum dysglycemia (PPD). Methods Observational, retrospective, multicenter study involving consecutive GDM women. Recursive partitioning (RECPAM) analysis was used to identify distinct and homogeneous subgroups of women at different PPD risk. Results From a sample of 2,736 women, OGTT was performed in 941 (34.4%) women, of whom 217 (23.0%) developed PPD. Insulin-treated women having family history of diabetes represented the subgroup with the highest PPD risk (OR 5.57, 95% CI 3.60–8.63) compared to the reference class (women on diet with pre-pregnancy BMI < = 28.1 kg/m2). Insulin-treated women without family diabetes history and women on diet with pre-pregnancy BMI > 28.1 kg/m2 showed a two-fold PPD risk. Previous GDM and socioeconomic status represent additional predictors. Fasting more than post-prandial glycemia plays a predictive role, with values of 81–87 mg/dl (4.5–4.8 mmol/l) (lower than the current diagnostic GDM threshold) being associated with PPD risk. Conclusions Increasing compliance to postpartum OGTT to prevent/delay PPD is a priority. Easily available characteristics identify subgroups of women more likely to benefit from preventive strategies. Fasting BG values during pregnancy lower than those usually considered deserve attention.

Prevalence of prediabetes and type 2 diabetes mellitus in south and southeast Asian women with history of gestational diabetes mellitus: Systematic review and meta-analysis

“…In addition, there seem to be limited evidence to compare the prevalence of T2DM post-GDM in different ethnicities including PIMA Indians. A recent study by Napoli et al [ 25 ] in Italy, reported that only 34.4% of women from ‘STRONG’ observational study underwent postpartum glucose monitoring. We also observed that only three studies had a follow-up rate of more than 70%, although we have showed earlier that it is feasible at least in research settings, with a follow up of 95.8% [ 26 ].…”

Risk stratification of women with gestational diabetes mellitus using mutually exclusive categories based on the International Association of Diabetes and Pregnancy Study Groups criteria for the development of postpartum dysglycaemia: a retrospective cohort study

“… 13 In addition to the reasons associated with clinicians and healthcare system, the mothers’ paucity of time to perform the glucose test and lack of knowledge that they are at higher risks of postpartum dysglycemia aggravate the poor uptake rate of follow-up after delivery. 30 31 Therefore, it may be more ideal and feasible, at an antepartum stage, to educate women with GDM about their future risk for T2DM to enhance their healthcare awareness and health management. On the other hand, early risk stratification spares low-risk patients from unnecessary medical care while ensuring knowledge of diabetes and preventative interventions are delivered adequately to women in high-risk categories.…”

“…Even in active care, the average follow-up rate was still relatively modest at 64.8% 13. In addition to the reasons associated with clinicians and healthcare system, the mothers’ paucity of time to perform the glucose test and lack of knowledge that they are at higher risks of postpartum dysglycemia aggravate the poor uptake rate of follow-up after delivery 30 31. Therefore, it may be more ideal and feasible, at an antepartum stage, to educate women with GDM about their future risk for T2DM to enhance their healthcare awareness and health management.…”

Investigating opportunities to prevent Type 2 Diabetes Mellitus after Gestational Diabetes Mellitus: the DIVINE-NSW study

“…Previously reported prevalence of persisting dysglycaemia in women following GDM affected pregnancy is found to vary, with 23% reported within 12 weeks from delivery in Italy,[20] 40% within 7 months post-partum in South Asia and even up to 48% at a median of 20 months post-partum in India. [21] The most recent estimates of persisting dysglycaemia in the Australian population was reported in 2021, with 22% of First Nation women but no Caucasian women developing T2DM following GDM at a median of 2.5 years follow-up.…”