Glucose intolerance in pregnancy and postpartum risk of metabolic syndrome in young women.
OBJECTIVE
Gestational diabetes mellitus (GDM) and even mild glucose intolerance in pregnancy are both associated with increased risks of developing type 2 diabetes and cardiovascular disease in the future. Because the metabolic syndrome also identifies patients at risk of type 2 diabetes and cardiovascular disease, we hypothesized that gestational dysglycemia may be associated with an unrecognized latent metabolic syndrome. Thus, we sought to evaluate the relationship between gestational glucose tolerance status and postpartum risk of metabolic syndrome.


METHODS
In this prospective cohort study, 487 women underwent oral glucose tolerance testing in pregnancy and cardiometabolic characterization at 3 months postpartum. The antepartum testing defined three gestational glucose tolerance groups: GDM (n = 137); gestational impaired glucose tolerance (GIGT) (n = 91); and normal glucose tolerance (NGT) (n = 259).


METHODS
The primary outcome was the presence of the metabolic syndrome at 3 months postpartum, as defined by International Diabetes Federation (IDF) and American Heart Association/National Heart Lung and Blood Institute (AHA/NHLBI) criteria, respectively.


RESULTS
The postpartum prevalence of IDF metabolic syndrome progressively increased from NGT (10.0%) to GIGT (17.6%) to GDM (20.0%) (overall P = 0.016). The same progression was observed for AHA/NHLBI metabolic syndrome (NGT, 8.9%; GIGT, 15.4%; and GDM, 16.8%; overall P = 0.046). On logistic regression analysis, both GDM (odds ratio, 2.05; 95% confidence interval, 1.07-3.94) and GIGT (odds ratio, 2.16; 95% confidence interval, 1.05-4.42) independently predicted postpartum metabolic syndrome.


CONCLUSIONS
Both GDM and mild glucose intolerance in pregnancy predict an increased likelihood of metabolic syndrome at 3 months postpartum, supporting the concept that women with gestational dysglycemia may have an underlying latent metabolic syndrome.
Retnakaran
Ravi
R
Leadership Sinai Centre for Diabetes, 60 Murray Street, Suite L5-039, Toronto, Canada M5T3L9. rretnakaran@mtsinai.on.ca
Qi
Ying
Y
Connelly
Philip W
PW
Sermer
Mathew
M
Zinman
Bernard
B
Hanley
Anthony J G
AJ
D000328:Adult; D002318:Cardiovascular Diseases / Q000209:etiology; D015331:Cohort Studies; D016640:Diabetes, Gestational / Q000378:metabolism; D005260:Female; D018149:Glucose Intolerance / Q000150:complications*; D006801:Humans; D024821:Metabolic Syndrome / Q000209:etiology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000378:metabolism*; D011446:Prospective Studies; D011644:Puerperal Disorders / Q000209:etiology*; D012306:Risk