Prediction of postpartum diabetes in women with gestational diabetes mellitus.
OBJECTIVE
We studied the incidence of postpartum diabetes after gestational diabetes mellitus and investigated biochemical and clinical predictors of postpartum diabetes.


METHODS
We monitored 174 women with gestational diabetes by performing oral glucose tolerance tests during pregnancy as well as 1, 2 and 5 years postpartum. Women who developed impaired fasting glucose, impaired glucose tolerance or diabetes were compared with women who remained normoglycaemic at 5 years. Insulinogenic index, disposition index and HOMA-beta cell index were used to assess beta cell function; insulin resistance was estimated by HOMA index of insulin resistance.


RESULTS
At 5 years postpartum, 30% of the women had developed diabetes and 51% some form of abnormal glucose tolerance. Women who developed diabetes had higher fasting glucose and HbA(1c) during pregnancy than those who remained normoglycaemic. They also had lower HOMA-beta cell index, insulinogenic index and disposition index than the normoglycaemic women. HbA(1c) and fasting glucose during pregnancy as well as the number of previous pregnancies and family history of diabetes were independent predictors of postpartum diabetes. HbA(1c) > or =4.7% (Swedish Mono S) or > or =5.7% (National Glycohemoglobin Standardization Program) and fasting blood glucose > or =5.2 mmol/l were associated with a four- to sixfold increased risk.


CONCLUSIONS
Among women with gestational diabetes mellitus, those at risk of future diabetes can be identified by HbA(1c) and fasting glucose values in the upper normal range during pregnancy. A family history of diabetes and previous pregnancies further increase this risk.
Ekelund
M
M
Department of Internal Medicine, Hospital of Helsingborg, SE-251 87 Helsingborg, Sweden. magnus.ekelund@skane.se
Shaat
N
N
Almgren
P
P
Groop
L
L
Berntorp
K
K
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000453:epidemiology; D016640:Diabetes, Gestational / Q000175:diagnosis / Q000503:physiopathology*; D005260:Female; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications; D012306:Risk; D013548:Sweden; D013997:Time Factors; D016896:Treatment Outcome
D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human