title: Clinical and genetic risk factors for type 2 diabetes at early or late post partum after gestational diabetes mellitus.
abstract: BACKGROUND
  Women with a history of gestational diabetes mellitus (GDM) are at increased risk of type 2 diabetes (T2DM). However, the time to progression to diabetes differs individually.
  
  
  OBJECTIVE
  We investigated the clinical and genetic risk factors that are associated with T2DM early or late post partum after GDM pregnancy.
  
  
  METHODS
  This was a hospital-based prospective cohort study that enrolled GDM women.
  
  
  METHODS
  A total of 843 GDM subjects were followed for the development of T2DM. Clinical risk factors were investigated during pregnancy, 2 months post partum, and annually thereafter. GDM subjects were genotyped for 21 known T2DM-associated genetic variants, and their genotype frequencies were compared with elderly nondiabetic controls.
  
  
  RESULTS
  At 2 months post partum, 105 (12.5%) subjects had T2DM (early converters). Among the 370 remaining subjects who underwent more than 1 year of follow-up, 88 (23.8%) had newly developed T2DM (late converters). Independent risk factors for early converters were higher prepregnancy body mass index, higher area under the curve of glucose during an antepartum oral glucose tolerance test, lower fasting insulin concentration, and decreased β-cell function. Independent risk factors for late converters were higher prepregnancy body mass index and higher glucose area under the curve. Variants in CDKN2A/2B and HHEX were associated with early conversion, whereas variants in CDKAL1 were associated with late conversion.
  
  
  CONCLUSIONS
  Obesity was a risk factor for both early and late T2DM converters. However, early converters had more pronounced defects in β-cell function, which might be explained, in part, by differences in genetic predisposition.
authors.affiliation: Department of Internal Medicine, Seoul National University Hospital, Seoul, 110-744, Korea.
authors.forename: Soo Heon
authors.initials: SH
authors.lastname: Kwak
authors.forename: Sung Hee
authors.initials: SH
authors.lastname: Choi
authors.forename: Hye Seung
authors.initials: HS
authors.lastname: Jung
authors.forename: Young Min
authors.initials: YM
authors.lastname: Cho
authors.forename: Soo
authors.initials: S
authors.lastname: Lim
authors.forename: Nam H
authors.initials: NH
authors.lastname: Cho
authors.forename: Seong Yeon
authors.initials: SY
authors.lastname: Kim
authors.forename: Kyong Soo
authors.initials: KS
authors.lastname: Park
authors.forename: Hak C
authors.initials: HC
authors.lastname: Jang
mesh_terms: D000328:Adult; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000209:etiology* / Q000235:genetics; D016640:Diabetes, Gestational / Q000453:epidemiology / Q000235:genetics; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D008297:Male; D049590:Postpartum Period / Q000502:physiology; D011247:Pregnancy; D011644:Puerperal Disorders / Q000453:epidemiology / Q000209:etiology* / Q000235:genetics; D012307:Risk Factors