Postpartum glucose tolerance status 6 to 12 weeks after gestational diabetes mellitus: a Brazilian cohort.
OBJECTIVE
The aims of this study were to estimate the local rate of postpartum diabetes screening after gestational diabetes mellitus (GDM) pregnancies, and to identify clinical variables associated with retesting rates and with the persistence of decreased glucose tolerance.


METHODS
Prospective cohort of GDM women with prenatal delivery at a specialized center, from November 2009 to May 2012. All women were advised to schedule a 6 weeks postpartum 75-g oral glucose tolerance test (OGTT).


RESULTS
Of the 209 women included, 108 (51.7%) returned to be tested with fasting plasma glucose (n=14), OGTT (n=93) or random glucose (n=1). Return was associated with lower parity rate (2 vs. 3, p<0.001) and higher pregnancy 2-h OGTT (165 vs. 155 mg/dL, p=0.034), but not with socio-demographic characteristics. Four women (3.7%) had diabetes, 22 (20.4%) had impaired fasting glucose or impaired glucose tolerance. Persistent hyperglycemia was associated with a positive family history of diabetes (relative risk-RR 2.41, p=0.050), diagnostic 2-h OGTT in pregnancy (RR 1.01, p=0.045), insulin use during pregnancy (RR 2.37, p=0.014), and cesarean section (RR 2.61, p=0.015).


CONCLUSIONS
Even though postpartum abnormalities were frequent in GDM, rates of postpartum diabetes screening were undesirably low. As no specific clinical profile defines who will adhere to postpartum testing, it is essential to encourage all women to reevaluate their glucose status, particularly those with a family history of diabetes and more severe hyperglycemia.
Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
Letícia Schwerz
LS
Weinert
Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
Livia Silveira
LS
Mastella
Faculdade de Medicina, UFRGS, Porto Alegre, RS, Brazil.
Maria Lúcia Rocha
ML
Oppermann
Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
Sandra Pinho
SP
Silveiro
Unidade de Bioestatística, HCPA, Porto Alegre, RS, Brazil.
Luciano Santos Pinto
LS
Guimarães
Serviço de Endocrinologia, HCPA, Porto Alegre, RS, Brazil.
Angela Jacob
AJ
Reichelt
D000328:Adult; D001786:Blood Glucose / Q000032:analysis*; D001938:Brazil / Q000453:epidemiology; D016009:Chi-Square Distribution; D016640:Diabetes, Gestational / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D005320:Fetal Macrosomia / Q000453:epidemiology; D005951:Glucose Tolerance Test; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis* / Q000453:epidemiology; D015999:Multivariate Analysis; D049590:Postpartum Period / Q000097:blood*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood / Q000175:diagnosis; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors
D001786:Blood Glucose