title: Estimating the Recurrence Rate of Gestational Diabetes Mellitus (GDM) in Massachusetts 1998-2007: Methods and Findings.
abstract: OBJECTIVE
  Women with gestational diabetes mellitus (GDM) may be able to reduce their risk of recurrent GDM and progression to type 2 diabetes mellitus through lifestyle change; however, there is limited population-based information on GDM recurrence rates.
  
  
  METHODS
  We used data from a population of women delivering two sequential live singleton infants in Massachusetts (1998-2007) to estimate the prevalence of chronic diabetes mellitus (CDM) and GDM in parity one pregnancies and recurrence of GDM and progression from GDM to CDM in parity two pregnancies. We examined four diabetes classification approaches; birth certificate (BC) data alone, hospital discharge (HD) data alone, both sources hierarchically combined with a diagnosis of CDM from either source taking priority over a diagnosis of GDM, and both sources combined including only pregnancies with full agreement in diagnosis. Descriptive statistics were used to describe population characteristics, prevalence of CDM and GDM, and recurrence of diabetes in successive pregnancies. Diabetes classification agreement was assessed using the Kappa statistic. Associated maternal characteristics were examined through adjusted model-based t tests and Chi square tests.
  
  
  RESULTS
  A total of 134,670 women with two sequential deliveries of parities one and two were identified. While there was only slight agreement on GDM classification across HD and BC records, estimates of GDM recurrence were fairly consistent; nearly half of women with GDM in their parity one pregnancy developed GDM in their subsequent pregnancy. While estimates of progression from GDM to CDM across sequential pregnancies were more variable, all approaches yielded estimates of ≤5 %. The development of either GDM or CDM following a parity one pregnancy with no diagnosis of diabetes was <3 % across approaches. Women with recurrent GDM were disproportionately older and foreign born.
  
  
  CONCLUSIONS
  Recurrent GDM is a serious life course public health issue; the inter-pregnancy interval provides an important window for diabetes prevention.
authors.affiliation: Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS K-79, Atlanta, GA, 30341, USA. lbe@cdc.gov.
authors.forename: Lucinda
authors.initials: L
authors.lastname: England
authors.affiliation: MGH Center for Child and Adolescent Health Research and Policy, MassGeneral Hospital for Children, Harvard Medical School, 100 Cambridge Street, Room 15-1545, Boston, MA, 02115, USA. mkotelchuck@partners.org.
authors.forename: Milton
authors.initials: M
authors.lastname: Kotelchuck
authors.affiliation: DB Consulting Group, Inc., 8403 Colesville Road, Silver Spring, MD, 20910, USA. hgw0@att.net.
authors.forename: Hoyt G
authors.initials: HG
authors.lastname: Wilson
authors.affiliation: Bureau of Family Health and Nutrition, Massachusetts Department of Public Health, 250 Washington Street, Boston, MA, 02108, USA. hafsatou.diop@state.ma.us.
authors.forename: Hafsatou
authors.initials: H
authors.lastname: Diop
authors.affiliation: Massachusetts Department of Public Health, 250 Washington Street, Boston, MA, 02108, USA. paul.oppedisano@state.ma.us.
authors.forename: Paul
authors.initials: P
authors.lastname: Oppedisano
authors.affiliation: Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS K-79, Atlanta, GA, 30341, USA. skim1@cdc.gov.
authors.forename: Shin Y
authors.initials: SY
authors.lastname: Kim
authors.affiliation: Bureau of Family Health and Nutrition, Massachusetts Department of Public Health, 250 Washington Street, Boston, MA, 02108, USA. xiaohui.cui@state.ma.usa.
authors.forename: Xiaohui
authors.initials: X
authors.lastname: Cui
authors.affiliation: Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Mailstop F74, Atlanta, GA, 30341-3717, USA. ayn9@cdc.gov.
authors.forename: Carrie K
authors.initials: CK
authors.lastname: Shapiro-Mendoza
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000401:mortality*; D016640:Diabetes, Gestational / Q000453:epidemiology / Q000401:mortality*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D010298:Parity; D011247:Pregnancy; D015995:Prevalence; D012008:Recurrence
keywords: Diabetes; Diabetes recurrence; Gestational diabetes mellitus; Pregnancy; Sequential pregnancies