title: Abnormal glucose tolerance post-gestational diabetes mellitus as defined by the International Association of Diabetes and Pregnancy Study Groups criteria.
abstract: OBJECTIVE
  An increase in gestational diabetes mellitus (GDM) prevalence has been demonstrated across many countries with adoption of the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) diagnostic criteria. Here, we determine the cumulative incidence of abnormal glucose tolerance among women with previous GDM, and identify clinical risk factors predicting this.
  
  
  METHODS
  Two hundred and seventy women with previous IADPSG-defined GDM were prospectively followed up for 5years (mean 2.6) post-index pregnancy, and compared with 388 women with normal glucose tolerance (NGT) in pregnancy.
  
  
  METHODS
  Cumulative incidence of abnormal glucose tolerance (using American Diabetes Association criteria for impaired fasting glucose, impaired glucose tolerance and diabetes) was determined using the Kaplan-Meier method of survival analysis. Cox regression models were constructed to test for factors predicting abnormal glucose tolerance.
  
  
  RESULTS
  Twenty-six percent of women with previous GDM had abnormal glucose tolerance vs 4% with NGT, with the log-rank test demonstrating significantly different survival curves (P<0.001). Women meeting IADPSG, but not the World Health Organization (WHO) 1999 criteria, had a lower cumulative incidence than women meeting both sets of criteria, both in the early post-partum period (4.2% vs 21.7%, P<0.001) and at longer-term follow-up (13.7% vs 32.6%, P<0.001). Predictive factors were glucose levels on the pregnancy oral glucose tolerance test, family history of diabetes, gestational week at testing, and BMI at follow-up.
  
  
  CONCLUSIONS
  The proportion of women developing abnormal glucose tolerance remains high among those with IADPSG-defined GDM. This demonstrates the need for continued close follow-up, although the optimal frequency and method needs further study.
authors.affiliation: Galway Diabetes Research CentreNational University of Ireland, Galway, Ireland eoin.noctor@hse.ie.
authors.forename: Eoin
authors.initials: E
authors.lastname: Noctor
authors.affiliation: Galway Diabetes Research CentreNational University of Ireland, Galway, Ireland.
authors.forename: Catherine
authors.initials: C
authors.lastname: Crowe
authors.affiliation: Galway Diabetes Research CentreNational University of Ireland, Galway, Ireland.
authors.forename: Louise A
authors.initials: LA
authors.lastname: Carmody
authors.affiliation: Statistical Consulting Unit/CSTAR @ ULUniversity of Limerick, Limerick, Ireland.
authors.forename: Jean A
authors.initials: JA
authors.lastname: Saunders
authors.affiliation: Galway Diabetes Research CentreNational University of Ireland, Galway, Ireland.
authors.forename: Breda
authors.initials: B
authors.lastname: Kirwan
authors.affiliation: Department of General Practice.
authors.forename: Angela
authors.initials: A
authors.lastname: O'Dea
authors.affiliation: School of Business and Economics.
authors.forename: Paddy
authors.initials: P
authors.lastname: Gillespie
authors.affiliation: Department of General Practice.
authors.forename: Liam G
authors.initials: LG
authors.lastname: Glynn
authors.affiliation: School of PsychologyNational University of Ireland, Galway, Ireland.
authors.forename: Brian E
authors.initials: BE
authors.lastname: McGuire
authors.affiliation: School of Business and Economics.
authors.forename: Ciarán
authors.initials: C
authors.lastname: O'Neill
authors.affiliation: Department of Clinical BiochemistryUniversity Hospital Galway, Galway, Ireland.
authors.forename: P M
authors.initials: PM
authors.lastname: O'Shea
authors.affiliation: Galway Diabetes Research CentreNational University of Ireland, Galway, Ireland.
authors.forename: F P
authors.initials: FP
authors.lastname: Dunne
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D016640:Diabetes, Gestational / Q000097:blood*; D005260:Female; D018149:Glucose Intolerance / Q000097:blood / Q000453:epidemiology*; D005951:Glucose Tolerance Test; D006801:Humans; D015994:Incidence; D049590:Postpartum Period; D011247:Pregnancy; D015995:Prevalence; D012307:Risk Factors
chemical_list: D001786:Blood Glucose