妊娠期糖尿病产后转归为2型糖尿病

… , might serve to reduce, and potentially prevent, progression to type 2 diabetes mellitus … type 2 diabetes mellitus risk reduction in women with a history of gestational diabetes mellitus …

Gestational diabetes mellitus (GDM) complicates 6% to 8% of pregnancies and up to 50% of women with GDM progress to type 2 diabetes mellitus (DM) within 5 years postpartum. Clinicians have little guidance on which women are most at risk for DM progression or when evidence-based prevention strategies should be implemented in a woman’s lifecycle. To help address this gap, the authors review identifiable determinants of progression from GDM to DM across the perinatal period, considering prepregnancy, pregnancy, and postpartum periods. The authors categorize evidence by pathways of risk including genetic, metabolic, and behavioral factors that influence progression to DM among women with GDM.

BackgroundWomen who develop gestational diabetes mellitus (GDM) have an increased risk for the development of type 2 diabetes. Despite this "window of opportunity," few intervention studies have targeted postpartum women with a history of GDM. We sought perspectives of women with a history of GDM to identify a) barriers and facilitators to healthy lifestyle changes postpartum, and b) specific intervention approaches that would facilitate participation in a postpartum lifestyle intervention program.MethodsWe used mixed methods to gather data from women with a prior history of GDM, including focus groups and informant interviews. Analysis of focus groups relied on grounded theory and used open-coding to categorize data by themes, while frequency distributions were used for the informant interviews.ResultsOf 38 women eligible to participate in focus groups, only ten women were able to accommodate their schedules to attend a focus group and 15 completed informant interviews by phone. We analyzed data from 25 women (mean age 35, mean pre-pregnancy BMI 28, 52% Caucasian, 20% African American, 12% Asian, 8% American Indian, 8% refused to specify). Themes from the focus groups included concern about developing type 2 diabetes, barriers to changing diet, and barriers to increasing physical activity. In one focus group, women expressed frustration about feeling judged by their physicians during their GDM pregnancy. Cited barriers to lifestyle change were identified from both methods, and included time and financial constraints, childcare duties, lack of motivation, fatigue, and obstacles at work. Informants suggested facilitators for lifestyle change, including nutrition education, accountability, exercise partners/groups, access to gyms with childcare, and home exercise equipment. All focus group and informant interview participants reported access to the internet, and the majority expressed interest in an intervention program delivered primarily via the internet that would include the opportunity to work with a lifestyle coach.ConclusionTime constraints were a major barrier. Our findings suggest that an internet-based lifestyle intervention program should be tested as a novel approach to prevent type 2 diabetes in postpartum women with a history of GDM.Trial RegistrationClinicalTrials.gov: NCT01102530

… To provide evidence-based data for health providers and promote postpartum screening, … the risks of type 2 diabetes mellitus (T2DM) diagnosis after gestational diabetes mellitus (GDM) …

… of gestational diabetes mellitus (GDM) are at increased risk of type 2 diabetes mellitus (… of T2DM compared with those who had a normoglycemic pregnancy (1). However, there are …

We examined antepartum clinical characteristics along with measures of glucose tolerance, insulin sensitivity, pancreatic β-cell function, and body composition in Latino women with gestational diabetes mellitus (GDM) for their ability to predict type 2 diabetes or impaired glucose tolerance (IGT) within 6 months after delivery. A total of 122 islet cell antibody-negative women underwent oral and intravenous glucose tolerance tests (OGTT; IVGTT), hyperinsulinemic-euglycemic clamps, and measurement of body fat between 29 and 36 weeks' gestation and returned between 1 and 6 months postpartum for a 75-g OGTT. Logistic regression analysis was used to examine the relationship between antepartum variables and glucose tolerance status postpartum. At postpartum testing, 40% of the cohort had normal glucose tolerance, 50% had IGT, and 10% had diabetes by American Diabetes Association criteria. Independent antepartum predictors of postpartum diabetes were the 30-min incremental insulin:glucose ratio during a 75-g OGTT (P = 0.0002) and the total area under the diagnostic 100-g glucose tolerance curve (P = 0.003). Independent predictors of postpartum IGT were a low firstphase IVGTT insulin response (P = 0.0001), a diagnosis of GDM before 22 weeks' gestation (P = 0.003), and weight gain between prepregnancy and the postpartum examination (P = 0.03). All subjects had low insulin sensitivity during late pregnancy, but neither glucose clamp nor minimal model measures of insulin sensitivity in the 3rd trimester were associated with the risk of IGT or diabetes within 6 months' postpartum. These results highlight the importance of pancreatic β-cell dysfunction, detectable under conditions of marked insulin resistance in late pregnancy, to predict abnormalities of glucose tolerance soon after delivery in pregnancies complicated by GDM. Moreover, the association of postpar-turn IGT with weight gain and an early gestational age at diagnosis of GDM suggests a role for chronic insulin resistance in mediating hyperglycemia outside the 3rd trimester in women with such a β-cell defect.

Background Lactation improves glucose metabolism, but its role in preventing type 2 diabetes mellitus (DM) after gestational diabetes mellitus (GDM) remains uncertain. Objective To evaluate lactation and the 2-year incidence of DM after GDM pregnancy. Design Prospective, observational cohort of women with recent GDM. (ClinicalTrials.gov: NCT01967030) Setting Integrated health care system. Participants 1035 women diagnosed with GDM who delivered singletons at 35 weeks' gestation or later and enrolled in the Study of Women, Infant Feeding and Type 2 Diabetes After GDM Pregnancy from 2008 to 2011. Measurements Three in-person research examinations from 6 to 9 weeks after delivery (baseline) and annual follow-up for 2 years that included 2-hour, 75-g oral glucose tolerance testing; anthropometry; and interviews. Multivariable Weibull regression models evaluated independent associations of lactation measures with incident DM adjusted for potential confounders. Results Of 1010 women without diabetes at baseline, 959 (95%) were evaluated up to 2 years later; 113 (11.8%) developed incident DM. There were graded inverse associations for lactation intensity at baseline with incident DM and adjusted hazard ratios of 0.64, 0.54, and 0.46 for mostly formula or mixed/inconsistent, mostly lactation, and exclusive lactation versus exclusive formula feeding, respectively (P trend = 0.016). Time-dependent lactation duration showed graded inverse associations with incident DM and adjusted hazard ratios of 0.55, 0.50, and 0.43 for greater than 2 to 5 months, greater than 5 to 10 months, and greater than 10 months, respectively, versus 0 to 2 months (P trend = 0.007). Weight change slightly attenuated hazard ratios. Limitation Randomized design is not feasible or desirable for clinical studies of lactation. Conclusion Higher lactation intensity and longer duration were independently associated with lower 2-year incidences of DM after GDM pregnancy. Lactation may prevent DM after GDM delivery.

Gestational diabetes mellitus (GDM), defined as any degree of glucose intolerance with onset or first recognition during pregnancy, is characterized by underlying maternal defects in the β-cell response to insulin during pregnancy. Women with a previous history of GDM have a greater than 7-fold higher risk of developing postpartum diabetes compared with women without GDM. Various risk factors for postpartum diabetes have been identified, including maternal age, glucose levels in pregnancy, family history of diabetes, pre-pregnancy and postpartum body mass index, dietary patterns, physical activity, and breastfeeding. Genetic studies revealed that GDM shares common genetic variants with type 2 diabetes. A number of lifestyle interventional trials that aimed to ameliorate modifiable risk factors, including diet, exercise, and breastfeeding, succeeded in reducing the incidence of postpartum diabetes, weight retention, and other obesity-related morbidities. The present review summarizes the findings of previous studies on the incidence and risk factors of postpartum diabetes and discusses recent lifestyle interventional trials that attempted to prevent postpartum diabetes.

The aim of this study was to stratify risk for postpartum diabetes in women who have gestational diabetes. Women with gestational diabetes were recruited between 1989 and 1999, and 302 were followed with oral glucose tolerance tests at 9 months and 2, 5, 8, and 11 years postpregnancy. The 8-year postpartum diabetes risk was 52.7% (130 diabetic cases). Risk was increased in women with autoantibodies to GAD and/or insulinoma antigen-2 (adjusted hazard ratio 4.1; P < 0.0001), women who required insulin during pregnancy (4.7; P < 0.0001), women with BMI >30 kg/m2 (1.5; P = 0.04), and women with more than two prior pregnancies (2.5; P = 0.02). Women without these risk factors had a postpartum diabetes risk of 14% by 8 years, and risk rose incrementally to 96% by 8 years in autoantibody-positive women. Parity status, C-reactive protein concentration, a diabetes family history, maternal age, weeks of gestation, and the child’s birth weight did not significantly affect risk in multivariate analysis. Prospective diabetes assessment is indicated and intervention should be considered in women with gestational diabetes who are autoantibody positive, require insulin treatment during pregnancy, or are obese.

Background: Gestational diabetes mellitus (GDM) is defined by World Health Organization as glucose intolerance diagnosed for the first time during pregnancy; GDM affects 7% of pregnancies. Women with earlier GDM have higher risk to develop type 2 diabetes (T2D). The aim of our study was to evaluate the outcomes of GDM and to assess the impact of recalling patients in the postpartum stage by phone, the target was to assess T2D or impaired glucose tolerance in women with a history of GDM. Methods: This prospective study included 200 patients with GDM that have received education sessions regarding the major interest of screen T2D using 75 g of oral glucose tolerance testing in the 3rd month after birth. Results: Only 22.5% (n = 45) women spontaneously complied to assess T2D. About 15% have had developed T2D and 28% prediabetes. Risk factors of T2D onset were younger gestational age at the occurrence GD, higher fasting blood glucose, and frequent use of insulin. Conclusions: Women with GD history demonstrated high risk of developing T2D. Simple changes of lifestyle were shown to be an efficient prevention protocol. Despite therapeutical education, few women spontaneously complied with T2D screening. The telephone reminders could improve the screening observance therefore patient's outcome.

Background There are differences in risk and risk factor findings of postpartum type 2 diabetes mellitus (T2DM) after gestational diabetes depending on study design and subjects of previous studies. This study aimed to assess these risk and risk factors more accurately through a population-based study to provide basic data for prevention strategies. Methods This open retrospective cohort included data of 419,101 women with gestational diabetes and matched 1,228,802 control women who delivered between 2004 and 2016 from the South Korea National Health Information Database of the National Health Insurance Service. Following 14 (median 5.9) years of follow-up, the incidence and hazard ratio (HR) of postpartum T2DM were evaluated using Kaplan-Meier curves and Cox proportional regression models. Results The incidence and HR of postpartum T2DM in women with gestational diabetes (compared to women without gestational diabetes) after the 14-year follow-up was 21.3% and 2.78 (95% confidence interval [CI], 2.74 to 2.82), respectively. Comorbid obesity (body mass index [BMI] ≥25 kg/m2) increased postpartum T2DM risk 7.59 times (95% CI, 7.33 to 7.86). Significant risk factors for postpartum T2DM were fasting glucose level, BMI, age, family history of diabetes, hypertension, and insulin use during pregnancy. Conclusion This population-based study showed higher postpartum T2DM risk in women with gestational diabetes than in those without, which was further increased by comorbid obesity. BMI and fasting glucose level were important postpartum risk factors. The management of obesity and glycemic control may be important strategies to prevent the incidence of diabetes after delivery.

For women with gestational diabetes mellitus (GDM), the evaluation of glucose tolerance (GT) in the early postpartum period is universally recommended. Nevertheless, few studies have evaluated the risk factors for T2DM on the basis of GT data obtained during the early postpartum period. We aimed to identify the risk factors for type 2 diabetes mellitus (T2DM) by evaluating GT in the first 12 weeks postpartum (12wPP) in women with GDM and to categorize the risk using a combination of the principal risk factors. This retrospective multicenter observational study included 399 East Asian women with GDM who underwent a 75-g oral glucose tolerance test (OGTT) within 12wPP, which was repeated annually or biennially and used to identify the postpartum development of T2DM. Forty-three women (10.8%) developed T2DM during a median follow-up period of 789 ± 477 days. The independent risk factors for T2DM were pre-pregnancy obesity (BMI ≥25 ‍kg/m2), early postpartum impairment in glucose tolerance (IGT), and an early postpartum glycated hemoglobin (HbA1c) ≥5.7%. The odds ratios (95% confidence intervals) for T2DM were 3.2 (1.3-7.8) in women with either early postpartum IGT or pre-pregnancy obesity, 9.2 (3.0-28.3) in those with early postpartum IGT, pre-pregnancy obesity, and HbA1c <5.7%, and 51.4 (16.1-163.9) in those with early postpartum IGT, pre-pregnancy obesity, and HbA1c ≥5.7%, compared with those without obesity or IGT. T2DM risk in East Asian women with GDM should be stratified according to pre-pregnancy obesity and early postpartum IGT, and these patients should be followed up and receive appropriate care for their risk category.

Gestational diabetes mellitus (GDM) affects 3–14% of pregnancies, with 20–50% of these women progressing to type 2 diabetes (T2D) within 5 years. This study sought to develop a metabolomics signature to predict the transition from GDM to T2D. A prospective cohort of 1,035 women with GDM pregnancy were enrolled at 6–9 weeks postpartum (baseline) and were screened for T2D annually for 2 years. Of 1,010 women without T2D at baseline, 113 progressed to T2D within 2 years. T2D developed in another 17 women between 2 and 4 years. A nested case-control design used 122 incident case patients matched to non–case patients by age, prepregnancy BMI, and race/ethnicity. We conducted metabolomics with baseline fasting plasma and identified 21 metabolites that significantly differed by incident T2D status. Machine learning optimization resulted in a decision tree modeling that predicted T2D incidence with a discriminative power of 83.0% in the training set and 76.9% in an independent testing set, which is far superior to measuring fasting plasma glucose levels alone. The American Diabetes Association recommends T2D screening in the early postpartum period via oral glucose tolerance testing after GDM, which is a time-consuming and inconvenient procedure. Our metabolomics signature predicted T2D incidence from a single fasting blood sample. This study represents the first metabolomics study of the transition from GDM to T2D validated in an independent testing set, facilitating early interventions.

Objective The reported incidence of type 2 diabetes mellitus (T2DM) after gestational diabetes (GDM) varies widely. The purpose of this meta-analysis was to define the incidence rate of T2DM among women with a history of GDM and to examine what might modulate the rate. Research Design and Methods. We searched PubMed and Embase for terms related to T2DM after GDM up to January 2019. Large cohort studies with sample size ≥300 and follow-up duration of at least one year were included. Data from selected studies were extracted, and meta-analysis was performed using the random-effects model. Subgroups analyses were based on the sample size of gestational diabetes, geographic region, maternal age, body-mass index, diagnostic criteria, and duration of follow-up. Results Twenty-eight studies involving 170,139 women with GDM and 34,627 incident cases of T2DM were identified. The pooled incidence of T2DM after GDM was 26.20 (95% CI, 23.31 to 29.10) per 1000 person-years. Women from Asia and those with older age and higher body mass index seem to experience higher risk of developing T2DM. The incidence rate of T2DM was lowest when applying IADPSG (7.16 per 1000 person-years) to diagnose GDM. The risk of developing T2DM after GDM increased linearly with the duration of follow-up. The increments per year of follow-up were estimated at 9.6‰. The estimated risks for T2DM were 19.72% at 10 years, 29.36% at 20 years, 39.00% at 30 years, 48.64% at 40 years, and 58.27% at 50 years, respectively. Conclusions The findings of very high incidence of T2DM after GDM add an important insight into the trajectory of the development of T2DM in the long-term postpartum periods, which could provide evidence for consultant and might motivate more women with GDM to screen for T2DM. This trial is registered with PROSPERO identifier CRD42019128980.

… trials of postpartum lifestyle interventions to prevent type 2 diabetes in women with prior GDM were reviewed. Outcomes included in this review are type 2 diabetes incidences, insulin …

… The women with early GDM also had an increased risk of postpartum diabetes mellitus, whereas those with late-onset GDM had a minimal risk [59]. The percentages of overt …

… women with gestational diabetes mellitus are not screened for type 2 DM after delivery. Opportunities … Gestational diabetes mellitus (GDM), or glucose intolerance first diagnosed during …

… same risk factors for recurrent GDM would predict the development of future type 2 diabetes. … during pregnancy was the strongest predictor of future diabetes, and that by 10 years after …

OBJECTIVE Gestational diabetes mellitus complicates ∼6% of pregnancies and strongly predicts subsequent type 2 diabetes. It has not been fully elucidated how risk depends on the number of affected pregnancies or how long the excess risk persists. RESEARCH DESIGN AND METHODS We assessed reproductive histories in relation to risk of type 2 diabetes using a nationwide cohort of 50,884 women. Among participants who initially did not have diabetes, 3,370 were diagnosed with diabetes during 10 years of follow-up. We used Cox proportional hazards models that allowed risk to depend on age, cumulative number of pregnancies with gestational diabetes mellitus, and time since the most recent affected pregnancy, adjusting for BMI, educational level, and race/ethnicity. RESULTS History of one or more pregnancies with gestational diabetes mellitus predicted elevated age-specific risk of type 2 diabetes, with a hazard ratio of 3.87 (95% CI 2.60–5.75) 6–15 years after an affected pregnancy. Risk increased steeply with multiple affected pregnancies. The age-specific associations attenuated over time after an affected pregnancy, with an estimated 24% reduction of the hazard ratio per decade. Risk remained elevated, however, for >35 years. CONCLUSIONS Gestational diabetes mellitus predicted markedly increased rates of type 2 diabetes. Relative risk increased substantially with each additional affected pregnancy. The estimated hazard ratio declined with time after a pregnancy with gestational diabetes mellitus but remained elevated for >35 years. Women recalling a history of gestational diabetes mellitus should be screened regularly for type 2 diabetes, even late in life.

… from GDM to type 2 diabetes, highlighting the potential for novel therapeutics or targeted interventions in high-risk … may mitigate the excess type 2 diabetes risk after a GDM pregnancy. …

Aims/hypothesisWomen with gestational diabetes mellitus (GDM) are at risk of developing type 2 diabetes, but individualised risk estimates are unknown. We conducted a meta-analysis to quantify the risk of progression to type 2 diabetes for women with GDM.MethodsWe systematically searched the major electronic databases with no language restrictions. Two reviewers independently extracted 2 × 2 tables for dichotomous data and the means plus SEs for continuous data. Risk ratios were calculated and pooled using a random effects model.ResultsThere were 39 relevant studies (including 95,750 women) BMI (RR 1.95 [95% CI 1.60, 2.31]), family history of diabetes (RR 1.70 [95% CI 1.47, 1.97]), non-white ethnicity (RR 1.49 [95% CI 1.14, 1.94]) and advanced maternal age (RR 1.20 [95% CI 1.09, 1.34]) were associated with future risk of type 2 diabetes. There was an increase in risk with early diagnosis of GDM (RR 2.13 [95% CI 1.52, 3.56]), raised fasting glucose (RR 3.57 [95% CI 2.98, 4.04]), increased HbA1c (RR 2.56 [95% CI 2.00, 3.17]) and use of insulin (RR 3.66 [95% CI 2.78, 4.82]). Multiparity (RR 1.23 [95% CI 1.01, 1.50]), hypertensive disorders in pregnancy (RR 1.38 [95% CI 1.32, 1.45]) and preterm delivery (RR 1.81 [95% CI 1.35, 2.43]) were associated with future diabetes. Gestational weight gain, macrosomia in the offspring or breastfeeding did not increase the risk.Conclusions/interpretationPersonalised risk of progression to type 2 diabetes should be communicated to mothers with GDM.Systematic review registration:www.crd.york.ac.uk/PROSPERO CRD42014013597

Gestational diabetes mellitus (GDM) is a common pregnancy complication with increased maternal and perinatal morbidity. However, significant long‐term morbidity also exists for the mother and offspring. Women with previous GDM have a very high risk of developing overt diabetes, primarily type 2 diabetes, later in life. Moreover, the risk of the metabolic syndrome is increased 3‐fold in these women. Their offspring have an 8‐fold risk of diabetes/prediabetes at 19–27 years of age. Thus, GDM is part of a vicious circle which increases the development of diabetes in the coming generations.

Aims/hypothesisWomen with a history of gestational diabetes mellitus (GDM) are advised to control their weight after pregnancy. We aimed to examine how adiposity and weight change influence the long-term risk of developing type 2 diabetes after GDM.MethodsWe included 1,695 women who had incident GDM between 1991 and 2001, as part of the Diabetes & Women’s Health study, and followed them until the return of the 2009 questionnaire. Body weight and incident type 2 diabetic cases were reported biennially. We defined baseline as the questionnaire period when women reported an incident GDM pregnancy. We estimated HRs and 95% CIs using Cox proportional hazards models.ResultsWe documented 259 incident cases of type 2 diabetes during up to 18 years of follow-up. The adjusted HRs of type 2 diabetes associated with each 1 kg/m2 increase in BMI were 1.16 (95% CI 1.12, 1.19) for baseline BMI and 1.16 (95% CI 1.13, 1.20) for most recent BMI. Moreover, each 5 kg increment of weight gain after GDM development was associated with a 27% higher risk of type 2 diabetes (adjusted HR 1.27; 95% CI 1.04, 1.54). Jointly, women who had a BMI ≥30.0 kg/m2 at baseline and gained ≥5 kg after GDM had an adjusted HR of 43.19 (95% CI 13.60, 137.11), compared with women who had a BMI <25.0 kg/m2 at baseline and gained <5 kg after GDM.Conclusions/interpretationBaseline BMI, most recent BMI and weight gain after GDM were significantly and positively associated with risk of progression from GDM to type 2 diabetes.

… glucose tolerance, and type 2 diabetes at an early … risk factors that predict GDM and subsequent type 2 diabetes in the mothers and their offsprings, could be the tools for future diabetes …

… a clinical risk model for the development of type 2 diabetes … of plasmalogens with future type 2 diabetes in this cohort may … is not considered a risk factor for type 2 diabetes in the general …

Structured abstract Aims To estimate development of type 2 diabetes (T2DM) in women with previous gestational diabetes (GDM) and investigate characteristics associated with higher diagnoses, building on previous meta-analyses and exploring heterogeneity. Methods Systematic literature review of studies published up to October 2019. We included studies reporting progression to T2DM ≥6 months after pregnancy, if diagnostic methods were reported and ≥50 women with GDM participated. We conducted random-effects meta-analyses and meta-regression of absolute and relative T2DM risk. PROSPERO ID: CRD42017080299. Results In 129 included studies, the percentage diagnosed with T2DM was 12% (95% confidence interval 8–16%) higher for each additional year after pregnancy, with a third developing diabetes within 15 years. Development was 18% (5–34%) higher per unit BMI at follow-up, and 57% (39–70%) lower in White European populations compared to others (adjusted for ethnicity and follow-up). Women with GDM had a relative risk of T2DM of 8.3 (6.5–10.6). 17.0% (15.1–19.0%) developed T2DM overall, although heterogeneity between studies was substantial (I2 99.3%), and remained high after accounting for various study-level characteristics. Conclusions Percentage developing T2DM after GDM is highly variable. These findings highlight the need for sustained follow-up after GDM through screening, and interventions to reduce modifiable risk factors.

Abstract Objective To estimate and compare progression rates to type 2 diabetes mellitus (T2DM) in women with gestational diabetes mellitus (GDM) and healthy controls. Design Systematic review and meta-analysis. Data sources Medline and Embase between January 2000 and December 2019, studies published in English and conducted on humans. Eligibility criteria for selecting studies Observational studies investigating progression to T2DM. Inclusion criteria were postpartum follow-up for at least 12 months, incident physician based diagnosis of diabetes, T2DM reported as a separate outcome rather than combined with impaired fasting glucose or impaired glucose tolerance, and studies with both a group of patients with GDM and a control group. Results This meta-analysis of 20 studies assessed a total of 1 332 373 individuals (67 956 women with GDM and 1 264 417 controls). Data were pooled by random effects meta-analysis models, and heterogeneity was assessed by use of the I2 statistic. The pooled relative risk for the incidence of T2DM between participants with GDM and controls was estimated. Reasons for heterogeneity between studies were investigated by prespecified subgroup and meta-regression analyses. Publication bias was assessed by funnel plots and, overall, studies were deemed to have a low risk of bias (P=0.58 and P=0.90). The overall relative risk for T2DM was almost 10 times higher in women with previous GDM than in healthy controls (9.51, 95% confidence interval 7.14 to 12.67, P<0.001). In populations of women with previous GDM, the cumulative incidence of T2DM was 16.46% (95% confidence interval 16.16% to 16.77%) in women of mixed ethnicity, 15.58% (13.30% to 17.86%) in a predominantly non-white population, and 9.91% (9.39% to 10.42%) in a white population. These differences were not statistically significant between subgroups (white v mixed populations, P=0.26; white v non-white populations, P=0.54). Meta-regression analyses showed that the study effect size was not significantly associated with mean study age, body mass index, publication year, and length of follow-up. Conclusions Women with a history of GDM appear to have a nearly 10-fold higher risk of developing T2DM than those with a normoglycaemic pregnancy. The magnitude of this risk highlights the importance of intervening to prevent the onset of T2DM, particularly in the early years after pregnancy. Systematic review registration PROSPERO CRD42019123079.

… Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. … the relative risk of developing type 2 diabetes after gestational diabetes among 675,455 …

Background Recent studies have suggested that gestational diabetes (GDM) is a heterogeneous condition with distinct subtypes determined by whether the predominant metabolic abnormality is impaired insulin sensitivity or deficient insulin secretion. However, it is not known if the elevated future risk of pre-diabetes/diabetes associated with GDM varies according to these subtypes. Thus, we sought to evaluate maternal metabolic function in the 1st year postpartum in relation to GDM subtypes. Methods In this prospective cohort study conducted in Toronto, Canada, 613 women underwent GDM screening by oral glucose tolerance test (OGTT) in pregnancy, followed by repeat OGTT at both 3-months and 12-months postpartum between 09/2003 and 03/2016. The antepartum OGTT identified 3 groups of women: GDM with predominant sensitivity defect (GDM-sensitivity), GDM with predominant secretion defect (GDM-secretion), and non-GDM. Findings Antepartum findings persisted after pregnancy, with lower insulin sensitivity in GDM-sensitivity (Matsuda index; HOMA-IR) and lower insulin secretion in GDM-secretion (Stumvoll first-phase; insulinogenic index (IGI)) at both 3-months and 12-months (all p<0.005). Beta-cell compensation (Insulin Secretion-Sensitivity Index-2; IGI/HOMA-IR) was lower in both GDM subtypes compared to non-GDM (all p<0.0005) but did not differ between GDM-sensitivity and GDM-secretion. Similarly, both subtypes exhibited higher post-challenge glycemia on OGTT at 3-months and 12-months than non-GDM (all p<0.0005) but did not differ from one another. The prevalence of pre-diabetes/diabetes was higher in both GDM-sensitivity (30.9%; 95%CI: 21.7–41.2) and GDM-secretion (27.6%; 16.7–40.9) than in non-GDM (10.4%; 7.7–13.6) at 12-months (both p<0.005), with no difference between GDM subtypes (p = 0.75). Interpretation Beta-cell dysfunction, glycemia and incident pre-diabetes/diabetes do not vary between GDM subtypes in the 1st year postpartum. Funding Canadian Institutes of Health Research; Diabetes Canada

OBJECTIVE: We aimed to quantify the risk of future maternal T2DM in women with GDM based on the type and number of abnormal 75g-OGTT values and the diagnostic criteria used for the diagnosis of GDM. &lt;p&gt;RESEARCH DESIGN AND METHODS: We conducted a population-based retrospective cohort study of all nulliparous women with a live singleton birth who underwent testing for GDM using a 75g-OGTT in Ontario, Canada (2007-2017). We estimated the incidence rates (per 1000 person years), overall risk (expressed as adjusted hazard ratio [aHR]), and risk at 5-year post the index pregnancy of future maternal T2DM. Estimates were stratified by the type and number of abnormal OGTT values, as well as by the diagnostic criteria for GDM (Diabetes Canada vs. IADPSG criteria). &lt;/p&gt; &lt;p&gt;RESULTS: A total of 55,361 women met the study criteria. The median duration of follow-up was 4.4 (IQR 2.8-6.3, maximum 10.3) years. Using women without GDM as reference (incidence rate 2.18 per 1000py), women with GDM were at an increased risk of future T2DM, with the risk being higher for the Diabetes Canada compared with the IADPSG criteria (incidence rate 18.74 [95%-CI 17.58-19.90] vs. 14.07 [95%-CI 13.24-14.91] per 1000py, respectively). The risk of future maternal T2DM increased with the number of abnormal OGTT values, and was highest for women with 3 abnormal values (incidence rate 49.93 per 1000py; aHR 24.57 [95%-CI 21.26-28.39]). The risk of future T2DM was also affected by the type of OGTT abnormality: women with an abnormal fasting value had the greatest risk while women with an abnormal 2-hour value had the lowest risk for future T2DM (aHR 14.09 [95%-CI 12.46-15.93) vs. 9.22 [95%-CI 8.19-10.37]), respectively). &lt;a&gt;&lt;/a&gt;&lt;a&gt;Similar findings to those described above were observed when the risk of T2DM at a fixed time point of 5-years post the index pregnancy was considered as the outcome of interest&lt;/a&gt;.&lt;/p&gt; &lt;p&gt;CONCLUSION: In women with GDM, individualized information regarding the future risk of T2DM can be provided based on the type and number of abnormal OGTT values, as well as the diagnostic criteria used for the diagnosis of GDM. &lt;/p&gt;

Background In this study of women with gestational diabetes we attempted to (a) Determine the magnitude of the long term risk of progression to diabetes and (b) Identify factors that predict the development of diabetes. Methods All women diagnosed with gestational diabetes (GDM) at Worcestershire Royal Hospital, UK from 1995 to 2003 were included in this observational cohort study and followed up till 2009. Diabetes was diagnosed if fasting glucose ≥ 7.0 mmol/L, random/two-hour glucose following 75 gram oral glucose test (OGTT) ≥ 11.1 mmol/L or HbA1c ≥ 7.0%. Results The risk of developing diabetes was 6.9% at five years and 21.1% at ten years following the initial diagnosis of GDM. Fasting and post-prandial glucose levels in the oral glucose tolerance test during pregnancy were associated with future risk of diabetes. There was no association with age, gestational age at diagnosis of GDM, numbers of previous and subsequent pregnancies. Conclusion Risk of progression to diabetes in a UK based cohort of women with GDM is estimated. Women with fasting antenatal glucose ≥ 7.0 mmol/L and/or an antenatal two-hour glucose ≥ 11.1 mmol/L are at higher risk and need close follow up.

… diabetes later in life. Many women with previous gestational diabetes mellitus show glucose intolerance … about the prevalence of postpartum glucose intolerance, the pathogenetic …

… This meta-analysis was aimed at exploring the incidence and risk factors of glucose intolerance in women with gestational diabetes mellitus (GDM) at 6–12 weeks postpartum to inform …

BACKGROUND: Patients with gestational diabetes mellitus are at increased risk for type 2 diabetes mellitus or glucose intolerance postpartum compared with those without diabetes mellitus. OBJECTIVE: We aimed to evaluate the association between early gestational diabetes mellitus and postpartum dysglycemia compared with gestational diabetes mellitus diagnosed by routine screening in a cohort of patients with obesity. STUDY DESIGN: This was a secondary analysis of a randomized controlled trial of patients with obesity and singleton, nonanomalous gestations that compared early gestational diabetes mellitus screening at 14 to 20 weeks of gestation with routine screening at 24 to 28 weeks of gestation. Patients were included in this analysis if they were diagnosed with gestational diabetes mellitus at the primary study site. The primary outcome was postpartum dysglycemia, defined as any abnormality on 2-hour oral glucose tolerance test 6 weeks postpartum or clinical diagnosis based on hyperglycemia requiring pharmacotherapy after delivery with deferred glucose tolerance test. Maternal characteristics and outcomes were compared in bivariable analysis, and logistic regression estimated the association between early gestational diabetes mellitus and postpartum dysglycemia. RESULTS: Of 119 patients included in this analysis, 30 were diagnosed by screening at <20 weeks of gestation and 89 at 24 to 28 weeks of gestation. Patients were overall similar in baseline characteristics. Patients with early gestational diabetes mellitus were more likely to have postpartum dysglycemia than those with gestational diabetes mellitus diagnosed with routine screening (36.7% vs 14.6%; odds ratio, 3.38; 95% confidence interval, 1.31–8.73). Most patients with early gestational diabetes mellitus who had postpartum dysglycemia were diagnosed clinically (n=7/11), whereas none of the patients with gestational diabetes mellitus established by routine testing were diagnosed with postpartum dysglycemia clinically. All (100%) patients with early gestational diabetes mellitus who completed a postpartum glucose tolerance test had dysglycemia compared with only 45% of patients with gestational diabetes mellitus diagnosed on routine screening. The proportion of patients who followed up for postpartum visits and the timing of follow-up were similar between groups. Postpartum glucose tolerance test completion was low but also similar between groups. CONCLUSION: Although postpartum glucose tolerance test completion is low, patients with gestational diabetes mellitus before 20 weeks of gestation, seem to be at higher risk for postpartum dysglycemia than those with gestational diabetes mellitus diagnosed at routine screening in a cohort of patients with obesity. Larger studies are needed to confirm these findings, but postpartum follow-up and diabetes mellitus testing may be even more important to improve long-term health in patients with early gestational diabetes mellitus.

… women with gestational diabetes. Hence, the purpose of our study was to determine the incidence of abnormal postpartum glucose tolerance in women with gestational diabetes in our …

… in the early postpartum period in women with gestational diabetes mellitus, … glucose tolerance tests between 5 and 8 weeks post partum in 246 women with recent gestational diabetes …

Gestational diabetes mellitus (GDM) is increasing in prevalence worldwide, and postpartum glucose intolerance represents one of the major complications after delivery in women with GDM. A wide range of risk factors for postpartum glucose intolerance have been identified, including ethnicity, genetic predisposition, age, obesity, pre-pregnancy body mass index, gestational weight gain, history of GDM, family history of diabetes, degree of hyperglycemia, insulin treatment, lipid profiles, and other metabolic factors. Lifestyle interventions, including weight loss, are thought to reduce the risk of postpartum glucose intolerance. Careful attention should be paid to the screening of postpartum glucose intolerance in women with GDM, and concerted efforts should be made to prevent or delay the development of diabetes and other metabolic disorders.

… Our findings confirm the high prevalence of glucose intolerance in the early postpartum period in women with previous GDM. PCOS emerges as a new strong antepartum predictor of …

… 238 women with gestational diabetes using a Z-hour, 75-g oral glucose tolerance test (GTT)… were analyzed for predictive ability for postpartum glucose intolerance. Results: Of 238 …

We tested 32 routine clinical parameters for their ability to discriminate between a high risk and a low risk of non-insulin-dependent diabetes mellitus (NIDDM) within 5–7 years after pregnancies complicated by gestational diabetes mellitus (GDM). Latino women (n = 671) with GDM who did not have diabetes 4–16 weeks after delivery returned for at least one 75-g oral glucose tolerance test (OGTT) within 7.5 years. Multivariate analysis was used to identify parameters ascertained during or immediately after the index pregnancy that were independently associated with the development of diabetes during follow-up. Life table analysis revealed a 47% cumulative incidence rate of NIDDM 5 years after delivery for this cohort of patients who did not have diabetes at the initial postpartum examination. Four variables were identified as independent predictors of NIDDM: the area under the OGTT glucose curve at 4–16 weeks postpartum, the gestational age at the time of diagnosis of GDM, the area under the OGTT glucose curve during pregnancy, and the highest fasting serum glucose concentration during pregnancy. Examination of relative risks (RRs) of NIDDM between the highest and lowest quartiles of the cohort for each variable, adjusted for the other three variables, revealed that the postpartum OGTT provided the best discrimination between high-risk and low-risk individuals (adjusted RR = 11.5 [95% confidence interval 4.5–29.1] compared with adjusted RRs of only 0.5–2.5 for the other three variables). Women who met World Health Organization criteria for impaired glucose tolerance at the early postpartum examination had a 5-year unadjusted 80% risk of diabetes, which was much higher than the risk of NIDDM that has been reported for Latino people with impaired glucose tolerance who were not selected for a history of GDM. Our findings indicate that postpartum glucose tolerance testing is superior to other routine clinical parameters in defining the risk of NIDDM within 5–7 years after pregnancies complicated by GDM. Furthermore, a history of GDM appears to impart a specific risk for NIDDM that cannot be explained by the degree of glucose tolerance observed when patients are not pregnant.

… postpartum glucose testing—more than one third (36%) of whom had persistent abnormal glucose tolerance. … was the diagnosis of persistent postpartum glucose intolerance. Persistent …

… a 75-g oral glucose tolerance test (75 g OGTT) at … glucose tolerance (IGT) at early postpartum OGTT have an 80% risk of DM within 5 years [Citation6,Citation7]. The American Diabetes …

To determine the prevalence of glucose intolerance in Korean women with gestational diabetes mellitus (GDM) between 6 and 8 weeks postpartum and identify which antepartum variables were predictive of postpartum diabetes and impaired glucose tolerance (IGT), we prospectively performed 75 g oral glucose tolerance test (OGTT) between 6 and 8 weeks postpartum in women with GDM. WHO criteria were used for classification of glucose tolerance postpartum. Of 392 women with GDM were detected during the study period, 311 women participated in this study. Of the 311 participants, 119 (38.3%) women were found to have persistent glucose intolerance; 47 (15.1%) had diabetes and 72 (23.2%) had IGT. The prevalence of postpartum IGT and diabetes increased in parallel with the metabolic severity during pregnancy. Multiple logistic regression analysis revealed that pre-pregnancy weight, gestational age at diagnosis of GDM, 2-h glucose and 3-h insulin concentrations of diagnostic OGTT were independently associated with postpartum diabetes. Pre-pregnancy weight, 2-h glucose and 1-h insulin concentrations were independently associated with postpartum IGT. Our results support the importance of postpartum testing in Korean women with GDM, and demonstrated that impaired beta-cell function and pre-pregnancy obesity were associated with glucose intolerance at early postpartum.

AIMS Women with a history of gestational diabetes mellitus (GDM) are likely to develop postpartum diabetes mellitus (DM). We examined women in the early stages of pregnancy who were at high risk of postpartum DM progression to establish a follow-up method for early detection. METHODS We performed the oral glucose tolerance test (OGTT) and identified predictive factors for postpartum impaired glucose tolerance (IGT) or DM in 77 women after GDM, for 2 years after delivery, retrospectively. Cutoff values for each factor were determined. We classified these women with GDM into four groups using these predictive factors and evaluated postpartum glucose intolerance (GI) in each group. RESULTS In total, 44.1% of the women with a GDM history had developed postpartum GI within 2 years. We determined three risk factors for postpartum GI: elevated glucose level 120 min after a 75-g OGTT (Glu120), elevated glycated hemoglobin (HbA1c) level at diagnosis, and perinatal complications. The cutoff Glu120 and the HbA1c level were 155 mg/dl and 5.3% (34 mmol/mol), respectively. Type 2 DM developed in 53.8% of women, and IGT developed in 38.5% of women within 2 years in groups with high Glu120 and high HbA1c. CONCLUSIONS High-risk groups require careful follow-up observation.

Objectives To identify the incidence of postpartum glucose intolerance and develop a prediction model based on antenatal characteristics to predict postpartum glucose intolerance. Design Prospective cohort study. Setting Gondar town public health facilities in Northwest Ethiopia. Participants Women who had gestational diabetes mellitus were advised to undergo postpartum oral glucose tolerance test at 6–12 weeks of delivery. Main outcome Postpartum glucose intolerance. Data analysis Predictors of postpartum glucose intolerance were identified using multivariable logistic regression analysis. The discriminative power of the predictor variables for postpartum glucose intolerance and the model accuracy were computed by area under the receiver operating characteristic curve and estimated by area under the curve (AUC) with 95% CI. Results A total of 112 (85.5%) women with gestational diabetes mellitus returned and completed the postpartum oral glucose tolerance test. The incidence of postpartum glucose intolerance was 21.4% (95% CI14.3 to 28.4), inclusive of 18.7% pre-diabetes and 2.7% diabetes. Multivariable logistic regression analysis revealed that advanced maternal age, high fasting plasma glucose level at diagnosis, overweight and/or obesity, and antenatal depression were predictors of postpartum glucose intolerance. The AUC of the final reduced model to predict postpartum glucose intolerance was 0.884 (95% CI 0.822 to 0.937). Fasting plasma glucose at diagnosis of gestational diabetes mellitus (AUC=0.736, 95% CI0.616 to 0.845) and overweight and/or obesity (AUC=0.718, 95% CI 0.614 to 0.814) were better predictors of postpartum glucose intolerance. Moreover, the AUC for the combined predictors of fasting plasma glucose at diagnosis and mid-upper arm circumference was 0.822 (95% CI 0.722 to 0.907), which was the best predictor. Conclusions The incidence of postpartum glucose intolerance was high among women with gestational diabetes mellitus. Antenatal predictors modestly predicted postpartum glucose intolerance. The findings suggest ongoing glucose screening is indicated for all women with gestational diabetes mellitus.

Despite the crucial role that prediction models play in guiding early risk stratification and timely intervention to prevent type 2 diabetes after gestational diabetes mellitus (GDM), their use is not widespread in clinical practice. The purpose of this review is to examine the methodological characteristics and quality of existing prognostic models predicting postpartum glucose intolerance following GDM. Recent Findings. A systematic review was conducted on relevant risk prediction models, resulting in 15 eligible publications from research groups in various countries. Our review found that traditional statistical models were more common than machine learning models, and only two were assessed to have a low risk of bias. Seven were internally validated, but none were externally validated. Model discrimination and calibration were done in 13 and four studies, respectively. Various predictors were identified, including body mass index, fasting glucose concentration during pregnancy, maternal age, family history of diabetes, biochemical variables, oral glucose tolerance test, use of insulin in pregnancy, postnatal fasting glucose level, genetic risk factors, hemoglobin A1c, and weight. The existing prognostic models for glucose intolerance following GDM have various methodological shortcomings, with only a few models being assessed to have low risk of bias and validated internally. Future research should prioritize the development of robust, high-quality risk prediction models that follow appropriate guidelines, in order to advance this area and improve early risk stratification and intervention for glucose intolerance and type 2 diabetes among women who have had GDM.

… The purpose of this study is to explore the incidence and risk factors of glucose intolerance within one year postpartum in women with gestational diabetes mellitus (GDM), with the goal …

Abstract Objective This study aims to examine factors associated with postpartum follow-up and glucose tolerance testing (GTT) in women with gestational diabetes mellitus (GDM). Materials and Methods Case-control study of women with GDM at a single institution with available outpatient records (January 2008–February 2016). Women with pregestational diabetes mellitus were excluded. The postpartum follow-up, GTT completion, and the reason for GTT completion failure (provider vs. patient noncompliance) were assessed. Bivariable and multivariable analyses were performed to identify factors associated with postpartum follow-up and GTT completion. Results Of 683 women, 82.0% (n = 560) returned postpartum, and 49.8% (n = 279) of those completed GTT. Women with Medicaid and late presentation to care were less likely to return (adjusted odds ratio [aOR]: 0.3, 95% confidence interval [CI]: 0.2–0.6 and aOR: 0.4, 95% CI: 0.2–0.7), but if they did, both factors were associated with increased odds of GTT completion (aOR: 2.0, 95% CI: 1.3–2.9 and aOR: 3.5, 95% CI: 1.8–6.6). Patient and provider noncompliance contributed equally to GTT completion failure. Trainee involvement was associated with improved test completion (aOR: 4.6, 95% CI: 2.4–8.8). Conclusion The majority of women with GDM returned postpartum, but many did not receive recommended GTT. Public insurance and late presentation were associated with failure to return postpartum, but better GTT completion when a postpartum visit occurred. Trainee involvement was associated with improved adherence to screening guidelines.

Predictors for glucose intolerance postpartum were evaluated in women with gestational diabetes mellitus (GDM) based on the 2013 World Health Organization (WHO) criteria. 1841 women were tested for GDM in a prospective cohort study. A postpartum 75g oral glucose tolerance test (OGTT) was performed in women with GDM at 14 ± 4.1 weeks. Of all 231 mothers with GDM, 83.1% (192) had a postpartum OGTT of which 18.2% (35) had glucose intolerance. Women with glucose intolerance were more often of Asian origin [15.1% vs. 3.7%, OR 4.64 (1.26–17.12)], had more often a recurrent history of GDM [41.7% vs. 26.7%, OR 3.68 (1.37–9.87)], higher fasting glycaemia (FPG) [5.1 (4.5–5.3) vs. 4.6 (4.3–5.1) mmol/L, OR 1.05 (1.01–1.09)], higher HbA1c [33 (31–36) vs. 32 (30–33) mmol/mol, OR 4.89 (1.61–14.82)], and higher triglycerides [2.2 (1.9–2.8) vs. 2.0 (1.6–2.5) mmol/L, OR 1.00 (1.00–1.01)]. Sensitivity of glucose challenge test (GCT) ≥7.2 mmol/l for glucose intolerance postpartum was 80% (63.1%–91.6%). The area under the curve to predict glucose intolerance was 0.76 (0.65–0.87) for FPG, 0.54 (0.43–0.65) for HbA1c and 0.75 (0.64–0.86) for both combined. In conclusion, nearly one-fifth of women with GDM have glucose intolerance postpartum. A GCT ≥7.2 mmol/L identifies a high risk population for glucose intolerance postpartum.

Key Points Question Do subtypes of gestational diabetes (GD) reclassify differently for glucose tolerance at 6 to 9 weeks after delivery? Findings In this cohort study of 1005 women diagnosed with GD, 3 subtypes were defined using the diagnostic oral glucose testing results, as having isolated postload glucose intolerance (GD-P), fasting hyperglycemia (GD-F), or both defects (GD-M). These subtypes exhibited statistically significant graded increases in adjusted prevalence of postpartum prediabetes with GD-P as most favorable profile, GD-F as intermediate, and GD-M as most predisposed to prediabetes. Meaning In this study, distinct postpartum prediabetes prevalence rates highlighted GD heterogeneity, calling for tailored early intervention and postpartum screening strategies by subtype.

A previous diagnosis of gestational diabetes (GDM) carries a lifetime risk of progression to type 2 diabetes of up to 60%. Identification of those women at higher risk of progression to diabetes allows the timely introduction of measures to delay or prevent diabetes onset. However, there is a large degree of variability in the literature with regard to the proportion of women with a history of GDM who go on to develop diabetes. Heterogeneity between cohorts with regard to diagnostic criteria used, duration of follow-up, and the characteristics of the study population limit the ability to make meaningful comparisons across studies. As the new International Association for Diabetes in Pregnancy Study Group criteria are increasingly adopted worldwide, the prevalence of GDM is set to increase by two-to three-fold. Here, we review the literature to examine the evolution of diagnostic criteria for GDM, the implications of changing criteria on the proportion of women with previous GDM progressing to diabetes, and how the use of different diagnostic criteria may influence the development of appropriate follow-up strategies.

Background To estimate the progression rates to type 2 diabetes mellitus (T2DM) in women with gestational diabetes mellitus (GDM) diagnosed by the International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria. Methods Systematic review and meta-analysis were conducted by searching Medline, Embase, and Cochrane between January 1, 2010 and December 31, 2021 for observational studies investigating progression to T2DM after GDM. Inclusion criteria were IADPSG-diagnosed GDM, studies with both GDM and controls, postpartum follow-up duration at least one year. Data were pooled by random effects meta-analysis models. Heterogeneity was assessed by I2 statistic. The pooled relative risk for incidence of T2DM and pre-diabetes between GDM participants and controls were estimated. Reasons for heterogeneity among studies were investigated by prespecified subgroup and meta-regression analysis. Publication bias was assessed by the Begg’s and Egger’s tests. Results This meta-analysis of six studies assessed a total of 61932 individuals (21978 women with GDM and 39954 controls). Women with IADPSG-diagnosed GDM were 6.43 times (RR=6.43, 95% CI:3.45-11.96) more likely to develop T2DM in the future compared with controls. For GDM women, the cumulative incidence of T2DM was 12.1% (95% CI: 6.9%-17.3%), while the pooled cumulative incidence of T2DM was estimated to be 8% (95% CI: 5-11%) in studies with 1 to 5 years of follow-up and increased to 19% (95% CI: 3-34%) for studies with more than 5 years of follow-up. Women with IADPSG-diagnosed GDM had 3.69 times (RR=3.69, 95% CI:2.70-5.06) higher risk of developing pre-diabetes (including impaired fasting glucose and/or impaired glucose tolerance) than controls. Meta-regression analysis showed that the study effect size was not significantly associated with study design, race, length of follow-up, and maternal age (P>0.05). Overall, the studies had a relatively low risk of bias. Conclusions Women with IADPSG-diagnosed GDM have higher risk of developing T2DM and pre-diabetes. The risk of T2DM in GDM women are higher with longer follow-up duration. Our results highlight the importance of promoting postpartum screening and keeping health lifestyle as well as pharmacological interventions to delay/prevent the onset of T2DM/pre-diabetes in GDM women. Systematic review registration https://www.crd.york.ac.uk/prospero, identifier (CRD42022314776)

… of women following a pregnancy complicated by gestational diabetes has … diabetes in patients with prior history of gestational diabetes. Lifestyle intervention programmes for diabetes …

Aim of this study was analyzing the time trajectories of the metabolic parameters in European women with former gestational diabetes (fGDM), and determining predictors of type 2 diabetes onset. A group of seventy-six fGDM women were studied at the outpatient department of the University Clinic of Vienna. They were evaluated yearly with a 3 h-oral glucose tolerance test (OGTT) up to 7-years from delivery. At baseline, women also underwent an intravenous glucose tolerance test (IVGTT). Insulin sensitivity and beta-cell function were assessed by both OGTT and IVGTT. Women were divided into progressors (PROG) to diabetes (n = 19) and non-progressors (n = 57). Time trajectories of glycemia and other parameters were analyzed after synchronization to time of diabetes onset or last OGTT. Then, Cox proportional hazard regression analysis was performed to assess the predictive power of studied variables for diabetes onset. We found that, in PROG, time trajectories of glycemia were flat until diabetes onset, when they showed a marked increase (P<0.0001). Insulin sensitivity showed similar marked decrease (P<0.0001) at diabetes onset, together with a tendency to continuous slow decline in the previous years. At contrast, beta-cell function showed only continuous slow decline. Major predictors of diabetes onset were glycemic levels, BMI, insulin resistance, and condition of impaired glucose tolerance. In conclusion, in fGDM, marked deterioration of insulin sensitivity is associated with diabetes onset. Prevention strategies aimed at opposing to the insulin sensitivity derangement may be particularly beneficial.

The aim of this work was to examine the progression to type 1 and type 2 diabetes after gestational diabetes mellitus (GDM) in a 23 year follow-up study. We carried out a cohort study of 391 women with GDM diagnosed by an OGTT or the use of insulin treatment during pregnancy, and 391 age- and parity-matched control participants, who delivered in 1984–1994 at the Oulu University Hospital, Finland. Diagnostic cut-off levels for glucose were as follows: fasting, ≥4.8 mmol/l; 1 h, ≥10.0 mmol/l; and 2 h, ≥8.7 mmol/l. Two follow-up questionnaires were sent (in 1995–1996 and 2012–2013) to assess the progression to type 1 and type 2 diabetes. Mean follow-up time was 23.1 (range 18.7–28.8) years. Type 1 diabetes developed (5.7%) during the first 7 years after GDM pregnancy and was predictable at a 2 h OGTT value of 11.9 mmol/l during pregnancy (receiver operating characteristic analysis: AUC 0.91, sensitivity 76.5%, specificity 96.0%). Type 2 diabetes increased linearly to 50.4% by the end of the follow-up period and was moderately predictable with fasting glucose (AUC 0.69, sensitivity 63.5%, specificity 68.2%) at a level of 5.1 mmol/l (identical to the fasting glucose cut-off recommended by the International Association of Diabetes and Pregnancy Study Groups [IADPSG) and WHO]). All women with GDM should be intensively monitored for a decade, after which the risk for type 1 diabetes is minimal. However, the incidence of type 2 diabetes remains linear, and therefore individualised lifelong follow-up is recommended.

… after the index pregnancy in GDM women, and several studies have shown a direct relationship between VAT and the development of both pre-diabetic hyperglycemia and diabetes [90]…

BackgroundThe aim of this study was to investigate long-term risk of type 2 diabetes (T2D) following a diagnosis of gestational diabetes and to identify factors that were associated with increased risk of T2D.MethodsAn observational cohort design was used, following up all women diagnosed with gestational diabetes mellitus (GDM) attending a Diabetes Antenatal Clinic in the Dundee and Angus region of Scotland between 1994 and 2004 for a subsequent diagnosis of T2D, as recorded on SCI-DC (a comprehensive diabetes clinical information system).ResultsThere were 164 women in the study who were followed up until 2012. One quarter developed T2D after a pregnancy with GDM in a mean time period of around eight years. Factors associated with a higher risk of developing T2D after GDM were increased weight during pregnancy, use of insulin during pregnancy, higher glycated haemoglobin (HbA1c) levels at diagnosis of GDM, and fasting blood glucose.ConclusionsThese findings suggest there is a viable time window to prevent progression from GDM to T2D and highlights those women who are at the greatest risk and should therefore be prioritised for preventative intervention.

BACKGROUND The incidence of type 2 diabetes (T2DM) is increasing. Having a pregnancy complicated by gestational diabetes mellitus (GDM) is a potent risk factor for the later development of T2DM. AIMS To explore the characteristics of women diagnosed with GDM in a single centre and their follow up for progression to T2DM. METHODS A retrospective cohort study using anonymised data of one hundred and fifty four (154) women with GDM receiving maternity care at the Oxford University Hospitals NHS Foundation Trust (OUHFT) in 2010 and their follow up until 2018. RESULTS The prevalence of GDM in women delivering in Oxfordshire in 2010 was 3.4%. 70% of pregnant women were overweight or obese (with 51% being obese) at booking. Gestational weight gain (GWG) was excessive in 29% of women, when compared to Institute of Medicine (IOM) guidelines. Almost a quarter of women (23.4%) had no follow up after delivery. Over a median follow up of 3.5 years (range 0-8 years) nearly one in six (16.9%) of the total cohort (22% of those tested) went on to develop T2DM. 74% of women with GDM were multiparous, and 65% of nulliparous women were tested compared to 81% of multiparous women. There was a significant difference between multiparous women (53.8%) compared to nulliparous women (46.2%) developing T2DM (p=0.01). There was no significant difference in BMI (p=0.866) or GWG (p=0.83) in women who progressed to T2DM versus those who did not. CONCLUSION The risk of T2DM after GDM is substantial however, follow up rates of this population is poor. Subsequent screening of women with GDM and their management crosses secondary and primary care with scope for improvement in counselling of women of the importance of annual reviews, in data collection and follow up in both obstetrics and general practice. The implementation of a recall system, an education programme for general practitioners and/or a registry of women diagnosed with GDM could be useful to identify those at high risk of developing T2DM as well as providing a platform for the potential development of interventions to prevent progression to T2DM after GDM.

Background Women with a history of gestational diabetes mellitus (GDM) have a 7-fold higher risk of developing type 2 diabetes (T2D) during midlife and an elevated risk of developing hypertension and cardiovascular disease. Glucose tolerance reclassification after delivery is recommended, but fewer than 40% of women with GDM are tested. Thus, improved risk stratification methods are needed, as is a deeper understanding of the pathology underlying the transition from GDM to T2D. We hypothesize that metabolites during the early postpartum period accurately distinguish risk of progression from GDM to T2D and that metabolite changes signify underlying pathophysiology for future disease development. Methods and findings The study utilized fasting plasma samples collected from a well-characterized prospective research study of 1,035 women diagnosed with GDM. The cohort included racially/ethnically diverse pregnant women (aged 20–45 years—33% primiparous, 37% biparous, 30% multiparous) who delivered at Kaiser Permanente Northern California hospitals from 2008 to 2011. Participants attended in-person research visits including 2-hour 75-g oral glucose tolerance tests (OGTTs) at study baseline (6–9 weeks postpartum) and annually thereafter for 2 years, and we retrieved diabetes diagnoses from electronic medical records for 8 years. In a nested case–control study design, we collected fasting plasma samples among women without diabetes at baseline (n = 1,010) to measure metabolites among those who later progressed to incident T2D or did not develop T2D (non-T2D). We studied 173 incident T2D cases and 485 controls (pair-matched on BMI, age, and race/ethnicity) to discover metabolites associated with new onset of T2D. Up to 2 years post-baseline, we analyzed samples from 98 T2D cases with 239 controls to reveal T2D-associated metabolic changes. The longitudinal analysis tracked metabolic changes within individuals from baseline to 2 years of follow-up as the trajectory of T2D progression. By building prediction models, we discovered a distinct metabolic signature in the early postpartum period that predicted future T2D with a median discriminating power area under the receiver operating characteristic curve of 0.883 (95% CI 0.820–0.945, p < 0.001). At baseline, the most striking finding was an overall increase in amino acids (AAs) as well as diacyl-glycerophospholipids and a decrease in sphingolipids and acyl-alkyl-glycerophospholipids among women with incident T2D. Pathway analysis revealed up-regulated AA metabolism, arginine/proline metabolism, and branched-chain AA (BCAA) metabolism at baseline. At follow-up after the onset of T2D, up-regulation of AAs and down-regulation of sphingolipids and acyl-alkyl-glycerophospholipids were sustained or strengthened. Notably, longitudinal analyses revealed only 10 metabolites associated with progression to T2D, implicating AA and phospholipid metabolism. A study limitation is that all of the analyses were performed with the same cohort. It would be ideal to validate our findings in an independent longitudinal cohort of women with GDM who had glucose tolerance tested during the early postpartum period. Conclusions In this study, we discovered a metabolic signature predicting the transition from GDM to T2D in the early postpartum period that was superior to clinical parameters (fasting plasma glucose, 2-hour plasma glucose). The findings suggest that metabolic dysregulation, particularly AA dysmetabolism, is present years prior to diabetes onset, and is revealed during the early postpartum period, preceding progression to T2D, among women with GDM. Trial registration ClinicalTrials.gov Identifier: NCT01967030.

Women with normal glucose tolerance pre‐gravid and developing gestational diabetes in late gestation have subclinical metabolic dysfunction prior to conception compared with women with normal glucose tolerance. Because of the 60% decrease in insulin sensitivity with normal pregnancy, these women develop clinical hyperglycaemia/gestational diabetes in late gestation. The metabolic dysfunction includes impaired insulin response, decreased hepatic suppression of glucose production during insulin infusion and decreased insulin‐stimulated glucose uptake in skeletal muscle, i.e. peripheral insulin resistance. The insulin resistance in normal glucose tolerance pregnancy is related to a decrease in the post‐receptor insulin signalling cascade, specifically decreased insulin receptor substrate 1 tyrosine phosphorylation. In women with normal glucose tolerance this is reversed post‐partum. In contrast, in gestational diabetes, in addition to the decrease in insulin receptor substrate 1 tyrosine phosphorylation, there is an additional decrease in tyrosine phosphorylation of the intracellular portion of the insulin receptor that is not related to the insulin receptor protein content. Post‐partum women with gestational diabetes, who had retention of gestational weight gain, had no significant improvement in insulin sensitivity and increased inflammation expressed as increased plasma and skeletal muscle tumour necrosis factor alpha. The increased inflammation or meta‐inflammation is a hallmark of obesity and during pregnancy develops in both white adipose tissue and placenta. Last gene array studies of placenta were associated with alterations in gene expression relating primarily to lipid in contrast to glucose metabolic pathways in gestational diabetes compared with Type 1 diabetes. Future studies are directed at decreasing inflammation prior to and during pregnancy using various lifestyle and nutritional interventions.

Gestational diabetes mellitus reflects impaired maternal insulin secretion relative to demand prior to pregnancy, as well as temporary metabolic stressors imposed by the placenta and fetus. Thus, after delivery, women with gestational diabetes have increased risk of diabetes and recurrent gestational diabetes because of their underlying impairment, which may be further exacerbated by fat accretion during pregnancy and post‐partum deterioration in lifestyle behaviours. This hypothetical model is discussed in greater detail, particularly the uncertainty regarding pregnancy as an accelerator of β‐cell decline and the role of gestational weight gain. This report also presents risk estimates for future glucose intolerance and diabetes and reviews modifiable risk factors, particularly body mass and lifestyle alterations, including weight loss and breastfeeding. Non‐modifiable risk factors such as race/ethnicity and insulin use during pregnancy are also discussed. The review concludes with current literature on lifestyle modification, recommendations for post‐partum glucose screening, and future directions for research to prevent maternal disease.

… Risk factors for the early development of diabetes mellitus after pregnancy include markers … Given the high rate of progression to diabetes mellitus after GDM, it is advisable to …

… test during pregnancy and insulin treatment during pregnancy. Conclusion. The risk of developing manifest diabetes after gestational diabetes may be high … progression to diabetes. …

BackgroundGestational diabetes mellitus (GDM) – a transitory form of diabetes first recognised during pregnancy complicates between < 1% and 28% of all pregnancies. GDM has important short and long-term health consequences for both the mother and her offspring. To prevent adverse pregnancy outcomes and to prevent or delay future onset of type 2 diabetes in mother and offspring, timely detection, optimum treatment, and preventive postpartum care and follow-up is necessary. However the area remains grossly under-prioritised.MethodsTo investigate determinants and barriers to GDM care from initial screening and diagnosis to prenatal treatment and postpartum follow-up, a PubMed database search to identify quantitative and qualitative studies on the subject was done in September 2012. Fifty-eight relevant studies were reviewed.ResultsAdherence to prevailing GDM screening guidelines and compliance to screening tests seems sub-optimal at best and arbitrary at worst, with no clear or consistent correlation to health care provider, health system or client characteristics. Studies indicate that most women express commitment and motivation for behaviour change to protect the health of their unborn baby, but compliance to recommended treatment and advice is fraught with challenges, and precious little is known about health system or societal factors that hinder compliance and what can be done to improve it. A number of barriers related to health care provider/system and client characteristics have been identified by qualitative studies. Immediately following a GDM pregnancy many women, when properly informed, desire and intend to maintain healthy lifestyles to prevent future diabetes, but find the effort challenging. Adherence to recommended postpartum screening and continued lifestyle modifications seems even lower. Here too, health care provider, health system and client related determinants and barriers were identified. Studies reveal that sense of self-efficacy and social support are key determinants.ConclusionsThe paper identifies and discusses determinants and barriers for GDM care, fully recognising that these are highly dependent on the context.

Gestational diabetes (GDM) in the short term is associated with various complications during pregnancy; however, in the long run, women have an increased risk of type 2 diabetes mellitus (T2DM). Therefore, short‐ and long‐term follow‐up postpartum is recommended.

… GDM, antenatal clinical factors predicted postpartum abnormal glucose tolerance and compliance with screening. … data is that ongoing screening of all women with GDM needs to occur. …

… guidelines recommending postpartum glucose screening following GDM, reviews current estimates of postpartum glucose screening following GDM including the type of screening used…

Introduction: Fifty percent of women with gestational diabetes mellitus (GDM) may progress to type 2 diabetes with highest risk among black women. This study aims to characterize postpartum diabetes screening rates among U.S. women with GDM by racial and ethnic group to characterize potential disparities. Materials and Methods: A standardized search of Ovid-Medline, Embase, Scopus, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Cochrane, ProQuest, and Clinicaltrials.gov was conducted through October 12, 2018. Of 1,555 titles reviewed, 27 studies met inclusion criteria. Meta-proportion routines with random-effects models estimated pooled postpartum screening proportion effect size (ES) with 95% confidence interval (CI) by racial and ethnic group. Heterogeneity was measured using Cochrane's Q and Higgins I 2 tests. Data were stratified by intervention and data source. Results: There were 96,439 women, of whom 81,930 had race/ethnicity recorded. Heterogeneity was high (I 2 = 99.7%). Postpartum screening rates were low (pooled ES 42% [95% CI 35%–48%]). Point estimates for pooled screening proportions were lower among white (pooled ES 35% [95% CI 28%–42%]) and black (pooled ES 33% [95% CI 24%–42%]) women than among Hispanic (pooled ES 45% [95% CI 37%–53%]) and Asian (pooled ES 50% [95% CI 41%–58%]) women. Interventions to improve screening were most common and effective among Hispanic women. Discussion: Postpartum screening for diabetes after GDM remains low, and black women have among the lowest postpartum screening rates despite highest risk for type 2 diabetes progression. Reporting of race/ethnicity, screening methods, and screening time frames varied across studies. Conclusion: Future studies must standardize racial/ethnic data reporting and examine interventions that address postpartum diabetes screening and prevention.

The postpartum period represents a critical window to initiate targeted interventions to improve cardiometabolic health following pregnancies complicated by gestational diabetes mellitus and/or a hypertensive disorder of pregnancy. The purpose of this systematic review was to examine studies published since 2011 that report rates of postpartum follow-up and risk screening for women who had gestational diabetes and/or a hypertensive disorder of pregnancy and to identify disparities in care. Nine observational studies in which postpartum follow-up visits and/or screening rates were measured among US women following pregnancies complicated by gestational diabetes and/or a hypertensive disorder of pregnancy were reviewed. Rates of postpartum follow-up ranged from 5.7% to 95.4% with disparities linked to black race and Hispanic ethnicity, low level of education, and coexisting morbidities such as mental health disorders. Follow-up rates were increased if the provider was an obstetrician/endocrinologist versus primary care. Payer source was not associated with follow-up rates. The screening rate for diabetes in women who had gestational diabetes did not exceed 58% by 4 months across the studies analyzed, suggesting little improvement in the last 10 years. While women who had a hypertensive disorder appear to have had a postpartum blood pressure measured, it is unclear whether follow-up intervention occurred. Overall, postpartum screening rates for at-risk women remain suboptimal and vary substantially. Further research is warranted including reliable population-level data to inform equitable progress to meeting the evidence-informed guidelines.

Background: Gestational diabetes (GDM) is glucose intolerance detected for the first time during pregnancy. Women with a history of GDM have a 7-fold higher lifetime risk of developing type 2 diabetes (DMII) compared to women without a history of GDM. Women with a history of GDM should be screened for DMII 6 to 12 weeks postpartum with a 2-hour 75-g oral glucose tolerance test (OGTT) and then again one year after delivery. The long-term goal of this project is to improve screening for DMII in women with a history of GDM. This report establishes the prevalence of GDM, determines the postpartum screening rate, and assesses for barriers to screening at an urban safety-net hospital. This information will be used to design interventions to improve postpartum screening. Methods: We conducted a retrospective chart review of women who had a delivery at Truman Medical Center between January 1, 2017 to December 31, 2019 and had a diagnosis of GDM. Charts were reviewed for demographic data, management of GDM, postpartum appointments, and screening for DMII. Results: There were 9569 deliveries during the three-year period. Of the total deliveries, 537 (5.6%) had a diagnosis of GDM. Of the patients with GDM, 426 (79%) had a postpartum visit scheduled, 354 (66%) attended a 6-week postpartum appointment, 219 (41%) had the recommended test ordered, and 49 (9%) completed the test. The data revealed a significant association with ethnicity, language, insurance type, and site of prenatal care with attending the postpartum appointment (p Conclusion: There is gap in the number of women with GDM and those who are screened for DMII in the postpartum period. There appears to be a disconnect in the ordering of the recommended 2-hour OGTT and the completion of the test. The baseline data supports a multi-prong approach including patient education, system changes, and advocacy for extended insurance benefits to cover screening. Disclosure V. Rakhra: None. M. Riley: None. S. Jordan: None. S. Bulchandani: None. J. Allsworth: None. B. Drees: None.

Gestational Diabetes Mellitus (GDM) is one of the critical risk factors for diabetes mellitus (DM). An early postpartum test done in the first few postpartum days can increase the screening rate in women with GDM. Therefore, this systematic review and meta-analysis aimed to combine and analyze data from different studies reporting the detection rate of postpartum diabetes in early and 4-12 week postpartum screening tests in women with GDM. ProQuest, Web of Science, EMBASE, PubMed, Cochrane, and Scopus were searched for English articles from January 1985 to January 2021. Two independent reviewers selected the eligible studies, and the outcomes of interest were extracted. The quality of studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for diagnostic test accuracy studies. Sensitivity and specificity, negative likelihood ratio (NLR), and positive likelihood ratio (PLR) were calculated for the early postpartum oral glucose tolerance test (OGTT). Of 1944 initially identified articles, four studies were included. The sensitivity and specificity of the early test were 74% and 56%, respectively, and the PLR and NLR were calculated as 1.7 and 0.4, respectively. The sensitivity of the early test was higher than the specificity. Based on this sensitivity and specificity, normal cases could be distinguished from abnormal cases, including diabetes and glucose intolerance. Early postpartum OGTT can be advised before hospital discharge. Early testing is a practical option in patients with GDM. Further studies are required to evaluate the early test detection rate for DM and glucose intolerance separately.

… an oral glucose tolerance test to improve the rate of glucose screening in women with gestational diabetes mellitus in the four largest maternity units in our area, starting in March 2011. …

… that influence whether women with GDM receive postpartum diabetes testing, focusing especially … type, race, and adverse neonatal outcome (composite of NICU admission or neonatal …

… with postpartum DM screening in women with GDM. We found that only 20.6% of the women with GDM performed the postpartum DM screening… for screening during the postpartum visit …

… We assessed two outcome variables: a clinician order for either a fasting plasma glucose test (FPG) or 2-hour 75-g OGTT within 1 month before to 3 months after delivery and test results …

… The primary outcome was the proportion of patients who … outcome was the performance of other postpartum screening … and treatment of GDM has been on obstetric outcomes, the high …

OBJECTIVE To summarize the current interventions aiming at improving postpartum diabetes screening attendance and compare their effectiveness. DATA SOURCES Literature searches were conducted in Web of Science, Embase, Cochrane Library, CINAHL, and PubMed from the inception to 20th March 2023. STUDY ELIGIBILITY CRITERIA Quantitative studies involving an intervention to increase postpartum diabetes screening attendance among women with gestational diabetes mellitus were included. STUDY APPRAISAL AND SYNTHESIS METHODS The Joanna Briggs Institute checklists were used for the quality appraisal of included studies. A Bayesian network meta-analysis was performed to synthesize the comparative effectiveness of relevant interventions in improving postpartum diabetes screening rates. RESULTS Forty studies were included in this review, with pooled data from 17,123 women. Studies included RCTs (n=11, including 3 US studies and 8 non-US studies) and non-randomised studies (NRS) (n=29, including 13 US studies and 16 non-US studies). Eleven out of 14 studies reporting screening outcomes detected early type 2 diabetes (T2DM), with a T2DM rate ranging from 2.0% to 23.0%. Types of interventions identified included reminders (e.g., postal letters, emails, and phone messages), educational interventions, screening methods and delivery, policy changes, antenatal groups, and multimodal interventions. Based on the network meta-analysis from RCTs, antenatal group intervention, which refers to antenatal patient education delivered in groups (1 US study), had the highest probability to be the most effective intervention (OR=10, 95%CI 1.6-77.0), followed by one-to-one educational intervention with written educational materials or counselling (OR:6.9; 95%CI 3.6-16.0). The results from NRS indicated flexible screening methods and delivery (2 US studies) had the greatest impact on screening uptake (OR=3.9, 95%CI 1.8-10.0), followed by educational interventions (1 US study and 2 non-US studies) with antenatal patient education and written educational materials (OR=3.4, 95%CI 1.9-6.3), and antenatal groups (OR:3.3, 95%CI 1.7-6.7). CONCLUSION The presented evidence suggests that antenatal patient education delivered in groups and offering more flexible screening methods were associated with the greatest increase in attendance. The multimodal interventions and reminders could still be important if they were more theoretically grounded and were more integrated into the healthcare system.

… clarified the risks of adverse outcomes associated with GDM. The International Association of … the screening rate and prevalence of GDM, as well as the postpartum diabetes screening …

… Factor associated with postpartum diabetes mellitus included family History of diabetes mellitus, gestational age at diagnosis of GDM, insulin use during pregnancy and pre-pregnancy …

Background Gestational diabetes mellitus (GDM) is an important risk factor for developing type 2 diabetes mellitus (T2DM) later in life. Postpartum screening provides an opportunity for early detection and management of T2DM, but uptake is poor. Aim To explore barriers to screening from clinicians’ perspectives to guide future interventions to increase uptake of postpartum screening. Design and setting Systematic review and qualitative synthesis. Method Qualitative studies included in a previous review were assessed, and then five electronic databases were searched from January 2013 to May 2019 for qualitative studies reporting clinicians’ perspectives on postpartum glucose screening after GDM. Study quality was assessed against the Critical Appraisal Skills Programmes checklist. Qualitative data from the studies were analysed using thematic synthesis. Results Nine studies were included, containing views from 187 clinicians from both community and hospital care. Three main themes were identified: difficulties in handover between primary and secondary care (ambiguous roles and communication difficulties); short-term focus in clinical consultations (underplaying risk so as not to overwhelm patients and competing priorities); and patient-centric barriers such as time pressures. Conclusion Barriers to diabetes screening were identified at both system and individual levels. At the system level, clarification of responsibility for testing among healthcare professionals and better systems for recall are needed. These could be achieved through registers, improved clinical protocols, and automatic flagging and prompts within electronic medical records. At the individual level, clinicians should be supported to prioritise the importance of screening within consultations and better educational resources made available for women. Making it more convenient for women to attend may also facilitate screening.

AIMS This study aimed to develop a prediction model for identifying a woman with gestational diabetes mellitus (GDM) at high risk of type 2 diabetes (T2DM) post-birth. METHODS Utilising data from 1299 women in the Lifestyle Intervention IN Gestational Diabetes (LIVING) study, two models were developed: one for pregnancy and another for postpartum. Key predictors included glucose test results, medical history, and biometric indicators. RESULTS Of the initial cohort, 124 women developed T2DM within three years. The study identified seven predictors for the antenatal T2DM risk prediction model and four for the postnatal one. The models demonstrated good to excellent predictive ability, with Area under the ROC Curve (AUC) values of 0.76 (95% CI: 0.72 to 0.80) and 0.85 (95% CI: 0.81 to 0.88) for the antenatal and postnatal models, respectively. Both models underwent rigorous validation, showing minimal optimism in predictive capability. Antenatal model, considering the Youden index optimal cut-off point of 0.096, sensitivity, specificity, and accuracy were measured as 70.97%, 70.81%, and 70.82%, respectively. For the postnatal model, considering the cut-off point 0.086, sensitivity, specificity, and accuracy were measured as 81.40%, 75.60%, and 76.10%, respectively. CONCLUSIONS These models are effective for predicting T2DM risk in women with GDM, although external validation is recommended before widespread application.

Background The increasing prevalence of gestational diabetes mellitus (GDM) is concerning as women with GDM are at high risk of type 2 diabetes (T2D) later in life. The magnitude of this risk highlights the importance of early intervention to prevent the progression of GDM to T2D. Rates of postpartum screening are suboptimal, often as low as 13% in Asian countries. The lack of preventive care through structured postpartum screening in several health care systems and low public awareness are key barriers to postpartum diabetes screening. Objective In this study, we developed a machine learning model for early prediction of postpartum T2D following routine antenatal GDM screening. The early prediction of postpartum T2D during prenatal care would enable the implementation of effective strategies for diabetes prevention interventions. To our best knowledge, this is the first study that uses machine learning for postpartum T2D risk assessment in antenatal populations of Asian origin. Methods Prospective multiethnic data (Chinese, Malay, and Indian ethnicities) from 561 pregnancies in Singapore’s most deeply phenotyped mother-offspring cohort study—Growing Up in Singapore Towards healthy Outcomes—were used for predictive modeling. The feature variables included were demographics, medical or obstetric history, physical measures, lifestyle information, and GDM diagnosis. Shapley values were combined with CatBoost tree ensembles to perform feature selection. Our game theoretical approach for predictive analytics enables population subtyping and pattern discovery for data-driven precision care. The predictive models were trained using 4 machine learning algorithms: logistic regression, support vector machine, CatBoost gradient boosting, and artificial neural network. We used 5-fold stratified cross-validation to preserve the same proportion of T2D cases in each fold. Grid search pipelines were built to evaluate the best performing hyperparameters. Results A high performance prediction model for postpartum T2D comprising of 2 midgestation features—midpregnancy BMI after gestational weight gain and diagnosis of GDM—was developed (BMI_GDM CatBoost model: AUC=0.86, 95% CI 0.72-0.99). Prepregnancy BMI alone was inadequate in predicting postpartum T2D risk (ppBMI CatBoost model: AUC=0.62, 95% CI 0.39-0.86). A 2-hour postprandial glucose test (BMI_2hour CatBoost model: AUC=0.86, 95% CI 0.76-0.96) showed a stronger postpartum T2D risk prediction effect compared to fasting glucose test (BMI_Fasting CatBoost model: AUC=0.76, 95% CI 0.61-0.91). The BMI_GDM model was also robust when using a modified 2-point International Association of the Diabetes and Pregnancy Study Groups (IADPSG) 2018 criteria for GDM diagnosis (BMI_GDM2 CatBoost model: AUC=0.84, 95% CI 0.72-0.97). Total gestational weight gain was inversely associated with postpartum T2D outcome, independent of prepregnancy BMI and diagnosis of GDM (P=.02; OR 0.88, 95% CI 0.79-0.98). Conclusions Midgestation weight gain effects, combined with the metabolic derangements underlying GDM during pregnancy, signal future T2D risk in Singaporean women. Further studies will be required to examine the influence of metabolic adaptations in pregnancy on postpartum maternal metabolic health outcomes. The state-of-the-art machine learning model can be leveraged as a rapid risk stratification tool during prenatal care. Trial Registration ClinicalTrials.gov NCT01174875; https://clinicaltrials.gov/ct2/show/NCT01174875

Objective The aim of the present study was to identify the factors associated with non-attendance of immediate postpartum glucose test using a machine learning algorithm following gestational diabetes mellitus (GDM) pregnancy. Method A retrospective cohort study of all GDM women (n = 607) for postpartum glucose test due between January 2016 and December 2019 at the George Eliot Hospital NHS Trust, UK. Results Sixty-five percent of women attended postpartum glucose test. Type 2 diabetes was diagnosed in 2.8% and 21.6% had persistent dysglycaemia at 6–13 weeks post-delivery. Those who did not attend postpartum glucose test seem to be younger, multiparous, obese, and continued to smoke during pregnancy. They also had higher fasting glucose at antenatal oral glucose tolerance test. Our machine learning algorithm predicted postpartum glucose non-attendance with an area under the receiver operating characteristic curve of 0.72. The model could achieve a sensitivity of 70% with 66% specificity at a risk score threshold of 0.46. A total of 233 (38.4%) women attended subsequent glucose test at least once within the first two years of delivery and 24% had dysglycaemia. Compared to women who attended postpartum glucose test, those who did not attend had higher conversion rate to type 2 diabetes (2.5% vs 11.4%; p = 0.005). Conclusion Postpartum screening following GDM is still poor. Women who did not attend postpartum screening appear to have higher metabolic risk and higher conversion to type 2 diabetes by two years post-delivery. Machine learning model can predict women who are unlikely to attend postpartum glucose test using simple antenatal factors. Enhanced, personalised education of these women may improve postpartum glucose screening.

… develop diabetes, mostly type 2 diabetes (T2D), within five to ten years after pregnancy [2], [… rs7903146 variant predicted postpartum diabetes when applying an additive model (hazard …

… , 110 developed postpartum diabetes. In order to derive and test the prediction model in two … , or short stature might be relevant predictors of type 2 diabetes [25]. However, these results …

Summary Early onset of type 2 diabetes and cardiovascular disease are common complications for women diagnosed with gestational diabetes. Prediabetes refers to a condition in which blood glucose levels are higher than normal, but not yet high enough to be diagnosed as type 2 diabetes. Currently, there is no accurate way of knowing which women with gestational diabetes are likely to develop postpartum prediabetes. This study aims to predict the risk of postpartum prediabetes in women diagnosed with gestational diabetes. Our sparse logistic regression approach selects only two variables – antenatal fasting glucose at OGTT and HbA1c soon after the diagnosis of GDM – as relevant, but gives an area under the receiver operating characteristic curve of 0.72, outperforming all other methods. We envision this to be a practical solution, which coupled with a targeted follow-up of high-risk women, could yield better cardiometabolic outcomes in women with a history of GDM.

… diabetes mellitus, which affects about 2% of pregnant women in Sweden [1], increases the risk of postpartum diabetes, particularly type 2 [2… In addition to a model including only main …

… of type 2 diabetes mellitus (T2DM… prediction models for postpartum glucose intolerance in women with GDM. The results obtained demonstrate that these models exhibit good prediction …

… We employed penalised logistic regression model followed by bootstrapping to identify this … a specific miRNA appears to be discriminatory in the prediction model (Fig. 1c). We then …

Gestational diabetes mellitus (GDM) significantly increases the risk of developing type 2 diabetes (T2D) postpartum. Early identification of high-risk women using machine learning (ML) models could enable targeted interventions and improve outcomes. This systematic review aims to evaluate the performance, predictive features, and methodological quality of ML models designed to predict the transition from GDM to T2D. A comprehensive search was conducted across PubMed, Scopus, IEEE Xplore, and Web of Science, yielding 178 records. After removing duplicates and screening for eligibility, 13 studies were included. Data on study characteristics, ML algorithms, predictive features, model performance, and validation methods were extracted. Risk of bias was assessed using the PROBAST (Prediction model Risk of Bias Assessment Tool). The included studies demonstrated variable performance, with area under the curve (AUC) values ranging from 0.72 to 0.92. Models incorporating omics data outperformed clinical-only models. Key predictive features included age, body mass index (BMI), glycemic measures, and pregnancy-specific factors. However, only 38% of studies employed robust external validation, and small sample sizes limited generalizability in some cases. Risk of bias assessment revealed low overall bias, though analytical validation methods were often unclear or insufficient. ML models, particularly those integrating omics data, show strong potential for predicting T2D risk in women with prior GDM. However, heterogeneity in validation methods and limited external validation highlight the need for standardized reporting and larger, diverse cohorts to enhance clinical applicability. Future research should focus on developing reproducible, generalizable models to guide personalized prevention strategies.

This systematic review aims to explore the early predictive value of machine learning (ML) models for the progression of gestational diabetes mellitus (GDM) to type 2 diabetes mellitus (T2DM). A comprehensive and systematic search was conducted in Pubmed, Cochrane, Embase, and Web of Science up to July 02, 2024. The quality of the studies included was assessed. The risk of bias was assessed through the prediction model risk of bias assessment tool and a graph was drawn accordingly. The meta-analysis was performed using Stata15.0. A total of 13 studies were included in the present review, involving 11,320 GDM patients and 22 ML models. The meta-analysis for ML models showed a pooled C-statistic of 0.82 (95% CI: 0.79 ~ 0.86), a pooled sensitivity of 0.76 (0.72 ~ 0.80), and a pooled specificity of 0.57 (0.50 ~ 0.65). ML has favorable diagnostic accuracy for the progression of GDM to T2DM. This provides evidence for the development of predictive tools with broader applicability.

In this study, we sought to identify antepartum characteristics that predict the de novo development of diabetes 11-26 months after the index pregnancy in a carefully characterized cohort of women with gestational diabetes mellitus (GDM). Oral and frequently sampled intravenous glucose tolerance tests (OGTTs and FSIGTs), hyperinsulinemic-euglycemic clamps with labeled glucose, and body composition studies were performed on 91 islet cell antibody-negative Latino women with GDM during the third trimester of pregnancy. The women were documented to be diabetes-free within 6 months postpartum. Their diabetes status was ascertained again between 11 and 26 months postpartum. Logistic regression analysis was used to identify independent predictors of the development of diabetes within that interval. Fourteen of the women developed diabetes by World Health Organization criteria 11-26 months after delivery of the index pregnancy. Three antepartum variables were independent predictors of diabetes: the 1-h postchallenge plasma glucose concentration from the 100-g OGTT at which GDM was diagnosed (higher = increased risk; P = 0.003); an index of pancreatic beta-cell compensation for insulin resistance, defined as the product of the 30-min incremental plasma insulin:glucose ratio on a 75-g OGTT and the insulin sensitivity index from a hyperinsulinemic-euglycemic clamp (lower = increased risk, P = 0.009); and the basal glucose production rate after an overnight fast (higher = increased risk; P = 0.04). We conclude that postchallenge hyperglycemia, poor pancreatic beta-cell compensation for insulin resistance, and elevated endogenous glucose production during pregnancy precede the development of type 2 diabetes in young Latino women by at least 1-2 years.

Women with a history of gestational diabetes mellitus (GDM) face a substantially elevated risk of developing type 2 diabetes mellitus (T2DM), yet healthcare systems lack systematic approaches to prioritize these women for preventive interventions under resource constraints. This proof-of-concept study develops and demonstrates an integrated framework that combines machine-learning–based risk prediction with multi-algorithm optimization to enable evidence-based patient prioritization using synthetic data. A two-phase methodology was implemented using synthetic data from 6,000 women with prior GDM. Phase 1 deployed five classification algorithms (Logistic Regression, Random Forest, XGBoost, LSTM, and CNN-1D) with 10-fold stratified cross-validation and SMOTE-ENN resampling for T2DM risk prediction. Phase 2 implemented 9 optimization algorithms across 10 budget scenarios and 5 priority thresholds, yielding 450 optimization runs. The prioritization framework targets postpartum and interpregnancy follow-up care for women with prior GDM. Logistic Regression achieved the highest predictive performance with an AUC-ROC of 0.9454 (accuracy: 0.8875, recall: 0.8533, F1-score: 0.7913). SHAP analysis identified insulin treatment during pregnancy (mean |SHAP| = 0.099), GDM recurrence history (0.073), and postpartum weight gain (0.063) as the most influential predictors. Linear Programming consistently produced optimal solutions with a mean total priority of 901.47 and 65.26% high-risk coverage. At a 25% budget allocation ($1.95 million), 60.5% of very high-risk women could be prioritized, whereas full high-risk coverage would require a 50% budget allocation. Overall, the proposed framework demonstrates the feasibility of integrating risk prediction with constrained optimization to support resource allocation for T2DM prevention. Clinical validation using real-world prospective data is required prior to practical implementation.

AIMS We examined the association between serum metabolome in women with pharmacologically treated gestational diabetes (GDM) and measures of glucose metabolism 9 years postpartum. METHODS Serum targeted metabolome, adiponectin, inflammatory markers, and insulin-like growth factor-binding protein-1 phosphoisoforms were analyzed at the time of diagnosing GDM. Glucose metabolism and insulin resistance were assessed at 9 years postpartum. Data from 119 subjects were available for analyses. Associations between baseline measures and future measures of glycemia were examined with univariate regressions and multivariate prediction models. This is a secondary analysis of a previous prospective trial (NCT02417090). RESULTS Baseline serum markers were most strongly related to measures of insulin resistance at 9-years follow-up. In multivariate analyses combination of IDL cholesterol, early gestational weight gain and in oral glucose tolerance test fasting and 2-h glucose predicted development of disorders of glucose metabolism (pre-diabetes and/or type 2 diabetes) better than clinical predictors alone (ROC-AUC 0.75 vs. 0.65, p = 0.020). CONCLUSIONS Serum metabolome in pregnancy in women with GDM is related to future glucose metabolism and insulin resistance. Compared to clinical variables alone metabolome might result in better prediction of future disorders of glucose metabolism and could facilitate personalized risk stratification for postpartum interventions and follow-up.

OBJECTIVE To examine the association between breastfeeding intensity in relation to maternal blood glucose and insulin and glucose intolerance based on the postpartum 2-h 75-g oral glucose tolerance test (OGTT) results at 6–9 weeks after a pregnancy with gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS We selected 522 participants enrolled into the Study of Women, Infant Feeding, and Type 2 Diabetes (SWIFT), a prospective observational cohort study of Kaiser Permanente Northern California members diagnosed with GDM using the 3-h 100-g OGTT by the Carpenter and Coustan criteria. Women were classified as normal, prediabetes, or diabetes according to American Diabetes Association criteria based on the postpartum 2-h 75-g OGTT results. RESULTS Compared with exclusive or mostly formula feeding (>17 oz formula per 24 h), exclusive breastfeeding and mostly breastfeeding (≤6 oz formula per 24 h) groups, respectively, had lower adjusted mean (95% CI) group differences in fasting plasma glucose (mg/dL) of −4.3 (−7.4 to −1.3) and −5.0 (−8.5 to −1.4), in fasting insulin (μU/mL) of −6.3 (−10.1 to −2.4) and −7.5 (−11.9 to −3.0), and in 2-h insulin of −21.4 (−41.0 to −1.7) and −36.5 (−59.3 to −13.7) (all P < 0.05). Exclusive or mostly breastfeeding groups had lower prevalence of diabetes or prediabetes (P = 0.02). CONCLUSIONS Higher intensity of lactation was associated with improved fasting glucose and lower insulin levels at 6–9 weeks’ postpartum. Lactation may have favorable effects on glucose metabolism and insulin sensitivity that may reduce diabetes risk after GDM pregnancy.

… Only a few studies have addressed adipokine levels in GDM and postpartum, and the … insulin resistance and some adipokines in gestational diabetes during pregnancy and postpartum…

Aims The objective of the present study was to explore the long-term postpartum glucose metabolism in women with previous GDM, and study the mechanism of hyperglycemia from gestation to postpartum by investigating the postpartum insulin resistance and insulin secretion. Methods A total of 321 females with previous GDM were followed up once during 1- to 6-years postpartum. Characteristics during pregnancy, perinatal period, and postpartum were compared between postpartum NGT and hyperglycemic women. HOMA-IR and HOMA-β were used to assess insulin resistance and insulin secretion levels with different glucose statuses. Results The prevalence of postpartum hyperglycemia had a fluctuant increase from 25.9% at 1 year, to 53.7% at 5 year. 75 g OGTT 2 hPG during pregnancy was an independent predictor of postpartum hyperglycemia with an OR of 2.15 (95% CI 1.245, 3.722) (P=0.006). After ROC analysis, the best equilibrium between sensitivity (70.3%) and specificity (60.4%) for 2 hPG was 9.03 mmol/L. HOMA-IR was increased in postpartum normal glucose tolerance (NGT), prediabetes, and T2DM (1.64 vs. 2.14 vs. 4.27, P=0.006). After ROC analysis, the best equilibrium between sensitivity (70.3%) and specificity (60.4%) for 2 hPG was 9.03 mmol/L. HOMA-IR was increased in postpartum normal glucose tolerance (NGT), prediabetes, and T2DM (1.64 vs. 2.14 vs. 4.27, β were used to assess insulin resistance and insulin secretion levels with different glucose statuses. P=0.006). After ROC analysis, the best equilibrium between sensitivity (70.3%) and specificity (60.4%) for 2 hPG was 9.03 mmol/L. HOMA-IR was increased in postpartum normal glucose tolerance (NGT), prediabetes, and T2DM (1.64 vs. 2.14 vs. 4.27, β were used to assess insulin resistance and insulin secretion levels with different glucose statuses. Conclusions 75 g OGTT 2h PG during pregnancy higher than 9.03 mmol/L is regarded as an independent risk factor of postpartum hyperglycemia. Insulin resistance with insufficient insulin secretion compensation is still common phenomenon during long-term postpartum. Women with heavier insulin resistance in the postpartum period are more likely develop prediabetes, while decreased β-cell function contributes more to T2DM development.β were used to assess insulin resistance and insulin secretion levels with different glucose statuses.

Introduction The metabolic abnormalities underlying gestational diabetes mellitus (GDM) include increased insulin resistance and beta cell defects, but it is essential to clarify how insulin resistance and insulin secretion develop post partum in order to decide when and how to screen for type 2 diabetes. The purpose of the present study was to characterize and compare changes in insulin sensitivity, insulin secretion and hormonal status around parturition and 6 months post partum in women with gestational diabetes. Research design and methods A longitudinal experimental study was performed at Aarhus University Hospital, Denmark. Eight women with GDM were examined at three identical visits: in late pregnancy (LP) between gestational age 34+0 and 36+6, early post partum (EPP) between 12 and 34 days post partum, and late post partum (LPP) 6 months post partum. An intravenous glucose tolerance test was performed, followed by a hyperinsulinemic euglycemic clamp. Blood samples were collected to assess metabolic, hormonal and inflammatory markers at each visit. Results First and second phase insulin secretion and C-peptide concentrations were higher in late pregnancy than post partum (p<0.001). Insulin sensitivity index (ISI) was different at all three visits: ISILP=0.03±0.004, ISIEPP=0.09±0.008 and ISILPP=0.07±0.008) (p<0.001). Also, significant changes in lipids, leptin, glucagon, growth hormone and insulin-like growth factor-1 were seen when comparing the visits. Conclusions Insulin sensitivity improves immediately after delivery in women with GDM but seems to deteriorate within the first 6 months post partum. Our findings underline the importance of having an increased awareness of the profound risk of developing type 2 diabetes after GDM. Trial registration number NCT02770079.

… , women with GDM were more insulin resistant than nondiabetic … Postpartum, ISRs and insulin resistance decreased in … that women with GDM were more insulin resistant than controls) …

Abstract Gestational diabetes mellitus (GDM) imparts a high risk of developing postpartum diabetes and is considered to be an early stage of type 2 diabetes mellitus (T2DM). In this study, a 75-g oral glucose tolerance test was performed on 472 women with GDM at 6–8 weeks after delivery. The clinical and metabolic characteristics were compared between the patients with normal glucose tolerance (NGT) and abnormal glucose metabolism (AGM). These data were then compared between pre-diabetic and diabetic patients. A total of 37.7% of the women with GDM continued to have abnormal glucose levels after delivery. Compared with the women who reverted to normal, HOMA-IR was significantly higher in AGM. A multiple stepwise regression analysis revealed that age, the postpartum body mass index (BMI), low density lipoprotein-cholesterol (LDL-C), 2 h glucose load plasma glucose (2 h PG), triglycerides (TG), hemoglobin A1c (HbA1c), 1 h glucose load plasma insulin (INS) level, and 2 h INS level were independent risk factors for the development of insulin resistance after delivery. This study has identified a high prevalence of AGM after GDM. Insulin resistance appears to be the major contributor. Any treatment to reduce the postpartum BMI and lipids level may be beneficial to decrease insulin resistance.

BACKGROUND Gestational diabetes mellitus (GDM) is characterized by a higher degree of insulin resistance (IR) than in a normal pregnancy. Several surrogate measures have been proposed to assess insulin sensitivity, including glycated hemoglobin, the Homeostatic Model Assessment-Insulin Resistance (HOMA-IR), and the Quantitative Insulin Sensitivity Check Index (QUICKI). OBJECTIVES The aim of the study was to determine whether markers of IR in the 1st week postpartum differ between mothers with GDM and healthy controls, and whether mothers with GDM treated with insulin have significantly different levels of IR markers compared with those treated with diet and physical activity. The association between IR markers, pregnancy outcomes, and maternal glucose profiles based on the oral glucose tolerance test (OGTT) was also investigated. MATERIAL AND METHODS Among the 70 participants, 50 mothers were diagnosed with GDM; 21 were treated with diet and physical activity (GDM G1), while 29 received insulin therapy (GDM G2). The remaining 20 participants constituted a control group with no history of glucose intolerance before or during pregnancy (non-GDM). A range of statistical methods (e.g., analysis of variance (ANOVA), Kruskal-Wallis test, χ2 test, regression analysis, and cluster analysis) were used to compare data between study groups, with a significance level of α = 0.05. RESULTS The results showed that selected markers of IR in the 1st week after delivery differed significantly between mothers. Mothers with GDM exhibited considerably higher levels of HOMA-IR and HbA1c (p < 0.05), yet no substantially divergent QUICKI (p > 0.05) in the 1st week postpartum. Additionally, they demonstrated elevated glucose levels at 3 OGTT time points in comparison with non-GDM mothers. The GDM G2 group exhibited higher values than the GDM G1 group, except for the 1 h OGTT. Identification of maternal glucose phenotypes confirmed variability in the degree of glucose metabolism disorders among mothers. CONCLUSIONS Cluster analysis and glucose phenotype stratification in mothers with GDM help identify high-risk groups and support targeted counseling and monitoring to improve pregnancy outcomes.

Background: Gestational diabetes mellitus (GDM) is defined by an insufficient insulin response to counteract the insulin resistance (IR) that arises from the physiological adaptations associated with pregnancy. However, the pathophysiology of IR is complex and unclear, as it encompasses elements such as epigenetics, environmental factors, modifiable lifestyle factors, and psychosocial factors. Aim: The objective of this study was to evaluate the influence of GDM and other maternal factors on IR markers in comparison to mothers with normal glucose tolerance during pregnancy in the first week postpartum. Material and Methods: The study population comprised 70 participants, including mothers with gestational diabetes who were treated with a diet and physical activity (GDM G1), with insulin (GDM G2), and a control group of healthy mothers without gestational diabetes (non-GDM). A series of statistical techniques were employed to facilitate the comparison of data between the study groups, with the objective of identifying potential associations with maternal factors. A taxonomic analysis was conducted using the following factors: classification by study group, a history of hypothyroidism in the maternal medical interview, and maternal gestational weight gain, which were identified as the best-fitting predictors. Results: The analysis resulted in the identification of four clusters of patients. Comparison of the insulin resistance markers between mothers assigned to the abovementioned clusters showed differences in the incidence of excessive weight loss and in the results of glucose screening tests during pregnancy. Also, differences concerning fasting glucose levels in the first and second/third trimesters of pregnancy and glucose levels at 1 h post-OGTT were found. For the clusters, the results of the HOMA-IR and the QUICKI did not show any differences in the first week after delivery (p > 0.05). HbA1c results varied significantly. Conclusions: Degree of glucose metabolism disorders, hypothyroidism, and weight gain in pregnancy influence maternal insulin resistance markers in the first week postpartum. Additionally, gestational weight fluctuation has a significant influence on the outcome of pregnancy, particularly with regard to fetal growth and, consequently, the infant’s birth weight and adipose tissue accumulation.

Background Hypovitaminosis D has been associated with the development of gestational diabetes mellitus (GDM) in many observational studies. Objectives We report the first study of the impact of prenatal vitamin D supplementation on postpartum dysglycemia in GDM patients in a randomized clinical trial. Patients and Methods Women with GDM at 12 - 32 weeks of gestation were assigned randomly to either the intervention group (in which serum 25-hydroxy vitamin D [25OHD] levels were measured immediately, n = 48) or the control group (in which the serum was stored and assayed at 6 - 12 weeks post-partum, n = 48). Participants with initial serum 25OHD < 30 ng/mL in the intervention group were instructed to take a total of 700,000 IU vitamin D3 during pregnancy. The primary outcomes were fasting plasma glucose (FPG), insulin, 2-h post 75 g glucose load plasma glucose (2-hPLG), homeostasis model assessment of insulin resistance (HOMA-IR), HbA1C, and 25 OHD at 6 - 12 weeks after delivery. Results The mean ± SD of serum 25OHD in the intervention group raised dramatically from 14.6 ± 6.3 to 32.4 ± 14.4 ng/mL, whereas no significant change occurred in the control group (from 17.7 ± 6.1 to 19.3 ± 9.6 ng/mL, P < 0.001). Thirteen participants developed dysglycemia in each group. Mean FPG, 2-hPLG, and HOMA-IR were not significantly different between the groups. There was no significant difference between the groups for maternal and neonatal outcomes. Conclusions Although the high vitamin D supplementation dose in the present study (compared to the 400 IU/day dose usually recommended for pregnancy) safely increases the serum 25OHD, in GDM cases, the higher dose does not affect the plasma glucose level or insulin resistance at short term follow-up after delivery.

Background Identifying risk factors for postpartum type 2 diabetes in women with gestational diabetes mellitus (GDM) is crucial for effective interventions. We examined whether changes in insulin sensitivity after delivery affects the risk of type 2 diabetes in women with GDM. Methods This prospective cohort study included 347 women with GDM or gestational impaired glucose tolerance, who attended the follow-up visits at 2 months postpartum and annually thereafter. Changes in insulin sensitivity were calculated using the Matsuda index at GDM diagnosis and at 2 months postpartum (ΔMatsuda index). After excluding women with pregestational diabetes or those followed up only once, we analyzed the risk of postpartum type 2 diabetes based on the ΔMatsuda index tertiles. Results The incidence of type 2 diabetes at the two-month postpartum visit decreased with increasing ΔMatsuda index tertiles (16.4%, 9.5%, and 1.8%, P=0.001). During a 4.1-year follow-up, 26 out of 230 women who attended more than two follow-up visits (11.3%) developed type 2 diabetes. Compared to the lowest tertile, subjects in the highest ΔMatsuda index tertile showed a significantly reduced risk of type 2 diabetes (hazard ratio, 0.33; 95% confidence interval, 0.12 to 0.93; P=0.036) after adjusting for confounders. Conclusion Improvement in insulin sensitivity after delivery is associated with a reduced risk of postpartum type 2 diabetes in women with GDM. Postpartum changes in insulin sensitivity could be a useful prediction for future type 2 diabetes development in women with GDM.

… of glucose intolerance in the early postpartum period across different GDM subtypes. Our aim … intolerance across GDM groups based on different degrees of insulin resistance compared …

… Insulin resistance has been further evidenced by … insulin and C-peptide concentration in GDM. Our findings of increased insulin and HOMA-IR confirmed insulin resistance in GDM. …

To investigate whether high‐intensity breastfeeding (HIB) reduces insulin resistance during early post‐partum period in women with gestational diabetes (GDM), independent of post‐partum weight change (PWC).

… As such, it is not surprising that detailed postpartum evaluation of women with a history of GDM typically reveals subtle metabolic defects, including the pathological hallmarks of type 2 …

Gestational diabetes mellitus (GDM) refers to a transient state of impaired glucose tolerance that develops during pregnancy, affecting a significant proportion of expectant mothers globally. This review aimed to comprehensively examine the subsequent incidence and management of type 2 diabetes mellitus (T2DM) in women who have previously experienced GDM. The transition from GDM to T2DM is a well-recognized continuum, with affected women facing an increased risk of developing T2DM postpartum. Several studies have demonstrated that women with a history of GDM face a substantially higher risk of developing T2DM compared to normoglycemic pregnant women. The long-term consequences of developing T2DM following GDM are significant, as it not only affects the health of the mother but also poses risks to the offspring. The most common risk factors associated with the progression of GDM to T2DM include pregnancy at an advanced age, insulin treatment during pregnancy, and delivering an overweight baby. As GDM women are at higher risk of developing T2DM, effective management strategies such as lifestyle changes, postpartum care, breastfeeding, screening tests, and gaining awareness of risk are crucial to mitigate the risk of T2DM in this population. The current review was conducted to guide healthcare providers and women with a history of GDM about the potential risks of T2DM and management strategies to prevent the condition. This review provides a summary of evidence on the incidence rate of T2DM in GDM patients, its associated risk factors, and approaches to mitigate this challenge.

The impact of factors that influence diabetes mellitus (DM) and impaired glucose tolerance (IGT) incidence rates among former gestational diabetes mellitus (GDM) patients undermine attempts at interstudy comparisons. The recommended diagnostic standards for GDM by oral glucose tolerance test (OGTT) are the O'Sullivan and Mahan criteria and the World Health Organization (WHO) criteria for IGT, which result in prevalence rates of 2.5 and 7.2%, respectively, when applied to 752 unselected pregnant women. In applying the O'Sullivan and Mahan criteria, the current open-ended definition of GDM without rules either to exclude overt diabetes uncovered by pregnancy or to require a return to a normal OGTT after pregnancy is shown to be a major source of differences in subsequent incidence rates of diabetes. For subsequent nonpregnant diagnoses, the differences between WHO and National Diabetes Data Group criteria and the allowable modifications within each of the diagnostic standards all result in different incidence rates of diabetes. Review of 12 worldwide studies of diabetes among former GDM patients indicated a wide range of incidence rates, from 19 to 87% for combined DM and IGT and 6 to 62% for DM. In applying WHO DM criteria to GDM patients and control subjects, the excess risk of diabetes among GDM patients was 18% in Copenhagen and 30.9% in Boston, MA. The potential impact of varying observation periods within studies was seen when the application of an actuarial method added a further 50% to the Boston incidence rates of both GDM patients and control subjects. Although the variability in diabetes incidence rates is wide, there is broad general agreement on the predictive nature of gestational blood glucose levels.

… Cox proportional hazard modelling was used to estimate the effect of GDM exposure to T2DM. To assess whether the risk of developing T2DM after GDM had changed in 15 years, we …

AIMS The true prevalence of gestational diabetes (GDM) in the United States is unknown. This study determined the prevalence of GDM and a subsequent diagnosis of diabetes in a nationally representative sample of U.S. women. METHODS The crude and age-adjusted prevalence of GDM and subsequent diabetes were evaluated by sociodemographic and health-related characteristics among women age ≥20 years in the National Health and Nutrition Examination Surveys, 2007-2014 (N = 8185). Logistic regression analyzed independent factors associated with GDM and subsequent diabetes. RESULTS The prevalence of GDM was 7.6%. Women who were Mexican American (vs. non-Hispanic white), had ≥4 live births (vs. 1), had a family history of diabetes, or were obese (vs. normal weight) had a higher age-standardized prevalence of GDM (each p < 0.04). Among women with a history of GDM, 19.7% had a subsequent diagnosis of diabetes; subsequent diabetes diagnosis was higher for those with health insurance, more time since GDM diagnosis, greater parity, family history of diabetes, and obesity, and lower for those with higher education and income (all p ≤ 0.005). By logistic regression, significant factors associated with GDM were age at first birth, parity, family history of diabetes, and obesity; significant factors for subsequent diabetes were older age, greater years since GDM diagnosis, less education, family history of diabetes, and obesity (each p < 0.01). CONCLUSIONS The prevalence of GDM in the U.S. was 7.6%, with 19.7% of these women having a subsequent diabetes diagnosis. Women with a history of GDM, family history of diabetes, and obesity should be carefully monitored for dysglycemia.

Background: Gestational diabetes mellitus (GDM) affects nearly 5% of pregnancies. Significant proportion of the women with previous GDM develops type 2 diabetes mellitus (T2DM) in the next years, which indicates a higher risk in them than in the general population. Objectives: We conducted this study to determine the risk factors and incidence of abnormal glucose level and metabolic syndrome (MetS) in women with a history of GDM in a long period after delivery in our region. Patients and Methods: We extracted the demographic characteristics of 110 women with GDM who had delivered during 2004 - 2010 in three main hospitals of Zanjan City, Iran. The patients were recalled to perform oral glucose tolerance test (OGTT) and other necessary tests for MetS diagnosis. Anthropometric measurements were recorded of all the participants. Results: In this study, 110 women with a history of GDM were studied at one to six years since delivery. Among these women, 36 (32.7%) developed T2DM and 11 (10%) had impaired fasting glucose (IFG) or impaired glucose tolerance (IGT). Moreover, 22 women (20%) had developed MetS. among those with abnormal results in glycemic test, 93.6% had fasting blood sugar (FBS) ≥ 95 mg/dL (≥ 5.27 mmol/L)at the time of GDM diagnosis in the index pregnancy that was significantly higher than the normal glycemic test (NGT) group with 42.9% being affected (OR, 19.55; P < 0.0001). There was a significant difference between those with abnormal results and NGT group in interval between delivery and performing laboratory tests (27 ± 18.8 and 18.5 ± 17.7 months, respectively; OR, 1.02; P = 0.02). No insulin use during pregnancy was discovered as a protective factor in women with a history of GDM (OR, 0.35; P = 0.01). Those with abnormal results were significantly different from NGT group in the number of parities (2.61 ± 1.4 vs. 2.05 ± 1.1, respectively; OR, 1.4; P = 0.03). The most common component of MetS among women with a history of GDM was FBS > 100 mg/dL (> 5.55 mmol/L). Conclusions: Regarding the high incidence of the T2DM and MetS among women with a history of GDM, they should be screened at a regular interval for diabetes and other cardiovascular risk factors.