Diabetes and abnormal glucose tolerance in women with previous gestational diabetes.

OBJECTIVE In Spanish women with gestational diabetes mellitus (GDM), we aimed to study the progression to diabetes and abnormal glucose tolerance (AGT) and identify predictive factors. RESEARCH DESIGN AND METHODS In 696 women with GDM and 70 control women, glucose tolerance was evaluated postpartum and at 5-year intervals. RESULTS In the GDM group, the cumulative risk for diabetes and AGT was 13.8 and 42.4% after 11 years compared with 0 and 2.8% in control women, respectively (P < 0.05). Independent predictive factors for diabetes were previous hyperglycemia, four abnormal glucose values on the diagnostic oral glucose tolerance test (OGTT) or overt diabetes during pregnancy, 2-h blood glucose on the diagnostic OGTT >/=11.7 mmol/l, gestational age at diagnosis <24 weeks, and prepregnancy BMI >/=26.4 kg/m(2). All of these factors (some with different cutoff points) in addition to fasting glycemia were predictors of AGT also. The risk was nonlinear. Four abnormal glucose values on the diagnostic OGTT or overt diabetes during pregnancy was the strongest predictive factor for diabetes (relative risk 3.92), and prepregnancy BMI was the predictive factor with the highest attributable fraction in the whole group (13.3%). When first postpartum OGTT data were included in the analysis, predictors changed, but the overall prediction was similar. CONCLUSIONS Spanish women with GDM have an increased risk of diabetes and AGT. Predictive factors display a nonlinear relationship. The strongest predictive factor for diabetes was four abnormal glucose values on the diagnostic OGTT or overt diabetes during pregnancy; the factor with the highest attributable fraction in the whole group was prepregnancy BMI.

[1]  P. Gorden,et al.  O-Linked Oligosaccharides on Insulin Receptor , 1991, Diabetes.

[2]  A. de Leiva,et al.  In pregnancies with gestational diabetes mellitus and intensive therapy, perinatal outcome is worse in small-for-gestational-age newborns. , 1998, American journal of obstetrics and gynecology.

[3]  T. Buchanan,et al.  Predicting Future Diabetes in Latino Women With Gestational Diabetes: Utility of Early Postpartum Glucose Tolerance Testing , 1995, Diabetes.

[4]  J. O'sullivan.  Gestational Diabetes: Factors Influencing the Rates of Subsequent Diabetes , 1979 .

[5]  C. Mahan,et al.  CRITERIA FOR THE ORAL GLUCOSE TOLERANCE TEST IN PREGNANCY. , 1964, Diabetes.

[6]  T. Sellers,et al.  Associations of general and abdominal obesity with multiple health outcomes in older women: the Iowa Women's Health Study. , 2000, Archives of internal medicine.

[7]  B. Metzger.  Summary and Recommendations of the Third International Workshop-Conference on Gestational Diabetes Mellitus , 1991, Diabetes.

[8]  J. Mestman.  Follow-up Studies in Women with Gestational Diabetes mellitus. The Experience at Los Angeles Country/ University of Southern California Medical Center , 1988 .

[9]  K. Yamada,et al.  Glucose tolerance in Japanese subjects with S20G mutation of the amylin gene , 1998, Diabetologia.

[10]  I. Okosun.  Racial Differences in Rates of Type 2 Diabetes in American Women: How much is due to differences in overall adiposity? , 2001, Ethnicity & health.

[11]  M. Rowley,et al.  Prevalence of antibodies to glutamic acid decarboxylase in women who have had gestational diabetes. , 1995, American journal of obstetrics and gynecology.

[12]  B. Metzger,et al.  Prepregnancy Weight and Antepartum Insulin Secretion Predict Glucose Tolerance Five Years After Gestational Diabetes Mellitus , 1993, Diabetes Care.

[13]  O S Miettinen,et al.  Proportion of disease caused or prevented by a given exposure, trait or intervention. , 1974, American journal of epidemiology.

[14]  P. Zimmet,et al.  Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus. Provisional report of a WHO Consultation , 1998, Diabetic medicine : a journal of the British Diabetic Association.

[15]  T. Buchanan,et al.  Long-term diabetogenic effect of single pregnancy in women with previous gestational diabetes mellitus , 1996, The Lancet.

[16]  M. Rewers,et al.  Global Estimates for Prevalence of Diabetes Mellitus and Impaired Glucose Tolerance in Adults , 1993, Diabetes Care.

[17]  A. de Leiva,et al.  Islet cell autoimmunity in women with gestational diabetes and risk of progression to insulin-dependent diabetes mellitus. , 1996, Diabetes/metabolism reviews.

[18]  P. Damm,et al.  Prevalence and Predictive Value of Islet Cell Antibodies and Insulin Autoantibodies in Women with Gestational Diabetes , 1994, Diabetic medicine : a journal of the British Diabetic Association.

[19]  M. Stowers,et al.  Carbohydrate Metabolism in Pregnancy and the Newborn · IV , 1989, Springer London.

[20]  R. Tresserras,et al.  Prevalence of diabetes in Catalonia (Spain): an oral glucose tolerance test-based population study. , 1999, Diabetes research and clinical practice.

[21]  P. Damm,et al.  Predictive factors for the development of diabetes in women with previous gestational diabetes mellitus. , 1992 .

[22]  A. Ziegler,et al.  Prediction of Type 1 Diabetes Postpartum in Patients With Gestational Diabetes Mellitus by Combined Islet Cell Autoantibody Screening: A Prospective Multicenter Study , 1997, Diabetes.

[23]  B. Metzger,et al.  Summary and recommendations of the Fourth International Workshop-Conference on Gestational Diabetes Mellitus. The Organizing Committee. , 1998, Diabetes care.

[24]  O A Henry,et al.  Long-term implications of gestational diabetes for the mother. , 1991, Bailliere's clinical obstetrics and gynaecology.

[25]  P. Damm,et al.  GAD65 autoantibodies in women with gestational or insulin dependent diabetes mellitus diagnosed during pregnancy , 1996, Diabetologia.

[26]  T. Buchanan.  Pancreatic B-cell defects in gestational diabetes: implications for the pathogenesis and prevention of type 2 diabetes. , 2001, The Journal of clinical endocrinology and metabolism.

[27]  H. King.  Epidemiology of glucose intolerance and gestational diabetes in women of childbearing age. , 1998, Diabetes care.

[28]  S. Carr,et al.  Gestational diabetes: predictors of subsequent disordered glucose metabolism. , 1993, American journal of obstetrics and gynecology.