Gestational diabetes and the incidence of type 2 diabetes: a systematic review.
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TLDR
Differences in rates of progression between ethnic groups was reduced by adjustment for various lengths of follow-up and testing rates, so that women appeared to progress to type 2 diabetes at similar rates after a diagnosis of GDM.Abstract:
OBJECTIVE —To examine factors associated with variation in the risk for type 2 diabetes in women with prior gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS —We conducted a systematic literature review of articles published between January 1965 and August 2001, in which subjects underwent testing for GDM and then testing for type 2 diabetes after delivery. We abstracted diagnostic criteria for GDM and type 2 diabetes, cumulative incidence of type 2 diabetes, and factors that predicted incidence of type 2 diabetes. RESULTS —A total of 28 studies were examined. After the index pregnancy, the cumulative incidence of diabetes ranged from 2.6% to over 70% in studies that examined women 6 weeks postpartum to 28 years postpartum. Differences in rates of progression between ethnic groups was reduced by adjustment for various lengths of follow-up and testing rates, so that women appeared to progress to type 2 diabetes at similar rates after a diagnosis of GDM. Cumulative incidence of type 2 diabetes increased markedly in the first 5 years after delivery and appeared to plateau after 10 years. An elevated fasting glucose level during pregnancy was the risk factor most commonly associated with future risk of type 2 diabetes. CONCLUSIONS —Conversion of GDM to type 2 diabetes varies with the length of follow-up and cohort retention. Adjustment for these differences reveals rapid increases in the cumulative incidence occurring in the first 5 years after delivery for different racial groups. Targeting women with elevated fasting glucose levels during pregnancy may prove to have the greatest effect for the effort required.read more
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References
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Predicting Future Diabetes in Latino Women With Gestational Diabetes: Utility of Early Postpartum Glucose Tolerance Testing
TL;DR: 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 gestational diabetes mellitus.
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Diabetes Mellitus After GDM
TL;DR: There is broad general agreement on the predictive nature of gestational blood glucose levels, and 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.
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Gestational Diabetes: Infant and Maternal Complications of Pregnancy in Relation to Third-Trimester Glucose Tolerance in the Pima Indians
TL;DR: A modified oral glucose tolerance test was done during the third trimester in 811 pregnancies in Pima Indian women over a 13-yr period, and maternal and fetal complications were documented, and the third-trimester glucose concentration was highly predictive of the subsequent incidence of diabetes.
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Prepregnancy weight and antepartum insulin secretion predict glucose tolerance five years after gestational diabetes mellitus
TL;DR: Impaired β-cell function and obesity at diagnosis of GDM were associated with the development of diabetes during a 5-yr, follow-up period and studies designed to prevent diabetes in this high-risk group should examine strategies to maintain both optimal β- cell function and maximum insulin sensitivity.
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Predictive factors for the development of diabetes in women with previous gestational diabetes mellitus.
TL;DR: Women with previous dietary-treated gestational diabetes mellitus have a considerably increased risk of later having diabetes and follow-up investigations are therefore important, especially in those women with previous gestational Diabetes mellitus in whom the identified predictive factors are present.