Risk factors for abnormal postpartum glucose outcome in women with gestational diabetes mellitus diagnosed by modified The International Association of the Diabetes and Pregnancy Study Groups criteria

Abstract

Aim: To characterize postpartum glycemic outcome and related risk factors in women diagnosed with gestational diabetes mellitus (GDM) by modified The International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria. Methods: This is a cohort study of 583 patients with GDM diagnosed by modified IADPSG criteria for Chinese women from 2016 to 2017. According to their oral glucose tolerance tests (OGTT) results at 6–12 weeks postpartum, the subjects were categorized into normal glucose tolerance (NGT) and abnormal glucose tolerance (AGT) groups using the World Health Organization criteria. Multivariate pregestational and gestational factors were compared between the NGT and AGT groups. Results: A total of 174 (29.9%) and 17 (2.9%) subjects were found to have AGT and diabetes, respectively. Multivariate logistic regression analysis showed that elevated 2 h postprandial plasma glucose (PPG) at the diagnosis of GDM (odds ratio [OR], 1.485; 95% confidence interval [CI], 1.253–1.760) and multigravida (OR, 2.187; 95% CI, 1.152–4.150) were independent predictors of AGT in GDM women. Subjects with elevated OGTT 2 h PPG at gestational 24–28 weeks had a 2.254-fold increased risk (95% CI, 1.439–3.530) of developing AGT. Presence of multigravida further increased the risk to 7.329 (95% CI, 2.879–18.659). Women with two or three elevated glucose levels at OGTT had higher risk for postpartum dysglycemia. There was a robust and continuous association of OGTT 2 h PPG at gestational 24–28 weeks with abnormal postpartum glycemic outcomes. Conclusion: In GDM women, OGTT 2 h PPG at gestational 24–28 weeks appear to confer a continuously increased risk for postpartum dysglycemia, which is further increased by the presence of multigravida. Multigravida and women with two or three elevated glucose levels during OGTT have higher risks of impaired postpartum glucose metabolism.