Weight gain and progression to type 2 diabetes in women with a history of gestational diabetes mellitus

Abstract

Context: The effect of weight gain on the development of type 2 diabetes after gestational diabetes mellitus (GDM) is not fully understood in Asian women who have a relatively low body mass index (BMI). Objective:Weinvestigated the effect of postpartum longitudinal BMI change on the development of diabetes in Korean women with a history of GDM. Design and Setting: The study included a hospital-based, multicenter, prospective cohort with median follow-up of 4.0 years. Participants: A total of 418 women with previous GDM or gestational impaired glucose tolerance were recruited and underwent an oral glucose tolerance test at 6 weeks postpartum and annually thereafter. Main Outcome Measure: The risk of diabetes was analyzed according to the tertiles of BMI change. Changes in BMI were calculated between the initial postpartum visit and the last follow-up or at the onset of diabetes. Results: TheBMIchange in each tertile was -1.8±1.1,-0.2±0.3, and 1.6±1.2 kg/m2, respectively. We observed an increased risk of incident diabetes as the tertile of BMI change increased (8.6%, 12.6%, and 16.9%, P = .039). Postpartum BMI change was an independent predictor of diabetes in a multivariate Cox analysis (hazard ratio 1.27,95%confidence interval 1.04-1.56 r=.021), even after adjusting for BMI at the last follow-up. In the highest tertile group, there was a significant deterioration in cardiovascular risk factors including blood pressure, lipid profile, and insulin sensitivity. Conclusions: Postpartum increase in BMI is significantly associated with a risk of diabetes and deterioration of metabolic phenotypes in Korean GDM women.