Prepregnancy factors as determinants of the development of diabetes mellitus after first pregnancy

Abstract

Context: The identification of modifiable factors at prepregnancy or early pregnancy as well as continued monitoring and management of these factors before and during pregnancy may reduce the incidence of diabetes mellitus (DM) among women, regardless of gestational diabetes mellitus (GDM) status. Objective: This study aimed to identify prepregnancy factors for the development of DM in women with or without GDM in their first pregnancy. Design and Participants: This retrospective, observational, cohort study included data for 53 109 women who underwent a National Health Screening Examination through the National Health Insurance Corporation between 2002 and 2003 and had their first delivery in 2004 with follow-up until 2012. Main Outcomes: The main outcome of the study was the risk of developing DM after 8 years in women with and without GDM during their first pregnancy. Results: The cumulative risks of developing DM after 8 years were 8.4% and 3.3% in women with and without GDM during their first pregnancy, respectively. Old age, a family history of DM, obesity, a high fasting glucose level, and high total cholesterol level were associated with DM development in women without GDM. In women with GDM, a family history of DM, prepregnancy obesity, a high fasting glucose level, and a high total cholesterol level were associated with DM. When stratified by GDM status and the number of prepregnancy risk factors, the number of prepregnancy risk factors was associated with the risk of DM in women with or without GDM. Women with GDM had a higher risk of DM for the same number of prepregnancy risk factors than women without GDM. Conclusion: The results show that GDM may be a marker for development of DM in the future because it shares the same risk factors with DM development. Thus, eliminating other risk factors in women with GDM may lead to a reduction in the risk of DM.