Risk for maternal postpartum diabetes

Abstract

For over half a century, gestational diabetes mellitus (GDM) has been recognized as a risk factor for maternal diabetes after delivery or postpartum. GDM confers a 7-fold risk for future diabetes, independent of other significant risk factors such as weight, visceral adiposity, and physical activity. Up to a third of women with diabetes may have been affected by prior GDM. However, postpartum studies of GDM women are relatively few compared to prenatal and peripartum examinations. This chapter reviews methodological issues and risk factors affecting postpartum maternal diabetes risk estimates. The chapter also presents evidence regarding the risk for future cardiovascular disease among women with a GDM history. In doing, so, the chapter underlines the need for, and lack of: uniform diagnostic criteria and screening strategies for the index diagnosis of GDM as well as for postpartum glucose intolerance; quality improvement initiatives to improve postpartum glucose screening; and diabetes prevention interventions in this population. Perhaps most importantly, this chapter underlines the significance of GDM upon postpartum maternal glucose tolerance outside of pregnancy. © 2010 Springer-Verlag London Limited.