The degree of glucose intolerance assessed in the mid-trimester of pregnancy is predictive of early postpartum glucose abnormality
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| Year of publication | 2013 |
| Type | Conference abstract |
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| Description | Aims: Given that (i) incidences of gestational diabetes mellitus (GDM) is increasing worldwide, (ii) women with previous GDM have increased risk of developing diabetes later in life and (iii) participation in the postpartum re-screening is low the aims of our study were (1) to ascertain a frequency of early (up to 12 months post-delivery) postpartum conversion of GDM into permanent diabetes or IGT, (2) to test whether the degree of glucose intolerance diagnosed by standard criteria at the time of GDM diagnosis correlates with the degree of early postpartum glucose (in)tolerance and (3) to find eventual significant predictive factors for early postpartum conversion of GDM to diabetes/IGT from glycaemic indices routinely measured in the mid-trimester of gravidity to enable risk-based stratification of overall GDM population. Methods: Retrospective analysis of electronic health records data of an ethnically homogenous cohort of women (central European population) with GDM diagnosis followed in a single medical centre during the period 2005 – 2011 that underwent repeated oGTT up to 1 year after the index delivery (n=1090) was carried out for the purpose of incidence analysis. A subgroup (n=305) of GDM subjects with compete anthropometric, clinical and biochemical data that underwent both mid-trimester and postpartum 3-point oGTT test was analysed in detail to identify eventual predictive factors for postpartum persistence of glucose abnormality. Results: Diabetes or IGT was detected in 16.7% subjects, of those 5.2% had T2DM and 1% T1DM. Fasting, 60 and 120 minute glycaemia of mid-trimester oGTT, respective area under the curve, mid-trimester HbA1c and number of above cut-off values were significantly associated with the postpartum glucose abnormality (P under 0.05, Mann-Whitney of chi-square). Uni- and multivariate regression models were used to identify the best predictive parameters for postpartum glucose abnormality and models using combination of both continuous variables exhibited significant predictive potential (logistic regression. Using ROC analysis we proposed optimal cut-off values for discrimination of postpartum risk-sub-population and replicate the model on the subsequent independent cohort. Conclusions: Parameters of glucose metabolism measured between 24-28th week of pregnancy exhibit not only diagnostic value (for GDM diagnosis) but also predictive potential for postpartum glucose intolerance. Acknowledgement: Supported by grants NT/11405 from The Ministry of Health of Czech Republic |
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