Article

Gestational Diabetes and the incidence of T2DM: A systematic review

Division of General Internal Medicine, University of Michigan, Ann Arbor, Michigan 48109, USA.
Diabetes Care (Impact Factor: 8.57). 11/2002; 25(10):1862-8. DOI: 10.2337/diacare.25.10.1862
Source: PubMed

ABSTRACT To examine factors associated with variation in the risk for type 2 diabetes in women with prior gestational diabetes mellitus (GDM).
We conducted a systematic literature review of articles published between January 1965 and August 2001, in which subjects underwent testing for GDM and then testing for type 2 diabetes after delivery. We abstracted diagnostic criteria for GDM and type 2 diabetes, cumulative incidence of type 2 diabetes, and factors that predicted incidence of type 2 diabetes.
A total of 28 studies were examined. After the index pregnancy, the cumulative incidence of diabetes ranged from 2.6% to over 70% in studies that examined women 6 weeks postpartum to 28 years postpartum. Differences in rates of progression between ethnic groups was reduced by adjustment for various lengths of follow-up and testing rates, so that women appeared to progress to type 2 diabetes at similar rates after a diagnosis of GDM. Cumulative incidence of type 2 diabetes increased markedly in the first 5 years after delivery and appeared to plateau after 10 years. An elevated fasting glucose level during pregnancy was the risk factor most commonly associated with future risk of type 2 diabetes.
Conversion of GDM to type 2 diabetes varies with the length of follow-up and cohort retention. Adjustment for these differences reveals rapid increases in the cumulative incidence occurring in the first 5 years after delivery for different racial groups. Targeting women with elevated fasting glucose levels during pregnancy may prove to have the greatest effect for the effort required.

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    • "GDM confers a strong risk for short-term pregnancy complications , such as gestational hypertensive disorders, fetal macrosomia, shoulder dystocia, and cesarean delivery [6] [7], in addition to an increase in the risk for future T2DM and cardiovascular disease [8] [9] [10] [11]. It has been reported that women with previous GDM have up to 7.5-fold higher risk of developing T2DM compared with women with normoglycemic pregnancy [8–10,12]. "
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    ABSTRACT: Aims: To determine the prevalence of both prediabetes and type 2 diabetes mellitus (T2DM) by postpartum oral glucose tolerance test (ppOGTT) in Italian women diagnosed with gestational diabetes mellitus (GDM), and identify antepartum predictors of glucose intolerance. Methods: Retrospective study of 454 Caucasian women that underwent a 75 g OGTT between 6 and 12 weeks postpartum in Calabria (Southern Italy) between 2004 and 2012. Prediabetes and T2DM were diagnosed according to the American Diabetes Association (ADA) criteria. Data were examined by univariate analysis and multiple regression analysis. Results: 290 women (63.9%) were normal, 146 (32.1%) had prediabetes (85 impaired fasting glycemia; 61 impaired glucose tolerance), and 18 (4.0%) had T2DM. Of the continuous variables, pre-pregnancy body mass index (BMI), age at pregnancy, fasting plasma glucose (FPG) at gravid OGTT, and week at diagnosis of GDM were associated with prediabetes and T2DM, whereas the parity was associated with T2DM only. For categorical traits, pre-pregnancy BMI >= 25 and previous diagnosis of polycystic ovary syndrome (PCOS) emerged as the strongest predictors of prediabetes whereas the strongest predictors of T2DM were FPG >= 100 mg/dl (5.6 mmol/l) at GDM diagnosis and pre-pregnancy BMI >= 25. Moreover, FPG at GDM screening was a good predictor of T2DM after receiver-operating-characteristic analysis. Conclusions: Our findings confirm the high prevalence of glucose intolerance in the early postpartum period in women with previous GDM. PCOS emerges as a new strong antepartum predictor of prediabetes.
    Diabetes Research and Clinical Practice 05/2014; 105(2). DOI:10.1016/j.diabres.2014.05.008 · 2.54 Impact Factor
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    • "One of the major concerns about GDM is that it may be contributing to a vicious intergenerational cycle of obesity and diabetes [3]. Women with a history of GDM are at increased risk of type 2 diabetes and impaired glucose tolerance (IGT) later in life [4], especially at the first 5 years after delivery [5]. The exposure to diabetes during pregnancy is associated with increased risks of neonatal adiposity, childhood obesity, insulin resistance, IGT, and type 2 diabetes in the offspring in some but not all studies [6] [7] [8]. "
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    02/2014; 2014:516980. DOI:10.1155/2014/516980
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    • "One of the major concerns about GDM is that it may be contributing to a vicious intergenerational cycle of obesity and diabetes [3]. Women with a history of GDM are at increased risk of type 2 diabetes and impaired glucose tolerance (IGT) later in life [4] [5] [6], especially in the first 5 years after delivery [6]. The exposure to diabetes during pregnancy is associated with increased risks of neonatal adiposity, childhood obesity, insulin resistance, IGT and type 2 diabetes in the offspring in some, but not all studies [7] [8] [9]. "
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