Recurrence of gestational diabetes mellitus: a systematic review.
ABSTRACT The purpose of this study was to examine rates and factors associated with recurrence of gestational diabetes mellitus (GDM) among women with a history of GDM.
We conducted a systematic literature review of articles published between January 1965 and November 2006, in which recurrence rates of GDM among women with a history of GDM were reported. Factors abstracted included recurrence rates, time elapsed between pregnancies, race/ethnicity, diagnostic criteria, and, when available, maternal age, parity, weight or BMI at the initial and subsequent pregnancy, weight gain at the initial or subsequent pregnancy and between pregnancies, insulin use, gestational age at diagnosis, glucose tolerance test levels, baby birth weight and presence of macrosomia, and breast-feeding.
Of 45 articles identified, 13 studies were eligible for inclusion. After the index pregnancy, recurrence rates varied between 30 and 84%. Lower rates were found in non-Hispanic white (NHW) populations (30-37%), and higher rates were found in minority populations (52-69%). Exceptions to observed racial/ethnic variations in recurrence were found in cohorts that were composed of a significant proportion of both NHW and minority women or that included women who had subsequent pregnancies within 1 year. No other risk factors were consistently associated with recurrence of GDM across studies. The rates of future preexisting diabetes in pregnancy, socioeconomic status, postpartum diabetes screening rates after the index pregnancy, and the average length of time between pregnancies were generally not reported.
Recurrence of GDM was common and may vary most significantly by NHW versus minority race/ethnicity.
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ABSTRACT: Gestational diabetes mellitus (GDM) is associated with a 7-fold increased lifetime risk for developing type 2 diabetes mellitus. Early diagnosis of type 2 diabetes is crucial for preventing complications. Despite recommendations for type 2 diabetes screening every 1 to 3 years for women with previous diagnoses of GDM and all women aged 45 years or older, screening prevalence is unknown. We sought to assess Ohio primary health care providers' practices and attitudes regarding assessing GDM history and risk for progression to type 2 diabetes. During 2010, we mailed surveys to 1,400 randomly selected Ohio family physicians and internal medicine physicians; we conducted analyses during 2011-2013. Overall responses were weighted to adjust for stratified sampling. Chi-square tests compared categorical variables. Overall response rate was 34% (380 eligible responses). Among all respondents, 57% reported that all new female patients in their practices are routinely asked about GDM history; 62% reported screening women aged 45 years or younger with prior GDM every 1 to 3 years for glucose intolerance; and 42% reported that screening for type 2 diabetes among women with prior GDM is a high or very high priority in their practice. Because knowing a patient's GDM history is the critical first step in the prevention of progression to type 2 diabetes for women who had GDM, suboptimal screening for both GDM history and subsequent glucose abnormalities demonstrates missed opportunities for identifying and counseling women with increased risk for type 2 diabetes.Preventing chronic disease 12/2014; 11:E213. DOI:10.5888/pcd11.140308 · 1.96 Impact Factor
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ABSTRACT: Women with gestational diabetes (GDM) have a fivefold higher risk of developing type 2 diabetes (T2DM). Furthermore, Hispanic and African-American women are disproportionately affected by GDM, but their views on prevention of T2DM after gestational diabetes are largely unknown. We conducted semi-structured interviews with 23 women (8 Hispanic, 8 African-American, 7 non-Hispanic White) from two academic clinics in Chicago, IL. Interview questions elicited perspectives on prevention of T2DM; the interview protocol was developed based on the Health Belief Model. Two investigators applied template analysis to identify emergent themes. Women conceptualized risk for T2DM based on family history, health behaviors, and personal history of GDM. A subgroup of women expressed uncertainty about how GDM influences risk for T2DM. Women who described a strong link between GDM and T2DM often viewed the diagnosis as a cue to action for behavior change. T2DM was widely viewed as a severe condition, and desire to avoid T2DM was an important motivator for behavior change. Children represented both a key motivator and critical barrier to behavior change. Women viewed preventive care as important to alert them to potential health concerns. Identified themes were congruent across racial/ethnic groups. Diagnosis with GDM presents a potent opportunity for engaging women in behavior change. To fully harness the potential influence of this diagnosis, healthcare providers should more clearly link the diagnosis of GDM with risk for future T2DM, leverage women's focus on their children to motivate behavior change, and provide support with behavior change during healthcare visits in the postpartum period and beyond.Maternal and Child Health Journal 11/2014; DOI:10.1007/s10995-014-1657-y · 2.24 Impact Factor
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ABSTRACT: Gestational diabetes (GDM) is a public health problem defined as any degree of glucose intolerance with onset or first recognition during pregnancy. Three to ten percent of all pregnancies are complicated with abnormal glycemic control, GDM accounting for 80% of them. Vitamin D plays a primary physiological role in maintaining extracellular calcium ion levels in the human body. The benefit of vitamin D has been heavily discussed over the past few years. Vitamin D not only plays a major role in maintaining bone health, but also offers a protective role against diseases such as cancer, diabetes mellitus and cardiovascular disease. This study was aimed as looking for a possible correlation between vitamin D receptor gene polymorphisms and prevalence of gestational diabetes in pregnant Saudi women. We analyzed two Single Nucleotide Polymorphisms (Snps) namely FokI and TaqI on the vitamin D receptor gene in 100 pregnant women, 50 normal glucose levels and 50 with gestational diabetes. We found a change in pattern between normal pregnant women and GDM patients at the TaqI site but not at the FokI site. Further complete molecular characterization of this gene is proposed as a follow up to this study for a better understanding.