Factors associated with compliance to the recommendations for postpartum diabetes mellitus screening among women with gestational diabetes mellitus

Gestational diabetes mellitus - Can we do better with postpartum diabetes screening?

OBJECTIVE

This study aimed to assess the accuracy of measuring fasting plasma glucose (FPG) within 24-48 h postpartum in women with gestational diabetes mellitus (GDM) as a predictor for abnormal 6-12-week postpartum oral glucose tolerance test (OGTT).

STUDY DESIGN

A retrospective cohort study (2012-2021) included women with GDM and singleton pregnancies who had FPG levels recorded 24-28 h postpartum and underwent a 6-12-week OGTT. The study compared the predictive accuracy of these FPG readings with the OGTT results.

RESULTS

Among 3128 GDM patients, 1163 (37.2 %) had a postpartum OGTT, with 935 (80.2 %) showing normal FPG (<100 mg/dL). In low-risk GDM cases (managed by lifestyle modifications), 86.15 % had normal postpartum FPG. Normal 24-48 h FPG readings, especially in low-risk GDM cases, had a high negative predictive value (NPV of 99.3 %) for type-2 diabetes at the 6-12-week OGTT, but a lower NPV (85.8 %) for predicting future glucose intolerance.

DISCUSSION

Immediate postpartum FPG testing effectively excludes low-risk GDM women with regards to future type-2 diabetes and reasonably excluded future glucose intolerance in this group. Due to low compliance with standard OGTT, postpartum FPG could be a more practical predictive tool for diabetes in low-risk GDM cases.

Evaluation of postpartum dysglycemia by serum glycosylated hemoglobin in patients with gestational diabetes mellitus: a national data analysis

PURPOSE

To assess the postpartum sensitivity and accuracy of serum HbA1c levels, compared to the gold standard of 75-g Oral Glucose Tolerance Test (OGTT), for diagnosis of dysglycemia in patients with a history of gestational diabetes mellitus (GDM).

METHODS

A nationwide retrospective analysis of individuals with a history of GDM and with records of both postpartum 2 h-OGTT and serum HbA1c measured anytime between delivery until 12 months post-delivery. Results were stratified into 3 different intervals: 0-3 months, 3-12 months, and > 12 months after delivery, according to the timing of both OGTT and HbA1c performance.

RESULTS

Between January 1st, 2015, until December 31st, 2021, a total of 55,119 individuals were screened, and 9,118 were diagnosed with GDM. Overall, 677 of the 9,118 individuals with GDM had laboratory results of both serum HbA1c levels and 2 h 75-gm-OGTT values after delivery. The overall Pearson correlation coefficient between HbA1c and 2 h-OGTT was 0.21 (P < 0.0001). However, when the OGTT results were stratified into 2 h-glucose values ≥ 200 mg/dL, a ROC curve yielded an Area Under the Curve (AUC) of 91.4% [95% CI: 83.9%-98.9%], with HbA1c levels of 5.7% yielding 80.0% sensitivity and 80.8% specificity (95% CI: 44.39-97.48%).

CONCLUSIONS

In patients with a recent diagnosis of GDM, serum HbA1c may be used as an auxiliary tool for postpartum diagnosis of dysglycemia.

Health impacts of new-onset diabetes in women post-gestational diabetes mellitus: Insights from Hong Kong's territory-wide data

AIMS/INTRODUCTION

To determine the population health burden attributable to the development of diabetes among women with a history of gestational diabetes mellitus (GDM).

MATERIALS AND METHODS

We conducted a retrospective analysis of women with a history of GDM attending the Hong Kong Hospital Authority between 2000 and 2019. The time-varying population attributable fraction was calculated.

RESULTS

A total of 76,181 women with a history of gestational diabetes mellitus were included, 6,606 of them developed diabetes during a median follow-up of 8.6 years. The respective hazard ratios (95% confidence interval) among women with GDM who developed diabetes vs those with GDM only were 2.8 (2.2, 3.7) for cardiovascular disease (CVD), 4.8 (3.0, 7.7) for end-stage kidney disease (ESKD), 2.2 (1.9, 2.6) for infection-related hospitalization, and 1.8 (1.3, 2.4) for all-cause mortality. The development of diabetes was associated with 1.3 (0.8, 1.7), 0.6 (0.3, 0.8), 3.2 (2.4, 4.0), and 0.5 (0.2, 0.9) additional incident cases per 1,000 person-years, accounting for 24.0% (13.2%, 35.9%), 42.0% (22.5%, 58.8%), 10.8% (7.1%, 14.9%), and 6.0% (-3.1%, 16.1%) of absolute number of CVD, ESKD, infection-related hospitalization, and all-cause mortality over 20 years after GDM, respectively.

CONCLUSIONS

Diabetes is a significant contributor to the population health burden of some clinical outcomes in women with a history of gestational diabetes mellitus, but other risk factors need to be considered.