Incidence and contributing factors of glucose intolerance in Saudi postpartum women: Sub-group analysis from RAHMA study

Incidence of glucose intolerance and risk factors in patients with gestational diabetes mellitus one year postpartum: a systematic review and meta-analysis

PURPOSE

The purpose of this study is to explore the incidence and risk factors of glucose intolerance within one year postpartum in women with gestational diabetes mellitus (GDM), with the goal of informing the creation of effective preventive measures.

METHOD

A systematic literature search was conducted in PubMed, Embase, Cochrane Library, Web of Science, Ovid, Scopus, CINAHL, Wiley, China National Knowledge Infrastructure Database (CNKI), WANFANG Database, China Science and Technology Journal Database (CSTJ), and China Biology Medicine Database (CBM) for records published from January 1990 to August 2024. The index terms included 'gestational diabetes mellitus', 'glucose intolerance', 'postpartum', and 'risk factor'. Investigators assessed eligibility, extracted data, and evaluated the methodological quality. The meta-analysis was conducted using Stata 17.0 and Review Manager 5.4.

RESULT

Eighteen studies were included in the analysis, with 14 categorized as low risk of bias and 4 classified as medium risk of bias. The pooled incidence of glucose intolerance in women with GDM within 1 year postpartum was 34.5% (95% CI: 1.34-1.58). The following risk factors for glucose intolerance one year postpartum in women with GDM were identified: age (MD = 1.71; 95% CI: 0.50-2.91), pre-pregnancy BMI (MD = 1.75; 95% CI: 0.73-2.78), weight gain during pregnancy (MD = 1.25; 95% CI: 0.74-1.76), family history of diabetes (OR = 1.96; 95% CI: 1.58-2.42), fasting blood glucose at diagnosis (MD = 0.64; 95% CI: 0.39-0.88), 1-h postprandial blood glucose at diagnosis (MD = 1.24; 95% CI: 0.92-1.57), 2-h postprandial blood glucose at diagnosis (MD = 1.30; 95% CI: 0.72-1.87), history of GDM (OR = 2.62; 95% CI: 1.79-3.84), insulin use (OR = 2.41; 95% CI: 1.43-4.08), postpartum BMI (MD = 0.90; 95% CI: 0.24-1.55), diagnosed gestational weeks (MD = -1.82; 95% CI: -2.94--0.71), glycated hemoglobin (HbA1c) level at diagnosis (MD = 0.36; 95% CI: 0.14-0.58), HbA1c levels at 6-12 weeks postpartum (MD = 0.85; 95% CI: 0.42-1.29), fasting blood glucose levels 6 to 12 weeks postpartum (MD = 0.31; 95% CI: 0.05-0.57), 2-h postprandial blood glucose level 6 to 12 weeks postpartum(MD = 2.47; 95% CI: 0.68-4.26), Low-density lipoprotein (LDL) levels at diagnosis (MD = 0.20; 95% CI: 0.01-0.40), and triglyceride (TG) level at diagnosis(MD = 0.55; 95% CI: 0.34-0.75).

CONCLUSION

The incidence of glucose intolerance one year postpartum in women with GDM is relatively high. The subgroup analysis of this study revealed that the incidence is highest among Asian women and lowest among Caucasian women. 17 risk factors have been identified; these findings may help to better understand which GDM patients are more likely to experience glucose intolerance one year postpartum, and provide higher-level evidence for assessing the incidence and risk factors of glucose intolerance in GDM patients one year after delivery.

Prevalence of prediabetes and associated risk factors in the Eastern Mediterranean Region: a systematic review

BACKGROUND

Prediabetes increases the risk of diabetes mellitus and complications. The current study was planned to assess the prevalence and risk factors of prediabetes in Eastern Mediterranean Region countries.

METHODS

The PRISMA reporting guidelines were followed when reporting this study. Five electronic databases: PubMed, Embase, Scopus, CINAHL, and Web of Science, were searched to identify relevant studies. We included observational studies that used either the American Diabetes Association or World Health Organization prediabetes criteria as definitions for adult populations in any of the Eastern Mediterranean Region countries. We identified 13,851 references, of which 41 were included for data extraction. The Quality Assessment Tool for Cross-Sectional Studies and the Newcastle-Ottawa Scale for other studies were used to assess the quality of the included studies.

RESULTS

The overall prevalence of prediabetes ranged from 2.2% to 47.9%; Age, gender, obesity, and high blood pressure were the most reported risk factors in the EMR. Factors like low education, smoking, family history of diabetes, and physical inactivity were associated with prediabetes in some populations.

CONCLUSION

The region was found to have a high prevalence of prediabetes, ranking it among regions with the most significant frequency. Modifiable factors such as obesity, hypertension, and inactivity, in addition to age and gender, are among the region's most frequently identified risk factors for prediabetes.

Early Postpartum Glucose Intolerance, Metabolic Syndrome and Gestational Diabetes Mellitus Determinants after Assisted Conception: A Prospective Cohort Study

BACKGROUND

This study aimed to determine the prevalence of postpartum metabolic syndrome (MetS), glucose intolerance,<br />and the determinants, 6-12 weeks postpartum in women with assisted reproduction technology conception<br />gestational diabetes mellitus diagnosis (ART-GDM) compared to women with spontaneous conception and GDM<br />diagnosis (SC-GDM).<br />Materials and Methods: In this prospective cohort study, two groups consisting of 62 ART-GDM and 64 SC-GDM<br />singleton pregnant women were followed 6-12 weeks after delivery for postpartum MetS. Fasting glucose, 75-g 2-h<br />OGTT, and lipid profile were assessed. Waist and hip circumference, and systolic and diastolic blood pressures (BP)<br />were measured at postpartum. Clinical, paraclinical, and obstetric data were recorded from registry offices. The prevalence<br />of MetS and glucose intolerance were determined. Predictors of MetS and glucose intolerance were evaluated<br />by logistic regression.<br />Results: The prevalence of postpartum MetS was 20.8% in ART-GDM women and 10.9% in SC-GDM (P=0.123).<br />Mean postpartum BMI and systolic BP were significantly higher in the ART-GDM group (P=0.016 and P=0.027<br />respectively). Adverse pregnancy outcomes were significantly higher in the ART-GDM group. Postpartum glucose<br />intolerance prevalence did not vary significantly between the groups. Family history of diabetes was a predictive factor<br />for postpartum MetS and glucose intolerance 6-12 weeks after delivery.<br />Conclusion: Early postpartum MetS and glucose intolerance prevalence after assisted conception did not vary significantly;<br />however, postpartum body mass index (BMI) and systolic BP were significantly higher in the ART-GDM group.<br />Lifestyle modification programs and long-term health care of ART women with GDM diagnosis can be recommended.<br />Further studies with larger sample size and longer follow-up are necessary to verify our findings.

Prevalence and Metabolic Predictors for Early Diagnosed Prediabetes in Women with Previous Gestational Diabetes: Observational Cohort Study

INTRODUCTION

Women with previous gestational diabetes (pGD) are at higher risk of prediabetes (PD) after delivery. The aim of this study was to determine the prevalence of and predictors for PD among women with pGD.

METHODS

The study included 186 women with pGD treated by lifestyle modification. After delivery, the women were divided into group A (n = 80) with PD and group B (n = 106) with normal glucose tolerance (NGT), defined by the results of the 2-h oral glucose tolerance test at 4-12 weeks after delivery. We recorded age, body mass index (BMI) at conception and after delivery, fasting glucose (FG), glycated hemoglobin (HbA1c), total cholesterol (TC), triglycerides (Tg), low density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c) and the Tg/HDL-c ratio measured in the third trimester of pregnancy.

RESULTS

Of the 186 women with pGD enrolled in the study, 43% showed prediabetes at 4-12 weeks after delivery, with 13.9% of these women showing impaired FG (IFG), 12.9% showing impaired glucose tolerance (IGT) and 16.2% with IFG/IGT. The groups differed in terms of age and BMI at conception and after delivery. In the third trimester of pregnancy, HbA1c was higher in women in group A than in those in group B (mean ± standard deviation: 5.6 ± 0.4 vs. 5.2 ± 0.3%; p < 0.001), while FG was comparable. Compared to women in group B, women in group A had higher TC (7.1 ± 0.8 vs. 6.6 ± 1.0 mmol/L), Tg (2.7 ± 0.9 vs. 2.1 ± 0.6 mmol/L) and LDL-c (4.7 ± 0.8 vs. 4.3 ± 1.0 mmol/L) (all p < 0.001), lower HDL-c (1.0 ± 0.2 vs. 1.4 ± 1.0; p < 0.001) and higher median Tg/HDL-c (5.4 [range 4.6-14.3] vs. 4.9 [range 1.1-11.5]; p < 0.001). Univariate analysis found an association between prediabetes and age, BMI at conception and after delivery, HbA1c, TC, LDL-c, HDL-c, Tg and Tg/HDL-c ratio. Of these variables, the multivariate analysis showed age (odds ratio [OR] 1.19; p < 0.001), HbA1c (OR 31.06; p < 0.001), Tg (OR 4.09; p < 0.001) and LDL-c (OR 2.00; p = 0.005) as predictors for prediabetes.

CONCLUSION

High prevalence of early diagnosed PD in women with pGD was accompanied by advanced age and higher BMI at conception and after delivery. Moreover, age, HbA1c, Tg and LDL-c were predictors for PD.

Predictors of postpartum glucose intolerance in women with gestational diabetes mellitus: a prospective cohort study in Ethiopia based on the updated diagnostic criteria

OBJECTIVES

To identify the incidence of postpartum glucose intolerance and develop a prediction model based on antenatal characteristics to predict postpartum glucose intolerance.

DESIGN

Prospective cohort study.

SETTING

Gondar town public health facilities in Northwest Ethiopia.

PARTICIPANTS

Women who had gestational diabetes mellitus were advised to undergo postpartum oral glucose tolerance test at 6-12 weeks of delivery.

MAIN OUTCOME

Postpartum glucose intolerance.

DATA ANALYSIS

Predictors of postpartum glucose intolerance were identified using multivariable logistic regression analysis. The discriminative power of the predictor variables for postpartum glucose intolerance and the model accuracy were computed by area under the receiver operating characteristic curve and estimated by area under the curve (AUC) with 95% CI.

RESULTS

A total of 112 (85.5%) women with gestational diabetes mellitus returned and completed the postpartum oral glucose tolerance test. The incidence of postpartum glucose intolerance was 21.4% (95% CI14.3 to 28.4), inclusive of 18.7% pre-diabetes and 2.7% diabetes. Multivariable logistic regression analysis revealed that advanced maternal age, high fasting plasma glucose level at diagnosis, overweight and/or obesity, and antenatal depression were predictors of postpartum glucose intolerance. The AUC of the final reduced model to predict postpartum glucose intolerance was 0.884 (95% CI 0.822 to 0.937). Fasting plasma glucose at diagnosis of gestational diabetes mellitus (AUC=0.736, 95% CI0.616 to 0.845) and overweight and/or obesity (AUC=0.718, 95% CI 0.614 to 0.814) were better predictors of postpartum glucose intolerance. Moreover, the AUC for the combined predictors of fasting plasma glucose at diagnosis and mid-upper arm circumference was 0.822 (95% CI 0.722 to 0.907), which was the best predictor.

CONCLUSIONS

The incidence of postpartum glucose intolerance was high among women with gestational diabetes mellitus. Antenatal predictors modestly predicted postpartum glucose intolerance. The findings suggest ongoing glucose screening is indicated for all women with gestational diabetes mellitus.

Postpartum Weight Retention and Cardiometabolic Risk among Saudi Women: A Follow-Up Study of RAHMA Subcohort

Objectives

This papers aims to investigate the association between different levels of postpartum weight retention (PPWR) and cardiometabolic risk among the Saudi women 12 months postpartum.

Methods

This study is a follow-up of subgroup of cohort from Riyadh mother and baby multicenter cohort study. Clinical data were collected from participants 12 months after delivery and included current Body Mass Index (BMI), waist circumference, hip circumference, and blood pressure. In addition the following blood tests done were fasting blood glucose (FBG), glycosylated haemoglobin (HbA1c) levels, and lipids profile to assess the participants' cardiometabolic risks. The participants were categorized into three groups based on the level of PPWR: weight retention < 3kg; weight retention 3 to < 7kg; and weight retention ≥ 7kg. Subsequently, the prevalence of cardiometabolic risk factors was compared in the three groups to assess the association between different levels of PPWR and cardiometabolic risk factors. Logistic regression was used to test the effect of PPWR in the development of metabolic syndrome and Adjusted Odds Ratio (AOR) was calculated.

Results

A total of 115 women participated in this study. Around 35% of the study population retained ≥ 7 kg of weight. The prevalence of cardiometabolic risk factors, including metabolic syndrome (MetS), increases with the increase of PPWR (p<0.01). The prevalence of MetS is 13% with highest frequency in the group with the highest weight retention. The determinants developing MetS were prepregnancy weight; AOR (95% CI); 1.08 (1.02-1.14), P< 0.01, current BMI, AOR (95% CI); 1.30 (1.12-1.51), P< 0.01, and FBG during pregnancy, AOR (95% CI); and 4.82 (1.72-13.48), P < 0.01.

Conclusion

Increased weight retention after delivery augments the rate of occurrence of cardiometabolic risk factors. Determinants of the development of MetS in postpartum Saudi women are increased prepregnancy weight, current BMI, and FBG during pregnancy.