Risk factors during the early postpartum period for type 2 diabetes mellitus in women with gestational diabetes

Maki Kawasaki; Naoko Arata; Naoko Sakamoto; Anna Osamura; Siori Sato; Yoshihiro Ogawa; Ichiro Yasuhi; Masako Waguri; Yuji Hiramatsu

doi:10.1507/endocrj.EJ19-0367

ORIGINAL

Risk factors during the early postpartum period for type 2 diabetes mellitus in women with gestational diabetes

Maki Kawasaki, Naoko Arata, Naoko Sakamoto, Anna Osamura, Siori Sato, Yoshihiro Ogawa, Ichiro Yasuhi, Masako Waguri, Yuji Hiramatsu

Author information

Maki Kawasaki
Department of Health Policy, National Center for Child Health and Development, Tokyo 157-0074, Japan
Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
Naoko Arata
Division of Maternal Medicine, Center for Maternal-Fetal, Neonatal, and Reproductive Medicine, National Center for Child Health and Development, Tokyo 157-0074, Japan
Naoko Sakamoto
Department of Epidemiologic Research, Faculty of Nursing, Toho University, Tokyo 143-8540, Japan
Anna Osamura
Division of Diabetes, Metabolism and Endocrinology, Department of Medicine, Showa University School of Medicine, Tokyo 142-8666, Japan
Siori Sato
Division of Maternal Medicine, Center for Maternal-Fetal, Neonatal, and Reproductive Medicine, National Center for Child Health and Development, Tokyo 157-0074, Japan
Yoshihiro Ogawa
Department of Molecular and Cellular Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
Ichiro Yasuhi
Department of Obstetrics and Gynecology, National Hospital Organization Nagasaki Medical Center, Omura, Nagasaki 856-8562, Japan
Masako Waguri
Department of Obstetric Medicine, Osaka Women’s and Children’s Hospital, Izumi, Osaka 594-1101, Japan
Yuji Hiramatsu
Okayama City General Medical Center, Okayama 700-0962, Japan

Keywords: Gestational diabetes mellitus, Type 2 diabetes mellitus, Early postpartum period, Oral glucose tolerance test, Prediction

JOURNAL FREE ACCESS FULL-TEXT HTML

2020 Volume 67 Issue 4 Pages 427-437

DOI https://doi.org/10.1507/endocrj.EJ19-0367

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Abstract

For women with gestational diabetes mellitus (GDM), the evaluation of glucose tolerance (GT) in the early postpartum period is universally recommended. Nevertheless, few studies have evaluated the risk factors for T2DM on the basis of GT data obtained during the early postpartum period. We aimed to identify the risk factors for type 2 diabetes mellitus (T2DM) by evaluating GT in the first 12 weeks postpartum (12wPP) in women with GDM and to categorize the risk using a combination of the principal risk factors. This retrospective multicenter observational study included 399 East Asian women with GDM who underwent a 75-g oral glucose tolerance test (OGTT) within 12wPP, which was repeated annually or biennially and used to identify the postpartum development of T2DM. Forty-three women (10.8%) developed T2DM during a median follow-up period of 789 ± 477 days. The independent risk factors for T2DM were pre-pregnancy obesity (BMI ≥25 kg/m²), early postpartum impairment in glucose tolerance (IGT), and an early postpartum glycated hemoglobin (HbA1c) ≥5.7%. The odds ratios (95% confidence intervals) for T2DM were 3.2 (1.3–7.8) in women with either early postpartum IGT or pre-pregnancy obesity, 9.2 (3.0–28.3) in those with early postpartum IGT, pre-pregnancy obesity, and HbA1c <5.7%, and 51.4 (16.1–163.9) in those with early postpartum IGT, pre-pregnancy obesity, and HbA1c ≥5.7%, compared with those without obesity or IGT. T2DM risk in East Asian women with GDM should be stratified according to pre-pregnancy obesity and early postpartum IGT, and these patients should be followed up and receive appropriate care for their risk category.

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