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Abnormal glucose tolerance in women with prior gestational diabetes mellitus: a 4-year follow-up study

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Abstract

Background

Adoption of the International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria for diagnosis of gestational diabetes mellitus (GDM) varies worldwide. Early detection of women at increased risk of developing type 2 diabetes mellitus (T2DM) following GDM enables initiation of measures to delay disease onset.

Objectives

To determine the 4-year cumulative incidence and risk factors for developing abnormal glucose tolerance (AGT) among women with previous GDM using modified IADPSG criteria. Additionally, to review post-natal attendance at diabetes screening and the impact of post-partum lifestyle modifications and breastfeeding on the risk of T2DM development.

Methods

Four hundred twenty-six women with a prior history of GDM were invited to participate in the study, 4 years after the index pregnancy. The following were completed: body measurements, oral glucose tolerance test (OGTT), glycated haemoglobin (HbA1c), vitamin D, and other biochemistry measurements. Participants also completed a lifestyle questionnaire.

Results

Of the 74 women who participated, 15 (20%) had AGT. Predictive factors for AGT development were as follows: fasting glucose levels (p = 0.004), HbA1c (p = 0.008) at GDM diagnosis, and early pregnancy BMI (p = 0.001). Thirty-three (45%) women had not attended their postnatal screening. The odds ratio of the association between breastfeeding and AGT development was 0.16 (95% CI: 0.05 to 0.53).

Conclusion

The proportion of women who develop AGT after a diagnosis of GDM remains high. The factors associated with progression to AGT are available at GDM diagnosis. Preventing AGT in this group is possible by supporting breastfeeding. Attendance at post-natal screening should also be encouraged.

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Availability of data and materials

The dataset used and/or analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors thank Linda Culliney for permission to use the database that she compiled in 2014 and appreciate the valuable insights provided by her and Louise O’Mahony. The authors also thank Darren Dahly for his statistical work.

Funding

The author was awarded the Irish Endocrine Society (IES) summer student research bursary for this study. The views expressed are those of the author(s) and not necessarily those of the IES.

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Authors and Affiliations

  1. Department of Medicine, University College Cork, Cork, Ireland

    Evelyn O’Shea

  2. Department of Endocrinology, Cork University Hospital, Cork, Ireland

    Mohd Hazriq Awang, Oratile Kgosidialwa & Antoinette Tuthill

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  1. Evelyn O’Shea
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  3. Oratile Kgosidialwa
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  4. Antoinette Tuthill
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Contributions

EO’S was involved in the design of the study and the acquisition and interpretation of the data. MA was involved in the acquisition of the data. AT was involved in the conception and design of the study. All authors read, contributed to, and approved the final manuscript.

Corresponding author

Correspondence to Evelyn O’Shea.

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Ethics approval and consent to participate

This research was approved by the Clinical Research Ethics Committee (CREC) of the Cork Teaching Hospitals on the 31st of August 2018 (ECM 6 (yy) 05/06/18 & ECM 3 (ee) 04/09/18). This project was a continuation of a project performed in 2014 by our research team, for which the Biomedical & Scientific Research Ethics Committee (BSREC) (REG-2015–1405) and CREC (ECM 4 (ttt) 14/4/15) granted approval in April 2015. Approval was granted to access this database and informed consent was obtained from the participants who took part in our follow-up study to use their data for research purposes.

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The authors declare no competing interests.

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Appendix: Modified questionnaire on diet and health

Appendix: Modified questionnaire on diet and health

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O’Shea, E., Awang, M.H., Kgosidialwa, O. et al. Abnormal glucose tolerance in women with prior gestational diabetes mellitus: a 4-year follow-up study. Ir J Med Sci 192, 641–648 (2023). https://doi.org/10.1007/s11845-022-03005-x

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