After Gestational Diabetes: Impact of Pregnancy Interval on Recurrence and Type 2 Diabetes

Incident Diabetes in Women With Patterns of Gestational Diabetes Occurrences Across 2 Pregnancies

Importance

Gestational diabetes is a type 2 diabetes risk indicator, and recurrence further augments risk. In women with a single occurrence across 2 pregnancies, it is unclear whether first- vs second-pregnancy gestational diabetes differ in terms of risk.

Objective

To compare the hazards of incident diabetes among those with gestational diabetes in the first, in the second, and in both pregnancies with women without gestational diabetes in either.

Design, Setting, and Participants

This was a retrospective cohort study with cohort inception from April 1, 1990, to December 31, 2012. Follow-up was April 1, 1990, to April 1, 2019. Participants were mothers with 2 singleton deliveries between April 1, 1990, and December 31, 2012, without diabetes before or between pregnancies, who were listed in public health care insurance administrative databases and birth, stillbirth, and death registries in Quebec, Canada. Data were analyzed from July to December 2023.

Exposure

Gestational diabetes occurrence(s) across 2 pregnancies.

Main outcomes and measures

Incident diabetes from the second delivery until a third pregnancy, death, or the end of the follow-up period, whichever occurred first.

Results

The 431 980 women with 2 singleton deliveries studied had a mean (SD) age of 30.1 (4.5) years at second delivery, with a mean (SD) of 2.8 (1.5) years elapsed between deliveries; 373 415 (86.4%) were of European background, and 78 770 (18.2%) were at the highest quintile of material deprivation. Overall, 10 920 women (2.5%) had gestational diabetes in their first pregnancy, 16 145 (3.7%) in their second, and 8255 (1.9%) in both (12 205 incident diabetes events; median [IQR] follow-up 11.5 [5.3-19.4] years). First pregnancy-only gestational diabetes increased hazards 4.35-fold (95% CI, 4.06-4.67), second pregnancy-only increased hazards 7.68-fold (95% CI, 7.31-8.07), and gestational diabetes in both pregnancies increased hazards 15.8-fold (95% CI, 15.0-16.6). Compared with first pregnancy-only gestational diabetes, second pregnancy-only gestational diabetes increased hazards by 76% (95% CI, 1.63-1.91), while gestational diabetes in both pregnancies increased it 3.63-fold (95% CI, 3.36-3.93).

Conclusions and relevance

In this retrospective cohort study of nearly half a million women with 2 singleton pregnancies, both the number and ordinal pregnancy of any gestational diabetes occurrence increased diabetes risk. These considerations offer greater nuance than an ever or never gestational diabetes dichotomy.

Gestational diabetes mellitus and its associated factors in Ethiopia: a systematic review and meta-analysis

BACKGROUND

In Ethiopia, gestational diabetes mellitus (GDM) is a significant public health issue and a risk to maternal and child health. Understanding the prevalence and factors of GDM in Ethiopia may also help determine the best interventions. Therefore, we tried to review gestational diabetes and its factors in Ethiopia.AQ: Please check and confirm the edit made to the article title.yes i have checked and confirm METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) instrument was used to conduct the review. In order to report on the prevalence and contributing factors of gestational diabetes mellitus, the following databases were used: Google Scholar, PubMed, EMBASE, Scopus, Web of Sciences, and Grey literature. Pilo-tests were conducted using a standardized data gathering form in research using a random sample. All statistical analyses were performed using STATA version 16 software for Windows and the random-effects meta-analysis method. The results are presented using texts, tables, and forest plots, along with measure of effect and a 95% confidence interval.Affiliations: Please confirm if the author names are presented accurately and in the correct sequence (given name, middle name/initial, family name). Author Given name: [Fentahun Yenealem], Last name [Beyene], Given name: [Bekalu Getnet], Last name [Kassa], Given name: [Gedefaye Nibret], Last name [Mihretie], Given name: [Alemu Degu], Last name [Ayele].yes checked and corrected AQ: Is this word Pilo-tests spelled correctly throughout the article?Thank you the correction Affiliations: Please check and confirm whether the city name is correctly identified for the affiliation 2.yes checked and corrected  RESULTS: Out of 1755 records, 10 studies with 6525 participants that fully satisfy the inclusion criteria were included for the meta-analysis. The pooled prevalence of gestational diabetes mellitus in Ethiopia was 12.04% [95% CI (8.17%, 15.90%)]. Inadequate dietary diversity, high body mass index, having a family history of DM, history of having macrosomic neonate, low physical activity, and previous history of GDM were statistically significant.AQ: Please note that the sentence Inadequate dietary diversity, high body mass index… is repeated under the below heading Conclusion.yes checked and corrected  CONCLUSION: The pooled prevalence of gestational diabetes mellitus is high in Ethiopia. Inadequate dietary diversity, high body mass index, having a family history of DM, history of having macrosomic neonate, low physical activity and previous history of GDM were statically significant variables. Emphasize on early screening, prenatal care and all women having risk factors and trying to get pregnant should get screens for diabetes to improve the maternal and child health at large.AQ: Please check the clarity of the sentence Emphasize on early screening, prenatal…it is clear and easly understand the readers.

Increased Oral Care Needs and Third Molar Symptoms in Women with Gestational Diabetes Mellitus: A Finnish Gestational Diabetes Case-Control Study

(1) Hyperglycemia and oral pathology accelerate each other in diabetes. We evaluated whether gestational diabetes mellitus (GDM) is associated with self-reported increased oral health care needs and oral symptoms, including third molar symptoms, during pregnancy. (2) Pregnant women with (n = 1030) and without GDM (n = 935) were recruited in this multicenter Finnish Gestational Diabetes study in 2009-2012. Of the women with GDM, 196 (19.0%) receiving pharmacological treatment, 797 (77.0%) receiving diet treatment and 233 (23.0%) with recurrent GDM were analyzed separately. Oral health was assessed using structured questionnaires and analyzed by multivariable logistic regression adjusted for background risk factors. (3) Women with GDM were more likely to report a higher need for oral care than controls (31.1% vs. 24.5%; odds ratio (OR) 1.39; 95% confidence interval (CI) 1.14-1.69), particularly women with recurrent GDM (38.1% vs. 24.5%; OR 1.90; 95% CI 1.40-2.58). Women with pharmacologically treated GDM (46.9%) more often had third molar symptoms than controls (36.1%; OR 1.57; 95% CI 1.15-2.15) than women with diet-treated GDM (38.0%; OR 1.47; 95% CI 1.07-2.02). (4) GDM is associated with perceived oral care needs. Third molar symptoms were associated with pharmacologically treated GDM.

Characteristics of pregnancy with gestational diabetes mellitus and the consecutive pregnancy as predictors for future diabetes mellitus type 2

AIM

To explore possible obstetrical history-related, modifiable risk factors of future type 2 diabetes mellitus (T2DM), with focus on characteristics of the index gestational diabetes mellitus (GDM) pregnancy and the consecutive pregnancy.

METHODS

This retrospective, population-based, cohort study included 788 women with GDM, who had consecutive deliveries at Emek Medical Center during 1991-2012. Women with pre-existing diabetes were excluded. Factors associated with T2DM development were examined using stepwise multiple Cox regression model.

RESULTS

Overall 178 women developed T2DM (23%). Multivariable analysis demonstrated that the most significant independent risk factors for T2DM development were birth weight ≥ 4000 g (HR_adj1.7 95% CI [1.001-2.8]), fasting oral glucose tolerance test value (OGTT, HR_adj1.03 95% CI [1.01-1.04], 1-hour post-OGTT glucose value (HR_adj1.01 95% CI [1.006-1.02]), earlier gestational week in which GDM was diagnosed (HR_adj 0.96 95% CI [0.93-0.99]), higher parity (HR_adj 1.15 95% CI [1.06-1.25] and GDM recurrence in the consecutive delivery (HR_adj2.4 95% CI [1.6-3.7]). Kaplan Meier survival curve of the time from the consecutive pregnancy until T2DM development showed a statistically significant effect of GDM recurrence and the risk for T2DM. Body mass index (BMI) gain between pregnancies and inter-pregnancy interval were not independent risk factors for T2DM.

CONCLUSIONS

Obstetric characteristics of women with GDM and particularly GDM recurrence are associated with increased risk for T2DM. Strategies to prevent those factors and especially GDM recurrence might reduce the risk of future T2DM.

Annual Body Mass Index Gain and Risk of Gestational Diabetes Mellitus in a Subsequent Pregnancy

Introduction

Weight change during the interpregnancy is related to gestational diabetes mellitus (GDM) in the subsequent pregnancy. In interpregnancy care/counseling, the timeframe for goal setting is important, while the timing of the next conception is unpredictable and preventing age-related body weight gain is difficult. This study aimed to investigate the association between annual weight gain during the interpregnancy, which provide clearer timeframe, and GDM in subsequent pregnancies.

Methods

This multicenter retrospective study was conducted by collecting data on two pregnancies of the same women in 2009-2019. The association between annual BMI gain and GDM during the subsequent pregnancy was examined.

Results

This study included 1,640 pregnant women. A history of GDM [adjusted odds ratio (aOR), 26.22; 95% confidence interval (CI), 14.93-46.07] and annual BMI gain (aOR, 1.48; 95% CI, 1.22-1.81) were related to GDM during the subsequent pregnancy. In the women with a pre-pregnant BMI of <25.0 kg/m2 and without GDM during the index pregnancy, an annual BMI gain of ≥0.6 kg/m2/year during the interpregnancy were associated with GDM in subsequent pregnancies; however, in the other subgroups, it was not associated with GDM in subsequent pregnancies.

Conclusions

For women with a pre-pregnant BMI of <25.0 kg/m2 and without GDM during the index pregnancy, maintaining an annual BMI gain of <0.6 kg/m2/year may prevent GDM during the subsequent pregnancy.

A Scoping Review on Gestational Diabetes in Hawai'i: A "Window of Opportunity" to Address Intergenerational Risk for Type 2 Diabetes Mellitus

The health of women over the entire span of their reproductive years is crucial - beginning in adolescence and extending through the postpartum period. This paper provides a scoping review of the relevant literature on risk factors for gestational diabetes mellitus (GDM) and progression from GDM to type 2 diabetes mellitus (T2DM), particularly among women of Native Hawaiian and Pacific Islander (NHPI) and Asian racial/ethnic backgrounds in Hawai'i, using the PubMed database (July 2010 to July 2020). NHPI and Asian populations have a greater likelihood of developing GDM compared to their White counterparts. Risk factors such as advanced maternal age, high maternal body mass index, and lack of education about GDM have varying levels of impact on GDM diagnosis between ethnic populations. Mothers who have a history of GDM are also at higher risk of developing T2DM. Common risk factors include greater increase in postpartum body mass index and use of diabetes medications during pregnancy. However, few studies investigate the progression from GDM to T2DM in Hawai'i's Asian and NHPI populations, and no studies present upstream preconception care programs to prevent an initial GDM diagnosis among Hawai'i's women. Thus, updated reports are necessary for optimal early interventions to prevent the onset of GDM and break the intergenerational cycle of increased susceptibility to T2DM and GDM in both mother and child. Further attention to the development of culturally sensitive interventions may reduce disparities in GDM and improve the health for all affected by this condition.

Comparison of immediate postpartum contraception among women with a high versus low risk pregnancy in Mexico: a retrospective cohort study

OBJECTIVE

We tested whether women who reported high-risk pregnancies or deliveries were more likely to receive immediate postpartum contraception prior to discharge compared with normal-risk women in Mexico.

METHODS

This is a retrospective study using the National Health and Nutrition Survey. We classified women as high-risk based on reported complications in pregnancy and delivery. We used multivariable logistic regression to test the association of high-risk status and receipt of postpartum contraception (any modern method and Tier one methods) prior to discharge.

RESULTS

Our sample included 5030 deliveries (population N=3 923 657). Overall, 19.1% of the sample were high risk. Over 60% of women in the high-risk and normal-risk group received immediate postpartum contraception, but a greater proportion of high-risk women received a method (67% vs 61% normal risk; p<0.001). However, in multivariable models, there were no significant differences in receipt of any modern method or tier 1 method by risk group.

CONCLUSION

Women with high-risk pregnancies were not more likely to receive postpartum contraception than the normal-risk group, once accounting for sociodemographic and clinical factors. Prenatal and postpartum contraception counselling should address the health effects of high-risk pregnancies and interpregnancy intervals to improve maternal health outcomes.

No deleterious effect of an additional pregnancy on glucose metabolism in women with previous gestational diabetes mellitus

OBJECTIVE

Women with gestational diabetes mellitus (GDM) often develop type 2 diabetes later in life. It remains unclear whether this results solely from a common underlying predisposition or, whether a pregnancy itself persistently impairs glucose metabolism in predisposed women. We therefore examined how an additional pregnancy affected different aspects of glucose metabolism in women with previous GDM.

RESEARCH DESIGN AND METHODS

Nested case-control study within the prospective cohort study PPSDiab, recruited in Munich, Germany from 2011-16. Cases (n = 41): women with previous GDM who completed an additional pregnancy; controls: no additional pregnancy, pairwise matching.

ENDPOINTS

change of the area under the glucose curve (AUGC) of an oral glucose tolerance, of plasma glucose at 60' of the test (PG 60'), of the insulin sensitivity index (ISI) and of the disposition index (DI), all between before and after the additional pregnancy in cases/the corresponding observation period in controls.

RESULTS

We observed no significant difference between cases and controls in the primary [ratio AUGC 1.05(0.92-1.15) vs. 0.97(0.85-1.14); p = 0.21] and in the secondary endpoints [difference PG 60', ratio ISI and ratio DI.

CONCLUSION

We did not find a deleterious effect of an additional pregnancy on glucose metabolism in women with previous GDM.

Effect of Gestational Diabetes Mellitus History on Future Pregnancy Behaviors: The Mutaba'ah Study

Gestational diabetes mellitus (GDM) increases the risk of adverse pregnancy outcomes in any pregnancy and recurrence rates are high in future pregnancies. This study aims to investigate the effect of self-reported history of previous GDM on behaviors in a future pregnancy. This is an interim cross-sectional analysis of the pregnant women who participated in the Mutaba'ah Study between May 2017 and March 2020 in the United Arab Emirates. Participants completed a baseline self-administered questionnaire on sociodemographic and pregnancy-related information about the current pregnancy and previous pregnancies. Regression models assessed the relationships between self-reported history of GDM and pre-pregnancy and pregnancy behaviors in the current pregnancy. Out of 5738 pregnant parous women included in this analysis, nearly 30% (n = 1684) reported a history of GDM in a previous pregnancy. Women with a history of previous GDM were less likely to plan their current pregnancies (adjusted odds ratio (aOR): 0.84, 95% confidence interval (CI) 0.74-0.96) and more likely to be worried about childbirth (aOR: 1.18, 95% CI 1.03-1.36). They had shorter interpregnancy intervals between their previous child and current pregnancy (aOR: 0.88, 95% CI 0.82-0.94, per SD increase). There were no significant differences between women with and without a history of GDM in supplement use, sedentary behavior, or physical activity before and during this current pregnancy. Nearly a third of parous pregnant women in this population had a history of GDM in a previous pregnancy. Pregnant women with a previous history of GDM were similar to their counterparts with no history of GDM in the adopted pre-pregnancy and prenatal health behaviors. More intensive and long-term lifestyle counseling, possibly supported by e-health and social media materials, might be required to empower pregnant women with a history of GDM. This may assist in adopting and maintaining healthy prenatal behaviors early during the pregnancy or the preconception phase to minimize the risk of GDM recurrence and the consequential adverse maternal and infant health outcomes.

Gestational Diabetes: Importance of Follow-up Screening for the Benefit of Long-term Health

Gestational diabetes mellitus (GDM) is the most common obstetric metabolic disorder. Long-term health consequences, including type 2 diabetes, metabolic syndrome, and cardiovascular disease, are common with GDM. Postpartum glucose screening is recommended for women with a prior GDM pregnancy. Rates of postpartum screening compliance remain low. Interventions ranging from appointment reminder systems to personalized chronic disease education are being used, emphasizing future chronic disease risk for patients with a history of GDM. With these practice changes, clinicians can more thoroughly engage in the early identification, intervention, and prevention of chronic disease for women with a history of GDM.