Glucose Intolerance after a Recent History of Gestational Diabetes Based on the 2013 WHO Criteria

• Published in: PloS one 2016-06, Vol.11 (6), p.e0157272-e0157272
• Main Authors: Benhalima, Katrien, Jegers, Katleen, Devlieger, Roland, Verhaeghe, Johan, Mathieu, Chantal
• Format: Article
• Language: English
• Subjects: Adult; Analysis; Beta cells; Biology and Life Sciences; Blood glucose; Blood Glucose - analysis; Body mass; Breast feeding; Breastfeeding & lactation; Chromium; Complications and side effects; Criteria; Demographic aspects; Diabetes; Diabetes mellitus; Diabetes, Gestational - epidemiology; Diagnosis; Endocrinology; Fasting; Female; Gestational diabetes; Glucose; Glucose intolerance; Glucose Intolerance - blood; Glucose Intolerance - diagnosis; Glucose Intolerance - epidemiology; Glucose tolerance; Glucose Tolerance Test; Gynecology; Homeostasis; Humans; Insulin; Insulin Resistance; Insulin-Secreting Cells - pathology; Intolerance; Laboratory testing; Medical records; Medicine and Health Sciences; Minority & ethnic groups; Obstetrics; Population; Postpartum; Postpartum Period; Prediabetic State - blood; Prediabetic State - diagnosis; Prediabetic State - epidemiology; Pregnancy; Primary care; Regression analysis; Retrospective Studies; Risk analysis; Risk assessment; Risk Factors; Screening; Secretion; Sensitivity; Sensitivity analysis; Strategy; Womens health
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0157272

Uncertainty exists on the prevalence of glucose intolerance in women with a recent diagnosis of gestational diabetes (GDM) based on a two-step screening strategy and the 2013 World Health Organization (WHO) criteria. Our aim was to evaluate the uptake of postpartum screening, the prevalence and the risk factors for glucose intolerance in women with a recent history of GDM. Retrospective analysis of the medical records of women with a recent history of GDM diagnosed in a universal two-step screening strategy with the 2013 WHO criteria. All women with a history of GDM are advised to undergo a 75g oral glucose tolerance test (OGTT) around 12 weeks postpartum. Indices of insulin sensitivity (the Matsuda index and the reciprocal of the homeostasis model assessment of insulin resistance, 1/HOMA-IR) and an index of beta-cell function, the Insulin Secretion-Sensitivity Index-2 (ISSI-2) were calculated based on the OGTT postpartum. Multivariable logistic regression was used to adjust for confounders such as age, BMI, ethnicity and breastfeeding. Of the 191 women with GDM, 29.3% (56) did not attend the scheduled postpartum OGTT. These women had a higher BMI (28.6 ±6.8 vs. 26.2 ± 5.6, p = 0.015), were more often from an ethnic minority (EM) background (41.1% vs. 25.2%, p = 0.029) and smoked more often during pregnancy (14.3% vs. 2.2%, p = 0.001) than women who attended the OGTT postpartum. Of all women (135) who received an OGTT postpartum, 42.2% (57) had prediabetes (11.9% impaired fasting glucose, 24.4% impaired glucose tolerance and 5.9% both impaired fasting and impaired glucose tolerance) and 1.5% (2) had overt diabetes. Compared to women with a normal OGTT postpartum, women with glucose intolerance were older (32.5±4.3 vs. 30.8±4.8 years, p = 0.049), were more often obese (34.5% vs. 17.3%, p = 0.023), were more often from an EM background (33.9% vs. 18.4%, p = 0.040), less often breastfed (69.5% vs. 84.2%, p = 0.041) and had more often an abnormal fasting glycaemia at the time of the OGTT in pregnancy (55.6% vs. 37.3%, p = 0.040). In the multivariable logistic regression, an EM background [OR = 2.76 (1.15-6.62), p = 0.023] and the HbA1c level at the time of the OGTT in pregnancy [OR = 4.78 (1.19-19.20), p = 0.028] remained significant predictors for glucose intolerance postpartum. Women with glucose intolerance postpartum had a similar insulin sensitivity [Matsuda index 0.656 (0.386-1.224) vs. 0.778 (0.532-1.067), p = 0.709; 1/HOMA-IR 0.004 (0.002-0.009) vs. (0