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Manifest diabetes after gestational diabetes: a double-cohort, long-term follow-up in a Danish population

  • Gynecologic Endocrinology and Reproductive Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

The aim was to follow-up two cohorts of women with GDM to investigate the incidence and time of diagnosis of manifest diabetes mellitus (DM) postpartum and identify the risk factors for diabetes in our population.

Methods

A follow-up study on two independent cohorts having oral glucose tolerance test (OGTT) in 1991/1992 and 2011–2016: Cohort 1 consisted of 406 women including 54 with GDM and 352 with a non-GDM OGTT-test and cohort 2 had 433 women diagnosed with GDM. The first cohort had nearly 25 years of follow-up and gave information on magnitude, conversion rate and type of diabetes manifestation. The second cohort was started recently to evaluate whether newer diagnostic criteria and baseline information on the old cohort are still valid for prediction of diabetes risk.

Results

The risk of manifest diabetes in cohort 1 at the end of follow-up was six times higher in women with previous GDM compared with non-GDM (RR = 6; 95% CI 4–11). We observed a 70% diabetes rate 25 years after pregnancy. Only family history of diabetes in cohort 2 was associated with conversion to manifest diabetes (p = 0.002), also after adjustment for age, BMI, non-Danish origin and smoking during pregnancy (p < 0.001)

Conclusion

The incidence of diabetes after GDM is higher than that previously reported in Scandinavian populations and the rate of manifest diabetes rises steeply 15 years after pregnancy and after 40 years of age. The women of cohort 2 with recent GDM are at risk of DM at a higher rate. On this background our results are useful in identifying the time where GDM women may benefit from the effective implementation of evidence-based treatment to postpone and advert manifest DM.

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Funding

This study was not funded by any grants.

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Authors and Affiliations

  1. Department of Gynecology and Obstetrics, Herning Hospital, Gl. Landevej 61, 7400, Herning, Denmark

    Kristina Aaskjær Aagaard, Hanine Mustafa Al-Far, Ulrika Piscator, Rubab Agha Krogh & Finn Friis Lauszus

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  1. Kristina Aaskjær Aagaard
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  2. Hanine Mustafa Al-Far
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  3. Ulrika Piscator
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  4. Rubab Agha Krogh
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  5. Finn Friis Lauszus
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Contributions

KAA data verification and qualification, manuscript writing. HMA data collection and verification, manuscript editing. UP data collection and manuscript editing. RAK protocol development and manuscript editing. FFL project idea and implementation, registration and legal applications, data analysis and manuscript editing.

Corresponding author

Correspondence to Finn Friis Lauszus.

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Conflict of interest

The authors report no conflict of interest.

Ethical approval

The Danish Data Protection Agency approved the project (Nos. 1-16-02-824-17, 1-16-02-825-17 and 1-16-02-180-17) and the ethical standards were in line with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The original approvals are enclosed together with permission to internals addition of data from one cohort study to the other which is covered by the running permission no 621549 and belongs to the approval no 1-16-02-824-17. The regions umbrella permission further covers retrospective follow-up studies as long as no single person is identifiable and thus anonymous. The handling of data and expression by the Gynecology Dept, Herning of conforming with personal data law is further expressed by the Data handling agreement no. 509 with the National Health Authority. All above correspondences are added in originals to the submission. This article does not contain any studies with human participants performed by any of the authors.

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Aagaard, K.A., Al-Far, H.M., Piscator, U. et al. Manifest diabetes after gestational diabetes: a double-cohort, long-term follow-up in a Danish population. Arch Gynecol Obstet 302, 1271–1278 (2020). https://doi.org/10.1007/s00404-020-05669-1

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