Skip to main content
SpringerLink
Log in

Maternal educational level and the risk of persistent post-partum glucose metabolism disorders in women with gestational diabetes mellitus

  • Original Article
  • Published:
Acta Diabetologica Aims and scope Submit manuscript

Abstract

Aims

Gestational diabetes mellitus (GDM) occurs in 5–15% of pregnancies, and lower maternal educational attainment has been associated with higher risk of GDM. We aimed to determine if maternal education level is associated with persistent post-partum glucose metabolism disorders in women with GDM.

Methods

Retrospective cohort study of women with GDM followed in 25 Portuguese health institutions between 2008 and 2012. Educational attainment was categorised into four levels. Prevalence of post-partum glucose metabolism disorders (type 2 diabetes mellitus, increased fasting plasma glucose or impaired glucose tolerance) was compared and adjusted odds ratios calculated controlling for confounders using logistic regression.

Results

We included 4490 women diagnosed with GDM. Educational level ranged as follows: 6.8% (n = 307) were at level 1 (≤ 6th grade), 34.6% (n = 1554) at level 2 (6–9th grade), 30.4% (n = 1364) at level 3 (10–12th grade) and 28.2% (n = 1265) at level 4 (≥ university degree). At 6 weeks post-partum re-evaluation, 10.9% (n = 491) had persistent glucose metabolism disorders. Educational levels 1 and 2 had a higher probability of persistent post-partum glucose metabolism disorders when compared to level 4 (OR = 2.37 [1.69;3.32], p < 0.001 and OR = 1.39 [1.09;1.76], p = 0.008, for level 1 and 2, respectively), an association that persisted in multivariable logistic regression adjusting for confounders (level 1 OR = 2.25 [1.53;3.33], p < 0.001; level 2 OR = 1.43 [1.09;1.89], p = 0.01).

Conclusions

Persistent post-partum glucose metabolism disorders are frequent in women with GDM and associated with lower maternal educational level. Interventions aimed at this risk group may contribute towards a decrease in prevalence of post-partum glucose metabolism disorders.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Kampmann U, Madsen LR, Skajaa GO, Iversen DS, Moeller N, Ovesen P (2015) Gestational diabetes: a clinical update. World J Diabetes 6(8):1065–1072. https://doi.org/10.4239/wjd.v6.i8.1065

    Article  PubMed  PubMed Central  Google Scholar 

  2. Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, Coustan DR et al (2008) Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 358(19):1991–2002. https://doi.org/10.1056/NEJMoa0707943

    Article  PubMed  Google Scholar 

  3. Di Cianni G, Miccoli R, Volpe L, Lencioni C, Del Prato S (2003) Intermediate metabolism in normal pregnancy and in gestational diabetes. Diabetes Metab Res Rev 19(4):259–270. https://doi.org/10.1002/dmrr.390

    Article  PubMed  Google Scholar 

  4. Gorgal R, Goncalves E, Barros M, Namora G, Magalhaes A, Rodrigues T et al (2012) Gestational diabetes mellitus: a risk factor for non-elective cesarean section. J Obstet Gynaecol Res 38(1):154–159. https://doi.org/10.1111/j.1447-0756.2011.01659.x

    Article  PubMed  Google Scholar 

  5. Mitanchez D, Yzydorczyk C, Simeoni U (2015) What neonatal complications should the pediatrician be aware of in case of maternal gestational diabetes? World J Diabetes 6(5):734–743. https://doi.org/10.4239/wjd.v6.i5.734

    Article  PubMed  PubMed Central  Google Scholar 

  6. Simeoni U, Barker DJ (2009) Offspring of diabetic pregnancy: long-term outcomes. Semin Fetal Neonatal Med 14(2):119–124. https://doi.org/10.1016/j.siny.2009.01.002

    Article  PubMed  Google Scholar 

  7. Yogev C, Hod C, Oats M et al (2010) Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study: preeclampsia. Am J Obstet Gynecol 202(3):255 e1–255 e7. https://doi.org/10.1016/j.ajog.2010.01.024

    Article  Google Scholar 

  8. Kim C, Newton KM, Knopp RH (2002) Gestational diabetes and the incidence of type 2 diabetes: a systematic review. Diabetes Care 25(10):1862–1868

    Article  PubMed  Google Scholar 

  9. Expert Committee on the Diagnosis and Classification of Diabetes Mellitus (2003) Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 26(Suppl 1):S5–S20. https://doi.org/10.2337/diacare.26.2007.S5

  10. Grundy SM, Benjamin IJ, Burke GL, Chait A, Eckel RH, Howard BV et al (1999) Diabetes and cardiovascular disease: a statement for healthcare professionals from the American Heart Association. Circulation 100(10):1134–1146

    Article  CAS  PubMed  Google Scholar 

  11. Nathan DM, Davidson MB, DeFronzo RA, Heine RJ, Henry RR, Pratley R et al (2007) Impaired fasting glucose and impaired glucose tolerance: implications for care. Diabetes Care 30(3):753–759. https://doi.org/10.2337/dc07-9920

    Article  CAS  PubMed  Google Scholar 

  12. Lee AJ, Hiscock RJ, Wein P, Walker SP, Permezel M (2007) Gestational diabetes mellitus: clinical predictors and long-term risk of developing type 2 diabetes: a retrospective cohort study using survival analysis. Diabetes Care 30(4):878–883. https://doi.org/10.2337/dc06-1816

    Article  CAS  PubMed  Google Scholar 

  13. Magliano DJ, Barr EL, Zimmet PZ, Cameron AJ, Dunstan DW, Colagiuri S et al (2008) Glucose indices, health behaviors, and incidence of diabetes in Australia: the Australian Diabetes, Obesity and Lifestyle Study. Diabetes Care 31(2):267–272. https://doi.org/10.2337/dc07-0912

    Article  PubMed  Google Scholar 

  14. Bouthoorn SH, Silva LM, Murray SE, Steegers EA, Jaddoe VW, Moll H et al (2015) Low-educated women have an increased risk of gestational diabetes mellitus: the Generation R Study. Acta Diabetol 52(3):445–452. https://doi.org/10.1007/s00592-014-0668-x

    Article  PubMed  Google Scholar 

  15. Carpenter MW, Coustan DR (1982) Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol 144(7):768–773

    Article  CAS  PubMed  Google Scholar 

  16. World Health Organization (2014) Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy: a World Health Organization Guideline. Diabetes Res Clin Pract 103(3):341–363. https://doi.org/10.1016/j.diabres.2013.10.012

  17. Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P et al (2010) International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 33(3):676–682. https://doi.org/10.2337/dc09-1848

    Article  PubMed  Google Scholar 

  18. Rasmussen KM, Yaktine AL (eds) (2009) Weight gain during pregnancy—reexamining the guidelines. Washington (DC): National Academies Press (US)

  19. Dores JM, Magalhães A, Carvalheiro M (2017) Relatório de Consenso sobre a Diabetes e Gravidez. Portuguese General-Directorate of Health. 2011. http://www.saudereprodutiva.dgs.pt/ficheiros-de-upload-diversos/relatorio-de-consenso-pdf.aspx

  20. Ferrara A, Peng T, Kim C (2009) Trends in postpartum diabetes screening and subsequent diabetes and impaired fasting glucose among women with histories of gestational diabetes mellitus: a report from the Translating Research Into Action for Diabetes (TRIAD) Study. Diabetes Care 32(2):269–274. https://doi.org/10.2337/dc08-1184

    Article  PubMed  PubMed Central  Google Scholar 

  21. Bennett WL, Ennen CS, Carrese JA, Hill-Briggs F, Levine DM, Nicholson WK et al (2011) Barriers to and facilitators of postpartum follow-up care in women with recent gestational diabetes mellitus: a qualitative study. J Womens Health (Larchmt) 20(2):239–245. https://doi.org/10.1089/jwh.2010.2233

    Article  Google Scholar 

  22. Pastore I, Chiefari E, Vero R, Brunetti A (2017) Postpartum glucose intolerance: an updated overview. Endocrine. https://doi.org/10.1007/s12020-017-1388-0

    Google Scholar 

  23. White IR, Royston P, Wood AM (2011) Multiple imputation using chained equations: issues and guidance for practice. Stat Med 30(4):377–399. https://doi.org/10.1002/sim.4067

    Article  PubMed  Google Scholar 

  24. Coustan DR, Carpenter MW, O’Sullivan PS, Carr SR (1993) Gestational diabetes: predictors of subsequent disordered glucose metabolism. Am J Obstet Gynecol 168(4):1139–1144 (discussion 44–5)

    Article  CAS  PubMed  Google Scholar 

  25. Kjos SL, Buchanan TA, Greenspoon JS, Montoro M, Bernstein GS, Mestman JH (1990) Gestational diabetes mellitus: the prevalence of glucose intolerance and diabetes mellitus in the first two months post partum. Am J Obstet Gynecol 163(1 Pt 1):93–98

    Article  CAS  PubMed  Google Scholar 

  26. Schaefer-Graf UM, Buchanan TA, Xiang AH, Peters RK, Kjos SL (2002) Clinical predictors for a high risk for the development of diabetes mellitus in the early puerperium in women with recent gestational diabetes mellitus. Am J Obstet Gynecol 186(4):751–756

    Article  PubMed  Google Scholar 

  27. Nielsen LR, Ekbom P, Damm P, Glumer C, Frandsen MM, Jensen DM et al (2004) HbA1c levels are significantly lower in early and late pregnancy. Diabetes Care 27(5):1200–1201

    Article  CAS  PubMed  Google Scholar 

  28. Wild S, Roglic G, Green A, Sicree R, King H (2004) Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 27(5):1047–1053

    Article  PubMed  Google Scholar 

  29. Karve A, Hayward RA (2010) Prevalence, diagnosis, and treatment of impaired fasting glucose and impaired glucose tolerance in nondiabetic U.S. adults. Diabetes Care 33(11):2355–2359. https://doi.org/10.2337/dc09-1957

    Article  PubMed  PubMed Central  Google Scholar 

  30. American Diabetes Association (2015) 5. Prevention or delay of type 2 diabetes. Diabetes Care 38(Suppl 1):S31–S32. https://doi.org/10.2337/dc15-S008

Download references

Acknowledgements

We thank the multidisciplinary teams of obstetricians and diabetologists of Portuguese health institutions who collected patient data for the National Registry of Gestational Diabetes. In addition, we would like to acknowledge the alumni and faculty of the Harvard Medical School—Portugal Clinical Scholars Research Training Programme for useful scientific discussions. DP was partially supported by Fundação para a Ciência e Tecnologia under the Program for doctoral training in clinical research for medical interns (SFRH/SINT/95317/2013).

Funding

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Obstetrics, Maternidade Bissaya Barreto - Centro Hospitalar e Universitário de Coimbra, Rua Augusta, 3000-061, Coimbra, Portugal

    Inês Gante & Maria do Céu Almeida

  2. Department of Nephrology, Hospital Curry Cabral - Centro Hospitalar Lisboa Central, Rua Beneficência 8, 1069-166, Lisbon, Portugal

    Ana Carina Ferreira

  3. Department of Cardiology, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, 4200–319, Porto, Portugal

    Gonçalo Pestana

  4. Department of Infectious Diseases, Centro Hospitalar de Lisboa Norte and Faculdade de Medicina de Lisboa, Av. Egas Moniz, 1649-035, Lisbon, Portugal

    Daniela Pires

  5. Infection Control Program, Geneva University Hospitals, Rue Gabrielle Perret-Gentil, 1205, Geneva, Switzerland

    Daniela Pires

  6. Department of Obstetrics and Gynecology, Hospital Beatriz Angelo, Avenida Carlos Teixeira 3, 2674-514, Loures, Portugal

    Njila Amaral

  7. Department of Endocrinology, Centro Hospitalar do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal

    Jorge Dores

  8. Unit of Population Epidemiology, Department of Community Medicine, Primary Care, and Emergency Medicine, Geneva University Hospitals, Rue Gabrielle Perret-Gentil, 1205, Geneva, Switzerland

    José Luis Sandoval

Authors
  1. Inês Gante
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ana Carina Ferreira
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gonçalo Pestana
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Daniela Pires
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Njila Amaral
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jorge Dores
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Maria do Céu Almeida
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. José Luis Sandoval
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Inês Gante or José Luis Sandoval.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures in this study were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

For this type of study using retrospective and anonymised data, participants’ written consent was not required.

Additional information

Managed by Massimo Federici.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gante, I., Ferreira, A.C., Pestana, G. et al. Maternal educational level and the risk of persistent post-partum glucose metabolism disorders in women with gestational diabetes mellitus. Acta Diabetol 55, 243–251 (2018). https://doi.org/10.1007/s00592-017-1090-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00592-017-1090-y

Keywords

Search

Navigation