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Adherence to a follow-up program after gestational diabetes

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Abstract

Aim

The aim of this study was to examine attendance for early postpartum follow-up among women with gestational diabetes mellitus (GDM), and to identify factors that influenced their likelihood of attending.

Methods

One thousand eight hundred and nineteen women with GDM were retrospectively analyzed. During pregnancy, the following data were collected: age, family history of diabetes, ethnicity, prepregnancy BMI, fasting plasma glucose, glycated hemoglobin, gestational week of GDM diagnosis, timing and mode of delivery, newborn’s birth weight and length. Glycemia and insulinemia during OGTT, lipid profile and postpartum BMI were assessed at follow-up. Based on the OGTT, women were classified as having normal glucose tolerance (NGT) or abnormal glucose tolerance (AGT), which included impaired fasting glucose (IFG), impaired glucose tolerance (IGT), IFG + IGT, and DM2. Factors predicting postpartum attendance for follow-up and onset of AGT were considered.

Results

Of the 889 (48.9%) who attended the scheduled postpartum OGTT, 741 (83.4%) had NGT, while 148 (16.6%) had AGT (IFG 6.7%, IGT 7.7%, IFG + IGT 0.8%, DM2 1.5%). The predictors of adherence to follow-up were: not belonging to an immigrant group; family history of DM2; and insulin therapy in pregnancy. The same factors were also predictive of AGT. Our data suggest a role of ethnicity in both attendance for postpartum follow-up and its outcome.

Conclusion

Despite efforts to provide care for women with GDM, postpartum screening rates are still low among Italian women, and especially among immigrants. Hence, the need to improve these patients’ awareness of the severe risk of developing diabetes after pregnancy, concentrating efforts especially on women belonging to the most at risk ethnic groups.

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Data availability

All data generated or analysed during this study are included in this published article.

References

  1. Bellamy L, Casas JP, Hingorani AD, Williams D (2009) Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet 373(9677):1773–1779

    Article  CAS  PubMed  Google Scholar 

  2. Kwak SH, Choi SH, Jung HS et al (2013) Clinical and genetic risk factors for type 2 diabetes at early or late post partum after gestational diabetes mellitus. J Clin Endocrinol Metab 8(4):E744–E752

    Article  Google Scholar 

  3. 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

    Article  PubMed  PubMed Central  Google Scholar 

  4. 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 

  5. Dabelea D, Snell-Bergeon JK, Hartsfield CL et al (2005) Increasing prevalence of gestational diabetes mellitus (GDM) over time and birth cohort: Kaiser permanent of Colorado GDM screening program. Diabetes Care 28:579–584

    Article  PubMed  Google Scholar 

  6. Fujimoto W, Samoa R, Wotring A (2013) Gestational diabetes in high-risk population. Clin Diabetes 31:90–94

    Article  Google Scholar 

  7. Noctor E, Crowe C, Carmody LA et al (2015) Prevalence of metabolic syndrome and insulin resistance in women with previous gestational diabetes mellitus by International Association of Diabetes in Pregnancy Study Groups criteria. Acta Diabetol 52(1):153–156

    Article  CAS  PubMed  Google Scholar 

  8. Di Cianni G, Lencioni C, Volpe L et al (2007) C-reactive protein and metabolic syndrome in women with previous gestational diabetes. Diabetes Metab Res Rev 23(2):135–140

    Article  PubMed  Google Scholar 

  9. Burlina S, Dalfrà MG, Chilelli NC et al (2016) Gestational diabetes mellitus and future cardiovascular risk: an update. Int J Endocrinol. https://doi.org/10.1155/2016/2070926

    Article  PubMed  PubMed Central  Google Scholar 

  10. Ratner RE, Christophi CA, Metzger BE et al (2008) Prevention of diabetes in women with a history of gestational diabetes: effects of metformin and lifestyle interventions. J Clin Endocrinol Metab 93(12):4774–4779

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. ACOG Practice bullettin – Obstetrics (2013) ACOG Practice Bullettin No 137: gestational diabetes mellitus. Obstet Gynecol 122:406–416

    Article  Google Scholar 

  12. American Diabetes Association (2020) Standard of medical care in diabetes. Gestational diabetes mellitus. Diabetes Care 43(Suppl 1):S14–S31

    Article  Google Scholar 

  13. Hod M, Kapur A, Sacks DA et al (2015) The International Federation of Gynecology and Obstetrics (FIGO) Initiative on gestational diabetes mellitus: a pragmatic guide for diagnosis, management, and care. Int J Gynaecol Obstet 131(Suppl 3):S173–S211

    Article  PubMed  Google Scholar 

  14. NICE Guideliness 2015. Diabetes in pregnancy

  15. Pastore I, Chiefari E, Vero R et al (2018) Postpartum glucose intolerance: an updated overview. Endocrine 59:481–494

    Article  CAS  PubMed  Google Scholar 

  16. Hamel MS, Werner EF (2017) Interventions to improve rate of diabetes testing postpartum in women with gestational diabetes mellitus. Curr Diab Rep 17:1–7

    Article  Google Scholar 

  17. International Association of Diabetes and Pregnancy Study Groups Consensus Panel (2010) International Association of Diabetes and Pregnancy Study Groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 33:676–682

    Article  PubMed Central  Google Scholar 

  18. Ministero della Salute. Sistema Nazionale per le Linee Guida Gravidanza Fisiologica 2014

  19. American Diabetes Association (2020) Classification and diagnosis of diabetes. Diabetes Care 43(Suppl 1):S25–S27

    Google Scholar 

  20. Huggett AS, Nixon DA (1957) Use of glucoseoxidase, peroxidase, and O-dianisidine in determination of blood and urinaryglucose. Lancet 273(6991):368–370

    Article  CAS  PubMed  Google Scholar 

  21. Cosma C, Padoan PA, Clerico A et al (2019) C-peptide and insulin assays with the Mindray CL-2000i: precision and comparability with differen methods. Clin Chim Acta 495:210–214

    Article  CAS  PubMed  Google Scholar 

  22. Mosca A, Paleari R, Dalfrà MG et al (2006) Reference intervals for hemoglobin A1c in pregnant women: data from an Italian multicenter study. Clin Chem 52:1138–1143

    Article  CAS  PubMed  Google Scholar 

  23. Dastych M, Wiewiofka O, Benovska M (2014) Ethamsylate (Dicynone) interference in determination of serum creatinine, uric acid, triglycerides and cholesterol in assays involving the Trinder reaction: in vivo and in vitro. Clin Lab 60:1373–1376

    Article  CAS  PubMed  Google Scholar 

  24. Lawrence JM, Black MH, Hsu JW et al (2010) Prevalence and timing of postpartum glucose testing and sustained glucose dysregulation after gestational diabetes mellitus. Diabetes Care 33(3):569–576

    Article  PubMed  Google Scholar 

  25. Russell MA, Phipps MG, Olson CL et al (2006) Rates of postpartum glucose testing after gestational diabetes mellitus. Obstet Gynecol 108(6):1456–1462

    Article  PubMed  Google Scholar 

  26. Capula C, Chiefari E, Vero A et al (2014) Prevalence and predictors of postpartum glucose intolerance in italian women with gestational diabetes mellitus. Diabetes Res Clin Pract 105:223–230

    Article  CAS  PubMed  Google Scholar 

  27. Hunt KJ, Conway DL (2008) Who returns for postpartum glucose screening following gestational diabetes mellitus? Am J Obstet Gynecol 198(4):404.e1–404.e6

    Article  Google Scholar 

  28. Waters TP, Kim SY, Sharma AJ et al (2020) Longitudinal changes in glucose metabolism in women with gestational diabetes, from late pregnancy to the postpartum period. Diabetologia 63:385–394

    Article  CAS  PubMed  Google Scholar 

  29. Blatt AJ, Nakamoto JM, Kaufman HW (2011) Gaps in diabetes screening during pregnancy and postpartum. Obstet Gynecol 117:61–68

    Article  PubMed  Google Scholar 

  30. Lapolla A, DiCianni G, DiBenedetto A et al (2012) Quality of life, wishes and needs in women with gestational diabetes: Italian DAWN pregnancy study. Endocrinology. https://doi.org/10.1155/2012/784726

    Article  Google Scholar 

  31. Dalfrà MG, Ragazzi E, Masin M et al (2001) Pregnancy outcome in immigrant women with gestational diabetes mellitus. Gynecol Endocrinol 27(6):379–383

    Article  Google Scholar 

  32. Valentini R, Dalfrà MG, Masin M et al (2012) A pilot study on dietary approaches in multiethnicity: two methods compared. Int J Endocrinol. https://doi.org/10.1155/2012/985136

    Article  PubMed  PubMed Central  Google Scholar 

  33. Liu H, Zhang C, Zhang S et al (2014) Prepregnancy body mass index and weight change on postpartum diabetes risk among gestational diabetes. Obesity 22(6):1560–1567

    Article  PubMed  Google Scholar 

  34. Burlina S, Dalfrà MG, Lapolla A (2018) Clinical and biochemical approach to predicting post-pregnancy metabolic decompensation. Diabetes Res Clin Pract 145:178–183

    Article  CAS  PubMed  Google Scholar 

  35. Kim SH, Kim MY, Yang JH et al (2011) Nutritional risk factors of early development of postpartum prediabetes and diabetes in women with gestational diabetes mellitus. Nutrition 27(7–8):782–788

    Article  PubMed  Google Scholar 

  36. Benhalima K, Leuridan L, Calewaert P et al (2014) Glucose intolerance after a recent history of gestational diabetes. Int J Endocrinol. ID:727652

  37. Dalfra MG, Lapolla A, Masin M et al (2001) Antepartum and early postpartum predictors of type 2 diabetes development in women with gestational diabetes mellitus. Diabetes Metab 27(6):675–680

    CAS  PubMed  Google Scholar 

  38. Kampmann U, Knorr S, Fuglsang J et al (2019) Determinants of maternal insulin resistance during pregnancy: an updated over review. J Diabetes Research ID 5320156

  39. Lapolla A, Dalfra MG, Mello G, Parretti E, Cioni R, Marzari C et al (2008) Early detection of insulin sensitivity and beta-cell function with simple tests indicates future derangements in late pregnancy. J Clin Endocrinol Metab 93(3):876–880

    Article  CAS  PubMed  Google Scholar 

  40. Ley SH, Chavarro JE, Li M et al (2020) Lactation duration and long-term risk for incident type 2 diabetes in women with a history of gestational diabetes mellitus. Diabetes Care 43:793–798

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Diabetology and Dietetics Unit, Department of Medicine DIMED, University of Padova, Via Giustiniani 2, 35128, Padua, Italy

    Maria Grazia Dalfrà, Silvia Burlina, Gloria Giovanna Del Vescovo, Francesca Anti & Annunziata Lapolla

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  1. Maria Grazia Dalfrà
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  2. Silvia Burlina
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  3. Gloria Giovanna Del Vescovo
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  4. Francesca Anti
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  5. Annunziata Lapolla
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Correspondence to Annunziata Lapolla.

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This article belongs to the topical collection Pregnancy and Diabetes, managed by Antonio Secchi and Marina Scavini.

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Dalfrà, M.G., Burlina, S., Del Vescovo, G.G. et al. Adherence to a follow-up program after gestational diabetes. Acta Diabetol 57, 1473–1480 (2020). https://doi.org/10.1007/s00592-020-01564-y

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  • DOI: https://doi.org/10.1007/s00592-020-01564-y

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