Skip to main content
SpringerLink
Log in

Prediction and Prevention of Type 2 Diabetes in Women with a History of GDM

  • Diabetes and Pregnancy (M-F Hivert and CE Powe, Section Editors)
  • Published:
Current Diabetes Reports Aims and scope Submit manuscript

Abstract

Purpose of the Review

Women with a history of gestational diabetes mellitus (GDM) have an alarmingly high risk of developing type 2 diabetes (T2D); yet, mechanisms underlying this progression are largely unknown.

Recent Findings

Clinical characteristics of a GDM pregnancy and postpartum metabolomics may contribute to risk prediction of T2D to identify those women at highest risk of progression and need for intervention. Evidence for effective postpartum lifestyle interventions from observational studies include adherence to a healthy dietary pattern, increasing physical activity, and maintaining a healthy body weight. Larger clinical trials with greater participant engagement are warranted to confirm the effectiveness of lifestyle interventions in women with recent GDM.

Summary

Research is needed to refine prediction models of T2D after GDM, and to determine the most effective strategies to delay or prevent T2D onset. Incorporating novel biomarkers in the postpartum period, such as metabolomics, could offer a powerful approach.

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

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Casagrande SS, Linder B, Cowie CC. Prevalence of gestational diabetes and subsequent Type 2 diabetes among U.S. women. Diabetes Res Clin Pract. 2018;141:200–8.

    Article  PubMed  Google Scholar 

  2. Bellamy L, Casas JP, Hingorani AD, Williams D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet. 2009;373(9677):1773–9.

    Article  CAS  PubMed  Google Scholar 

  3. Lavery JA, Friedman AM, Keyes KM, Wright JD, Ananth CV. Gestational diabetes in the United States: temporal changes in prevalence rates between 1979 and 2010. British Journal of Gynaecology. 2017;124(5):804–13.

    Article  CAS  Google Scholar 

  4. Martin JA, Hamilton BE, Osterman MJK, Driscoll AK, Drake P. Births: final data for 2016. National vital statistics reports: from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System. 2018;67(1):1–55.

    Google Scholar 

  5. Flegal KM, Kruszon-Moran D, Carroll MD, Fryar CD, Ogden CL. Trends in obesity among adults in the United States, 2005 to 2014. JAMA. 2016;315(21):2284–91.

    Article  CAS  PubMed  Google Scholar 

  6. Bellou V, Belbasis L, Tzoulaki I, Evangelou E. Risk factors for type 2 diabetes mellitus: an exposure-wide umbrella review of meta-analyses. PLoS One. 2018;13(3):e0194127.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  7. Rayanagoudar G, Hashi AA, Zamora J, Khan KS, Hitman GA, Thangaratinam S. Quantification of the type 2 diabetes risk in women with gestational diabetes: a systematic review and meta-analysis of 95,750 women. Diabetologia. 2016;59(7):1403–11.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Moon JH, Kwak SH, Jung HS, Choi SH, Lim S, Cho YM, et al. Weight gain and progression to type 2 diabetes in women with a history of gestational diabetes mellitus. J Clin Endocrinol Metab. 2015;100(9):3548–55.

    Article  CAS  PubMed  Google Scholar 

  9. Manolio TA, Collins FS, Cox NJ, Goldstein DB, Hindorff LA, Hunter DJ, et al. Finding the missing heritability of complex diseases. Nature. 2009;461(7265):747–53.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Ekelund M, Shaat N, Almgren P, Anderberg E, Landin-Olsson M, Lyssenko V, et al. Genetic prediction of postpartum diabetes in women with gestational diabetes mellitus. Diabetes Res Clin Pract. 2012;97(3):394–8.

    Article  CAS  PubMed  Google Scholar 

  11. Cormier H, Vigneault J, Garneau V, Tchernof A, Vohl MC, Weisnagel SJ, et al. An explained variance-based genetic risk score associated with gestational diabetes antecedent and with progression to pre-diabetes and type 2 diabetes: a cohort study. British Journal of Gynaecology. 2015;122(3):411–9.

    Article  CAS  Google Scholar 

  12. Kwak SH, Choi SH, Kim K, Jung HS, Cho YM, Lim S, et al. Prediction of type 2 diabetes in women with a history of gestational diabetes using a genetic risk score. Diabetologia. 2013;56(12):2556–63.

    Article  PubMed  Google Scholar 

  13. Guasch-Ferre M, Hruby A, Toledo E, Clish CB, Martinez-Gonzalez MA, Salas-Salvado J, et al. Metabolomics in prediabetes and diabetes: a systematic review and meta-analysis. Diabetes Care. 2016;39(5):833–46.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Chorell E, Hall UA, Gustavsson C, Berntorp K, Puhkala J, Luoto R, et al. Pregnancy to postpartum transition of serum metabolites in women with gestational diabetes. Metab Clin Exp. 2017;72:27–36.

    Article  CAS  PubMed  Google Scholar 

  15. Nowak C, Hetty S, Salihovic S, Castillejo-Lopez C, Ganna A, Cook NL, et al. Glucose challenge metabolomics implicates medium-chain acylcarnitines in insulin resistance. Sci Rep. 2018;8(1):8691.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  16. Batchuluun B, Al Rijjal D, Prentice KJ, Eversley JA, Burdett E, Mohan H, et al. Elevated medium-chain acylcarnitines are associated with gestational diabetes mellitus and early progression to type 2 diabetes and induce pancreatic beta-cell dysfunction. Diabetes. 2018;67(5):885–97.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Lappas M, Mundra PA, Wong G, Huynh K, Jinks D, Georgiou HM, et al. The prediction of type 2 diabetes in women with previous gestational diabetes mellitus using lipidomics. Diabetologia. 2015;58(7):1436–42.

    Article  CAS  PubMed  Google Scholar 

  18. • Allalou A, Nalla A, Prentice KJ, Liu Y, Zhang M, Dai FF, et al. A predictive metabolic signature for the transition from gestational diabetes mellitus to type 2 diabetes. Diabetes. 2016;65(9):2529–39. Metabolomic signatures predict the progression from GDM to type 2 diabetes, highlighting the potential for novel therapeutics or targeted interventions in high-risk women.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Bao W, Yeung E, Tobias DK, Hu FB, Vaag AA, Chavarro JE, et al. Long-term risk of type 2 diabetes mellitus in relation to BMI and weight change among women with a history of gestational diabetes mellitus: a prospective cohort study. Diabetologia. 2015;58(6):1212–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Bao W, Tobias DK, Bowers K, Chavarro J, Vaag A, Grunnet LG, et al. Physical activity and sedentary behaviors associated with risk of progression from gestational diabetes mellitus to type 2 diabetes mellitus: a prospective cohort study. JAMA Intern Med. 2014;174(7):1047–55.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Perez-Ferre N, Del Valle L, Torrejon MJ, Barca I, Calvo MI, Matia P, et al. Diabetes mellitus and abnormal glucose tolerance development after gestational diabetes: a three-year, prospective, randomized, clinical-based, Mediterranean lifestyle interventional study with parallel groups. Clin Nutr. 2015;34(4):579–85.

    Article  CAS  PubMed  Google Scholar 

  22. Tobias DK, Hu FB, Chavarro J, Rosner B, Mozaffarian D, Zhang C. Healthful dietary patterns and type 2 diabetes mellitus risk among women with a history of gestational diabetes mellitus. Arch Intern Med. 2012;172(20):1566–72.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. • Guo J, Chen JL, Whittemore R, Whitaker E. Postpartum lifestyle interventions to prevent type 2 diabetes among women with history of gestational diabetes: a systematic review of randomized clinical trials. J Women’s Health. 2016;25(1):38–49. Lifestyle interventions may mitigate the excess type 2 diabetes risk after a GDM pregnancy.

    Article  Google Scholar 

  24. Cheung NW, Smith BJ, van der Ploeg HP, Cinnadaio N, Bauman A. A pilot structured behavioural intervention trial to increase physical activity among women with recent gestational diabetes. Diabetes Res Clin Pract. 2011;92(1):e27–9.

    Article  CAS  PubMed  Google Scholar 

  25. Shek NW, Ngai CS, Lee CP, Chan JY, Lao TT. Lifestyle modifications in the development of diabetes mellitus and metabolic syndrome in Chinese women who had gestational diabetes mellitus: a randomized interventional trial. Arch Gynecol Obstet. 2014;289(2):319–27.

    Article  PubMed  Google Scholar 

  26. Wein P, Beischer N, Harris C, Permezel M. A trial of simple versus intensified dietary modification for prevention of progression to diabetes mellitus in women with impaired glucose tolerance. Aust N Z J Obstet Gynaecol. 1999;39(2):162–6.

    Article  CAS  PubMed  Google Scholar 

  27. Tobias DK, Chen M, Manson JE, Ludwig DS, Willett W, Hu FB. Effect of low-fat diet interventions versus other diet interventions on long-term weight change in adults: a systematic review and meta-analysis. Lancet Diabetes Endocrinol. 2015;3(12):968–79.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Salas-Salvado J, Guasch-Ferre M, Lee CH, Estruch R, Clish CB, Ros E. Protective effects of the Mediterranean diet on type 2 diabetes and metabolic syndrome. J Nutr 2016 9.

  29. Tobias DK, Zhang C, Chavarro J, Olsen S, Bao W, Bjerregaard AA, et al. Healthful dietary patterns and long-term weight change among women with a history of gestational diabetes mellitus. Int J Obes. 2016;40(11):1748–53.

    Article  CAS  Google Scholar 

  30. InterAct C. Adherence to predefined dietary patterns and incident type 2 diabetes in European populations: EPIC-InterAct Study. Diabetologia. 2014;57(2):321–33.

    Article  CAS  Google Scholar 

  31. Holmes VA, Draffin CR, Patterson CC, Francis L, Irwin J, McConnell M, et al. Postnatal lifestyle intervention for overweight women with previous gestational diabetes: a randomized controlled trial. J Clin Endocrinol Metab. 2018.

  32. Nicklas JM, Zera CA, England LJ, Rosner BA, Horton E, Levkoff SE, et al. A web-based lifestyle intervention for women with recent gestational diabetes mellitus: a randomized controlled trial. Obstet Gynecol. 2014;124(3):563–70.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Feng L, Xu Q, Hu Z, Pan H. Lactation and progression to type 2 diabetes in patients with gestational diabetes mellitus: a systematic review and meta-analysis of cohort studies. Journal of Diabetes Investigation 2018

  34. Gunderson EP, Hurston SR, Ning X, Lo JC, Crites Y, Walton D, et al. Lactation and progression to type 2 diabetes mellitus after gestational diabetes mellitus: a prospective cohort study. Ann Intern Med. 2015;163(12):889–98.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Much D, Beyerlein A, Kindt A, Krumsiek J, Stuckler F, Rossbauer M, et al. Lactation is associated with altered metabolomic signatures in women with gestational diabetes. Diabetologia. 2016;59(10):2193–202.

    Article  CAS  PubMed  Google Scholar 

  36. Ferrari U, Kunzel H, Trondle K, Rottenkolber M, Kohn D, Fugmann M, et al. Poor sleep quality is associated with impaired glucose tolerance in women after gestational diabetes. J Psychiatr Res. 2015;65:166–71.

    Article  CAS  PubMed  Google Scholar 

  37. Zulfiqar T, Lithander FE, Banwell C, Young R, Boisseau L, Ingle M, et al. Barriers to a healthy lifestyle post gestational-diabetes: an Australian qualitative study. Women and Birth. 2017;30(4):319–24.

    Article  PubMed  Google Scholar 

  38. Alus Tokat M, Sanci M, Girgec S, Kulhan NG, Ozcan CY. Postpartum education and lifestyle changes for preventing type 2 diabetes in Turkish women with previous gestational diabetes: a retrospective study. Int J Nurs Pract. 2016;22(5):427–35.

    Article  PubMed  Google Scholar 

  39. Moore AP, D’Amico MI, Cooper NAM, Thangaratinam S. Designing a lifestyle intervention to reduce risk of type 2 diabetes in postpartum mothers following gestational diabetes: an online survey with mothers and health professionals. Eur J Obstet Gynecol Reprod Biol. 2018;220:106–12.

    Article  PubMed  Google Scholar 

  40. •• Aroda VR, Christophi CA, Edelstein SL, Zhang P, Herman WH, Barrett-Connor E, et al. The effect of lifestyle intervention and metformin on preventing or delaying diabetes among women with and without gestational diabetes: the Diabetes Prevention Program outcomes study 10-year follow-up. The Journal of clinical endocrinology and metabolism. 2015;100(4):1646–53. This tested the effectiveness of a lifestyle intervention or metformin vs. placebo for the prevention of T2D in a randomized clinical trial setting, observing a significant reduction for both interventions among the subrgoup of women with a histtory of GDM

    Article  CAS  Google Scholar 

Download references

Funding

Deirdre K. Tobias received financial support through grants from NIH/NIDDK.

Author information

Authors and Affiliations

  1. Division of Preventive Medicine, 900 Commonwealth Avenue, Boston, MA, 02215, USA

    Deirdre K. Tobias

Authors
  1. Deirdre K. Tobias
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Deirdre K. Tobias.

Ethics declarations

Conflict of Interest

Deirdre K. Tobias declares that she has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Diabetes and Pregnancy

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tobias, D.K. Prediction and Prevention of Type 2 Diabetes in Women with a History of GDM. Curr Diab Rep 18, 78 (2018). https://doi.org/10.1007/s11892-018-1063-8

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11892-018-1063-8

Keywords

Search

Navigation