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Postpartum Glucose Intolerance in Gestational Diabetes

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Nutrition and Diet in Maternal Diabetes

Part of the book series: Nutrition and Health ((NH))

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Abstract

Clinical and epidemiological studies indicate that women who experience GDM while pregnant may exhibit glucose intolerance (either in the form of prediabetes or overt T2D) already in the early postpartum period, whereas these same women have up to a 60% lifetime risk for developing T2D. Many factors have been associated with the increased risk of postpartum glucose intolerance. They include: advanced maternal age at pregnancy, a family history of T2D, high pre-pregnancy weight and high pregnancy weight gain, prior GDM, insulin need during pregnancy, high-risk ethnicity, etc. Postpartum screening is critical for the early identification of glucose intolerance in women previously diagnosed with GDM. Hence, it is now recommended that all women who develop diabetes while pregnant be screened for glucose intolerance in the postpartum period. Such a recommendation is supported by a number of evidences indicating that T2D can be delayed or even prevented from developing by modifying lifestyle habits such as unhealthy diet and physical inactivity. Nevertheless, postpartum screening for glucose intolerance still remains disappointingly low among women with recent history of GDM. Hopefully, this will serve to encourage educational programs, that will improve women’s participation in postpartum screening.

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Abbreviations

ACOG:

American Congress of Obstetricians and Gynecologists

ADA:

American Diabetes Association

ADIPS:

Australasian Diabetes in Pregnancy Society

BMI:

Body Mass Index

CDA:

Canadian Diabetes Association

FPG:

Fasting Plasma Glucose

GDM:

Gestational Diabetes Mellitus

HbA1c:

Hemoglobin A1c

IADPSG:

International Association of the Diabetes and Pregnancy Study Groups

IFG:

Impaired Fasting Glucose

IGT:

Impaired Glucose Tolerance

NICE:

National Institute of health and Care Excellence

OGTT:

Oral Glucose Tolerance Test

PCOS:

Polycystic Ovary Syndrome

T2D:

Type 2 Diabetes

References

  1. American Diabetes Association. Standards of medical care in diabetes-2016. Diabetes Care. 2016;39 Suppl 1.

    Google Scholar 

  2. HAPO Study Cooperative Research Group, Metzger BE, Lowe LP, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358:1991–2002.

    Google Scholar 

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

    Article  PubMed  Google Scholar 

  4. Ratner RE. Prevention of type 2 diabetes in women with previous gestation diabetes. Diabetes Care. 2007;30(Suppl 2):S242–5.

    Article  PubMed  Google Scholar 

  5. Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010;87:4–14.

    Article  CAS  PubMed  Google Scholar 

  6. Hunt KJ, Schuller KL. The increasing prevalence of diabetes in pregnancy. Obstet Gynecol Clin North Am. 2007;34:173–99.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Capula C, Chiefari E, Vero A, et al. Gestational diabetes mellitus: screening and outcomes in southern italian pregnant women. ISRN Endocrinol. 2013;2013:387495.

    PubMed  PubMed Central  Google Scholar 

  8. Carr DB, Newton KM, Utzschneider KM, et al. Modestly elevated glucose levels during pregnancy are associated with a higher risk of future diabetes among women without gestational diabetes mellitus. Diabetes Care. 2008;31:1037–9.

    Article  CAS  PubMed  Google Scholar 

  9. Buchanan TA, Xiang A, Kjos SL, et al. Gestational diabetes: antepartum characteristics that predict postpartum glucose intolerance and type 2 diabetes in Latino women. Diabetes. 1998;47:1302–10.

    Article  CAS  PubMed  Google Scholar 

  10. Schaefer-Graf UM, Buchanan TA, Xiang A, et al. 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. 2002;186:751–6.

    Article  PubMed  Google Scholar 

  11. Jang HC, Yim CH, Han KO, et al. Gestational diabetes mellitus in Korea: prevalence and prediction of glucose intolerance at early postpartum. Diabetes Res Clin Pract. 2003;61:117–24.

    Article  CAS  PubMed  Google Scholar 

  12. Russell MA, Phipps MG, Olson CL, et al. Rates of postpartum glucose testing after gestational diabetes mellitus. Obstet Gynecol. 2006;108:1456–62.

    Article  PubMed  Google Scholar 

  13. Kitzmiller JL, Dang-Kilduff L, Taslimi MM. Gestational diabetes after delivery. Short-term management and long-term risks. Diabetes Care. 2007;30(Suppl 2):S225–35.

    Article  CAS  PubMed  Google Scholar 

  14. Hunt KJ, Conway DL. Who returns for postpartum glucose screening following gestational diabetes mellitus? Am J Obstet Gynecol. 2008;198:404–6.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Feig DS, Zinman B, Wang X, et al. Risk of development of diabetes mellitus after diagnosis of gestational diabetes. CMAJ. 2008;179:229–34.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Ogonowski J, Miazgowski T. The prevalence of 6 weeks postpartum abnormal glucose tolerance in Caucasian women with gestational diabetes. Diabetes Res Clin Pract. 2009;84:239–44.

    Article  CAS  PubMed  Google Scholar 

  17. Ferrara A, Peng T, Kim C. 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. 2009;32:269–74.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Kwong S, Mitchell RS, Senior PA, et al. Postpartum diabetes screening: adherence rate and the performance of fasting plasma glucose versus oral glucose tolerance test. Diabetes Care. 2009;32:2242–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Lawrence JM, Black MH, Hsu JW, et al. Prevalence and timing of postpartum glucose testing and sustained glucose dysregulation after gestational diabetes mellitus. Diabetes Care. 2010;33:569–76.

    Article  PubMed  Google Scholar 

  20. Kerimoğlu OS, Yalvaç S, Karçaaltınçaba D, et al. Incidence of diabetes mellitus at postpartum six to twelve months following the diagnosis of gestational diabetes mellitus. J Turk Ger Gynecol Assoc. 2010;11:89–94.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Stasenko M, Cheng YW, McLean T, et al. Postpartum follow-up for women with gestational diabetes mellitus. Am J Perinatol. 2010;27:737–42.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  23. Katon J, Reiber G, Williams MA, et al. Hemoglobin A1c and postpartum abnormal glucose tolerance among women with gestational diabetes mellitus. Obstet Gynecol. 2012;119:566–74.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Kwak SH, Choi SH, Jung HS, et al. Clinical and genetic risk factors for type 2 diabetes at early or late post partum after gestational diabetes mellitus. J Clin Endocrinol Metab. 2013;98:E744–52.

    Article  CAS  PubMed  Google Scholar 

  25. Mendez-Figueroa H, Dahlke JD, Daley J, et al. Prediction of abnormal postpartum glucose tolerance testing in mild gestational diabetes mellitus. J Reprod Med. 2014;59:393–400.

    PubMed  Google Scholar 

  26. Capula C, Chiefari E, Vero A, et al. Prevalence and predictors of postpartum glucose intolerance in Italian women with gestational diabetes mellitus. Diabetes Res Clin Pract. 2014;105:223–30.

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  PubMed Central  Google Scholar 

  28. Weinert LS, Mastella LS, Oppermann ML, et al. Postpartum glucose tolerance status 6 to 12 weeks after gestational diabetes mellitus: a Brazilian cohort. Arq Bras Endocrinol Metabol. 2014;58(2):197–204.

    Article  PubMed  Google Scholar 

  29. Cho GJ, An JJ, Choi SJ, et al. Postpartum glucose testing rates following gestational diabetes mellitus and factors affecting testing non-compliance from four tertiary centers in Korea. J Korean Med Sci. 2015;30:1841–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Bellamy L, Casas JP, Hingorani AD, et al. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet. 2009;373:1773–9.

    Article  CAS  PubMed  Google Scholar 

  31. Feig DS, Zinman B, Wang X, et al. Risk of development of diabetes mellitus after diagnosis of gestational diabetes. CMAJ. 2008;179:229–34.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Brunetti A, Chiefari E, Foti D. Recent advances in the molecular genetics of type 2 diabetes mellitus. World J Diabetes. 2014;5:128–40.

    PubMed  PubMed Central  Google Scholar 

  33. Masuzaki H, Ogawa Y, Sagawa N, et al. Nonadipose tissue production of leptin: leptin as a novel placenta-derived hormone in humans. Nat Med. 1997;3:1029–33.

    Article  CAS  PubMed  Google Scholar 

  34. Xiang AH, Kawakubo M, Kjos SL, et al. Long-acting injectable progestin contraception and risk of type 2 diabetes in Latino women with prior gestational diabetes mellitus. Diabetes Care. 2006;29:613–7.

    Article  CAS  PubMed  Google Scholar 

  35. Peters RK, Kjos SL, Xiang A, et al. Long-term diabetogenic effect of single pregnancy in women with previous gestational diabetes mellitus. Lancet. 1996;347:227–30.

    Article  CAS  PubMed  Google Scholar 

  36. Samuel VT, Shulman GI. Mechanisms for insulin resistance: common threads and missing links. Cell. 2012;148:852–71.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Ratner RE, Christophi CA, Metzger BE, et al. Prevention of diabetes in women with a history of gestational diabetes: effects of metformin and lifestyle interventions. J Clin Endocrinol Metab. 2008;93:4774–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Metzger BE, Buchanan TA, Coustan DR, et al. Summary and recommendations of the fifth international workshop-conference on gestational diabetes mellitus. Diabetes Care. 2007;30 (Suppl 2):S251–60.

    Google Scholar 

  39. Buchanan TA, Xiang A, Kjos SL, et al. What is gestational diabetes? Diabetes Care. 2007;30(Suppl 2):S105–11.

    Article  CAS  PubMed  Google Scholar 

  40. Kramer CK, Swaminathan B, Hanley AJ, et al. Each degree of glucose intolerance in pregnancy predicts distinct trajectories of β-cell function, insulin sensitivity, and glycemia in the first 3 years postpartum. Diabetes Care. 2014;37:3262–9.

    Article  CAS  PubMed  Google Scholar 

  41. Zhang C, Bao W, Rong Y, et al. Genetic variants and the risk of gestational diabetes mellitus: a systematic review. Hum Reprod Update. 2013;19:376–90.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Catalano PM, Vargo KM, Bernstein IM, et al. Incidence and risk factors associated with abnormal postpartum glucose tolerance in women with gestational diabetes. Am J Obstet Gynecol. 1991;165(4 Pt 1):914–19.

    Google Scholar 

  43. Buchanan TA, Xiang A, Kjos SL, et al. Gestational diabetes: antepartum characteristics that predict postpartum glucose intolerance and type 2 diabetes in Latino women. Diabetes. 1998;47:1302–10.

    Article  CAS  PubMed  Google Scholar 

  44. Pallardo F, Herranz L, Garcia-Ingelmo T, et al. Early postpartum metabolic assessment with prior gestational diabetes. Diabetes Care. 1999;22:1053–8.

    Article  CAS  PubMed  Google Scholar 

  45. Aberg AE, Jönsson EK, Eskilsson I, et al. Predictive factors of developing diabetes mellitus in women with gestational diabetes. Acta Obstet Gynecol Scand. 2002;81:11–6.

    Article  PubMed  Google Scholar 

  46. Albareda M, Caballero A, Badell G, et al. Diabetes and abnormal glucose tolerance in women with previous gestational diabetes. Diabetes Care. 2003;26:1199–205.

    Article  PubMed  Google Scholar 

  47. Lee AJ, Hiscock RJ, Wein P, et al. Gestational diabetes mellitus: clinical predictors and long-term risk of developing type 2 diabetes. Diabetes Care. 2007;30:878–83.

    Article  CAS  PubMed  Google Scholar 

  48. Retnakaran R, Qi Y, Sermer M, et al. Glucose intolerance in pregnancy and future risk of pre-diabetes or diabetes. Diabetes Care. 2008;31:2026–31.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Ekelund M, Shaat N, Almgren P, et al. Prediction of postpartum diabetes in women with gestational diabetes mellitus. Diabetologia. 2010;53:452–7.

    Article  CAS  PubMed  Google Scholar 

  50. Liu H, Zhang S, Wang L, et al. Fasting and 2-hour plasma glucose, and HbA1c in pregnancy and the postpartum risk of diabetes among Chinese women with gestational diabetes. Diabetes Res Clin Pract. 2016;112:30–6.

    Article  PubMed  Google Scholar 

  51. Ekelund M, Shaat N, Almgren P, Groop L, Berntorp K, et al. Genetic prediction of postpartum diabetes in women with gestational diabetes mellitus. Diabetes Res Clin Pract. 2012;97:394–8.

    Article  CAS  PubMed  Google Scholar 

  52. Sinha B, Brydon P, Taylor RS, et al. Maternal ante-natal parameters as predictors of persistent postnatal glucose intolerance: a comparative study between Afro-Caribbeans, Asians and Caucasians. Diabetes Med. 2003;20:382–6.

    Article  CAS  Google Scholar 

  53. Sivaraman SC, Vinnamala S, Jenkins D. Gestational diabetes and future risk of diabetes. J Clin Med Res. 2013;5:92–6.

    PubMed  PubMed Central  Google Scholar 

  54. Golden SH, Bennett WL, Baptist-Roberts K, et al. Antepartum glucose tolerance test results as predictors of type 2 diabetes mellitus in women with a history of gestational diabetes mellitus: a systematic review. Gend Med. 2009;6(Suppl 1):109–22.

    Article  PubMed  Google Scholar 

  55. Göbl CS, Bozkurt L, Yarragudi R, et al. Is early postpartum HbA1c an appropriate risk predictor after pregnancy with gestational diabetes mellitus? Acta Diabetol. 2014;51:715–22.

    Article  PubMed  Google Scholar 

  56. O’Reilly MW, Avalos G, Dennedy MC, et al. Atlantic dip: high prevalence of abnormal glucose tolerance postpartum is reduced by breast-feeding in women with prior gestational diabetes mellitus. Eur J Endocrinol. 2011;165:953–9.

    Article  PubMed  Google Scholar 

  57. Venkataraman H, Sattar N, Saravanan P. Postnatal testing following gestational diabetes: time to replace the oral glucose tolerance test? Lancet Diabetes Endocrinol. 2015;3:754–6.

    Article  PubMed  Google Scholar 

  58. Kwong S, Mitchell RS, Senior PA, et al. Postpartum diabetes screening: adherence rate and the performance of fasting plasma glucose versus oral glucose tolerance test. Diabetes Care. 2009;32:2242–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Duke A, Yap C, Bradbury R, et al. The discordance between HbA1c and glucose tolerance testing for the postpartum exclusion of diabetes following gestational diabetes. Diabetes Res Clin Pract. 2015;108:72–7.

    Article  CAS  PubMed  Google Scholar 

  60. O’Keeffe DT, Maraka S, Rizza RA. HbA1c in the evaluation of diabetes Mellitus. JAMA. 2016;315:605–6.

    Article  PubMed  Google Scholar 

  61. Capula C, Chiefari E, Vero A, et al. Predictors of postpartum glucose tolerance testing in italian women with gestational diabetes mellitus. ISRN Endocrinol. 2013;2013:182505.

    PubMed  PubMed Central  Google Scholar 

  62. Ferrara A, Peng T, Kim C. 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. 2009;32:269–74.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Halperin IJ, Sehgal P, Lowe J, et al. Increasing timely postpartum oral glucose tolerance test completion in women with gestational diabetes: a quality-improvement initiative. Can J Diabetes. 2015;39:451–6.

    Article  PubMed  Google Scholar 

  64. Mohd Suan MA. Return for postpartum oral glucose tolerance test following gestational diabetes mellitus. Asia Pac J Public Health. 2015;27:601–9.

    Article  PubMed  Google Scholar 

  65. Expert committee on the diagnosis and classification of diabetes mellitus: follow-up report on the diagnosis of diabetes mellitus. Diabetes Care. 2003;26:3160–7.

    Google Scholar 

  66. Tobias DK, Hu FB, Chavarro J, et al. Healthful dietary patterns and type 2 diabetes mellitus risk among women with a history of gestational diabetes mellitus. Arch Intern Med. 2012;172:1566–72.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  67. Rice GE, Illanes SE, Mitchell MD. Gestational diabetes mellitus: a positive predictor of type 2 diabetes? Intl J Endocrinol. 2012;2012:721653.

    Article  Google Scholar 

  68. Wahabi HA, Alzeidan RA, Bawazeer GA, et al. Preconception care for diabetic women for improving maternal and fetal outcomes: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2010;10:63.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Health Sciences, University “Magna Græcia” of Catanzaro, Viale Europa (Loc. Germaneto), Catanzaro, Italy

    Antonio Brunetti, Ida Pastore, Rossella Liguori & Eusebio Chiefari

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  1. Antonio Brunetti
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  2. Ida Pastore
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  3. Rossella Liguori
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  4. Eusebio Chiefari
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Correspondence to Antonio Brunetti .

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Editors and Affiliations

  1. Department of Nutrition, King’s College London, London, United Kingdom

    Rajkumar Rajendram

  2. Department of Nutrition, King’s College London, London, United Kingdom

    Victor R. Preedy

  3. Department of Biomedical Sciences, University of Westminster, London, United Kingdom

    Vinood B. Patel

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Brunetti, A., Pastore, I., Liguori, R., Chiefari, E. (2018). Postpartum Glucose Intolerance in Gestational Diabetes. In: Rajendram, R., Preedy, V., Patel, V. (eds) Nutrition and Diet in Maternal Diabetes. Nutrition and Health. Humana Press, Cham. https://doi.org/10.1007/978-3-319-56440-1_24

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  • DOI: https://doi.org/10.1007/978-3-319-56440-1_24

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