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DOI: 10.2337/diacare.29.03.06.dc05-1118
© 2006 by the American Diabetes Association
Cardiovascular and Metabolic Risk |
Gestational Diabetes Identifies Women at Risk for Permanent Type 1 and Type 2 Diabetes in Fertile Age
Predictive role of autoantibodies
1 Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland
2 National Public Health Institute, Oulu, Finland
3 Department of Pediatrics, Oulu University Hospital, Oulu, Finland
4 Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
5 Department of Pediatrics, Tampere University Hospital, Tampere, Finland
Address correspondence reprint requests to Juha S. Tapanainen, Department of ObstetricsGynecology, Oulu University Hospital, P.O. Box 5000, Oulu 90014, Finland. E-mail: juha.tapanainen{at}oulu.fi
OBJECTIVE—Our aim was to evaluate the predictive value of gestational diabetes mellitus (GDM), diabetes-associated autoantibodies, and other factors for development of clinical diabetes later in life.
RESEARCH DESIGN AND METHODS—In this case-control study the presence of autoantibodies was studied in 435 women with GDM and in healthy matched control subjects. The need for exogenous insulin during GDM was recorded. In the GDM group, the mean follow-up period was 5.7 years and in the control group 6.1 years.
RESULTS—Among the subjects with GDM, 20 (4.6%) developed type 1 diabetes and 23 (5.3%) developed type 2 diabetes, whereas none of the control subjects became diabetic. Two-thirds of those who developed type 1 diabetes tested positive initially for islet cell antibodies (ICAs), whereas 56% of them had autoantibodies to GAD (GADAs) and 38% to the protein tyrosine phosphatase–related IA-2 molecule. Only 2 of the 23 women who presented later with type 2 diabetes tested positive for autoantibodies. According to multivariate analysis, initial age 
30 years, the need for insulin treatment for GDM, and antibody positivity for ICAs and GADAs were associated with increased risk for clinical type 1 diabetes.
CONCLUSIONS—Pregnancy seems to identify women who are at risk of developing diabetes later in life. About 10% of Finnish women with GDM will develop diabetes over the next 6 years; nearly half of them develop type 1 diabetes and the other half type 2 diabetes. Age 30 years, the need for insulin treatment during pregnancy, and positivity for ICAs and GADAs confer a high risk of subsequent progression to type 1 diabetes in women affected by GDM.
Abbreviations: GADA, GAD antibody • GDM, gestational diabetes mellitus • IA-2A, protein tyrosine phosphatase–related IA-2 molecule antibody • IAA, insulin autoantibody, ICA, islet cell antibody • PPV, positive predictive value
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