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Gestational Diabetes Mellitus: Clinical Predictors and Long-Term Risk of Developing Type 2 Diabetes

A retrospective cohort study using survival analysis

¹ Mercy Hospital for Women, Victoria, Australia
² University of Melbourne, Victoria, Australia
³ Royal Women's Hospital, Victoria, Australia

Address correspondence and reprint requests to Dr. Anna J. Lee, Department of Perinatal Medicine, Level 3 Mercy Hospital for Women, 163 Studley Rd., Heidelberg 3084, Victoria, Australia. E-mail: annalee71{at}hotmail.com

OBJECTIVE—We sought to determine the long-term risk of type 2 diabetes following a pregnancy complicated by gestational diabetes mellitus (GDM) and assess what maternal antepartum, postpartum, and neonatal factors are predictive of later development of type 2 diabetes.

RESEARCH DESIGN AND METHODS—This was a retrospective cohort study using survival analysis on 5,470 GDM patients and 783 control subjects who presented for postnatal follow-up at the Mercy Hospital for Women between 1971 and 2003.

RESULTS—Risk of developing diabetes increased with time of follow-up for both groups and was 9.6 times greater for patients with GDM. The cumulative risk of developing type 2 diabetes for the GDM patients was 25.8% at 15 years postdiagnosis. Predictive factors for the development of type 2 diabetes were use of insulin (hazard ratio 3.5), Asian origin compared with Caucasian (2.1), and 1-h blood glucose (1.3 for every 1 mmol increase above 10.1 mmol). BMI was associated with an increased risk of developing type 2 diabetes but did not meet the assumption of proportional hazards required for valid inference when using Cox proportional hazards.

CONCLUSIONS—While specific predictive factors for the later development of type 2 diabetes can be identified in the index pregnancy, women with a history of GDM, as a group, are worthy of long-term follow-up to ameliorate their excess cardiovascular risk.

Abbreviations: BwtGC, birth weight gestational centile • FBG, fasting blood glucose • GDM, gestational diabetes mellitus • OGTT, oral glucose tolerance test

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