Gestational Diabetes Mellitus: Clinical Predictors and Long-Term Risk of Developing Type 2 Diabetes
A retrospective cohort study using survival analysis
- Anna J. Lee, MBBS12,
- Richard J. Hiscock, FANZCA12,
- Peter Wein, FRANZCOG23,
- Susan P. Walker, FRANZCOG, MD, CMFM12 and
- Michael Permezel, FRANZCOG, MRCP, MD12
- 1Mercy Hospital for Women, Victoria, Australia
- 2University of Melbourne, Victoria, Australia
- 3Royal 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
Abstract
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.
- BwtGC, birth weight gestational centile
- FBG, fasting blood glucose
- GDM, gestational diabetes mellitus
- OGTT, oral glucose tolerance test
Footnotes
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A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact.
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- Accepted December 19, 2006.
- Received August 29, 2006.
- DIABETES CARE
