Abstract

Objective: Up to 30% of the women with recent gestational diabetes (GDM) remain glucose intolerant after delivery. However, the rate of postpartum glucose tolerance testing (ppOGTT) is low. Our study aimed to develop a model for risk assessment to target women with high risk for postpartum diabetes.

Research and Methods: In 605 Caucasian women with GDM antenatal obstetrical and glucose data and the glucose data of the ppOGTT performed 13 weeks(median) after delivery were prospectively collected.

Results: A total of 132(21.8%) women had an abnormal ppOGTT (2.8% impaired fasting glucose(IFG), 13.6% impaired glucose tolerance(IGT), 5.5% Diabetes). Independent risk factors were BMI≥30 kg/m² (prevalence of abnormal ppOGTT 36.0 vs 17.3%), gestational age(GA) at diagnosis <24 weeks (32.4 vs 18.0%), 1-h-antenatal-value >200 mg/dl(11.1 mmol/L) (35.2 vs 14.8%) and insulin therapy (30.3 vs 14.5%). Prevalence of abnormal ppOGTT was assessed according to the number of risk factors: 0=9.2% (14/153), 1=13.4% (25/186), 2=28.5% (43/151), 3=45.6% (26/57, 4=68.4% (13/19). Subjects were divided according to significant increase of prevalence and risk for ppOGTT: Low risk (59.9% of subjects):<2 RF, 11.6 %, OR 1.3; intermediate:2 RF, 28.5%, OR 4.0 and high:>2 RF, 51.3%, OR 10.5. 86.6% of diabetes and 67% of all abnormal ppOGTTs were identified by the intermediate/high risk group.

Conclusion: Women with ≥2 risk factor have a high risk for abnormal postpartum OGTT, 86% of postpartum diabetes is diagnosed within this group. Targeting women for ppOGTT testing based on a risk assessment using available antenatal risk factors might reduce the number of missed postpartum diabetes.