Section of Diabetes, Azienda-Ospedaliero Universitaria Pisana, Pisa, Italy.
Section of Diabetes, Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy.
J Diabetes Complications. 2021 Apr;35(4):107854. doi: 10.1016/j.jdiacomp.2021.107854. Epub 2021 Jan 9.
For women with previous gestational diabetes (GDM), international guidelines recommend 75 g oral glucose tolerance test (OGTT) at 4-12 weeks after delivery to assess glucose tolerance, considering their increased risk of type 2 diabetes. We evaluated prevalence of postpartum impaired glucose regulation (IGR) and identified associated risk factors.
We retrospectively collected data from 749 women with previous GDM (IADPSG criteria) who underwent postpartum OGTT for type 2 diabetes screening between 2011 and 2019. IGR was identified according to ADA criteria.
Prevalence of IGR was 12.7%, lower in women with pre-pregnancy normal weight, higher in women with family history of type 2 diabetes and in those treated with insulin during pregnancy. Prevalence of IGR raised with increasing number of altered glucose values at OGTT performed during pregnancy for GDM screening. HbA1c and triglycerides measured during the third trimester of pregnancy were higher in women with postpartum IGR. At postpartum screening, women with IGR had higher BMI, waist, blood pressure. At multivariate logistic regression analysis, family history of diabetes (OR 2.21; 95% CI: 1.33-3.69; p < 0.01) and presence of all three glucose values exceeding threshold at OGTT during pregnancy (OR 2.89; 95% CI: 1.42-5.86; p < 0.01) were independently associated with IGR.
In women with GDM, persistence of IGR in the immediate postpartum period is associated with family history of diabetes and the presence of all three glucose values exceeding diagnostic threshold for GDM at OGTT in pregnancy, suggesting that these women should undergo specific diabetes monitoring and prevention programs.
对于有既往妊娠糖尿病（GDM）的女性，国际指南建议在分娩后 4-12 周进行 75g 口服葡萄糖耐量试验（OGTT）以评估葡萄糖耐量，因为她们患 2 型糖尿病的风险增加。我们评估了产后糖调节受损（IGR）的患病率，并确定了相关的危险因素。
我们回顾性收集了 749 名既往 GDM（IADPSG 标准）女性的数据，这些女性在 2011 年至 2019 年间进行了产后 OGTT 以筛查 2 型糖尿病。根据 ADA 标准确定 IGR。
IGR 的患病率为 12.7%，孕前体重正常的女性患病率较低，有 2 型糖尿病家族史和孕期接受胰岛素治疗的女性患病率较高。随着用于 GDM 筛查的 OGTT 期间异常血糖值数量的增加，IGR 的患病率也随之升高。孕期第 3 个三个月测量的 HbA1c 和甘油三酯在产后 IGR 女性中较高。在产后筛查时，IGR 女性的 BMI、腰围和血压更高。在多变量逻辑回归分析中，糖尿病家族史（OR 2.21；95%CI：1.33-3.69；p<0.01）和孕期 OGTT 期间所有三个血糖值均超过阈值（OR 2.89；95%CI：1.42-5.86；p<0.01）与 IGR 独立相关。
在 GDM 女性中，产后即刻 IGR 的持续存在与糖尿病家族史和孕期 OGTT 时所有三个血糖值均超过 GDM 诊断阈值相关，这表明这些女性应进行特定的糖尿病监测和预防计划。
