Jotic Aleksandra Z, Stoiljkovic Milica M, Milicic Tanja J, Lalic Katarina S, Lukic Ljiljana Z, Macesic Marija V, Stanarcic Gajovic Jelena N, Milovancevic Mina M, Gojnic Dugalic Miroslava G, Jeremic Veljko M, Lalic Nebojsa M
Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Center of Serbia, Dr. Subotica 13, 11000, Belgrade, Serbia.
Faculty of Medicine, University of Belgrade, Dr. Subotica 8, 11000, Belgrade, Serbia.
Diabetes Ther. 2021 Oct;12(10):2691-2700. doi: 10.1007/s13300-021-01144-5. Epub 2021 Aug 30.
Women with previous gestational diabetes (pGD) are at higher risk of prediabetes (PD) after delivery. The aim of this study was to determine the prevalence of and predictors for PD among women with pGD.
The study included 186 women with pGD treated by lifestyle modification. After delivery, the women were divided into group A (n = 80) with PD and group B (n = 106) with normal glucose tolerance (NGT), defined by the results of the 2-h oral glucose tolerance test at 4-12 weeks after delivery. We recorded age, body mass index (BMI) at conception and after delivery, fasting glucose (FG), glycated hemoglobin (HbA1c), total cholesterol (TC), triglycerides (Tg), low density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c) and the Tg/HDL-c ratio measured in the third trimester of pregnancy.
Of the 186 women with pGD enrolled in the study, 43% showed prediabetes at 4-12 weeks after delivery, with 13.9% of these women showing impaired FG (IFG), 12.9% showing impaired glucose tolerance (IGT) and 16.2% with IFG/IGT. The groups differed in terms of age and BMI at conception and after delivery. In the third trimester of pregnancy, HbA1c was higher in women in group A than in those in group B (mean ± standard deviation: 5.6 ± 0.4 vs. 5.2 ± 0.3%; p < 0.001), while FG was comparable. Compared to women in group B, women in group A had higher TC (7.1 ± 0.8 vs. 6.6 ± 1.0 mmol/L), Tg (2.7 ± 0.9 vs. 2.1 ± 0.6 mmol/L) and LDL-c (4.7 ± 0.8 vs. 4.3 ± 1.0 mmol/L) (all p < 0.001), lower HDL-c (1.0 ± 0.2 vs. 1.4 ± 1.0; p < 0.001) and higher median Tg/HDL-c (5.4 [range 4.6-14.3] vs. 4.9 [range 1.1-11.5]; p < 0.001). Univariate analysis found an association between prediabetes and age, BMI at conception and after delivery, HbA1c, TC, LDL-c, HDL-c, Tg and Tg/HDL-c ratio. Of these variables, the multivariate analysis showed age (odds ratio [OR] 1.19; p < 0.001), HbA1c (OR 31.06; p < 0.001), Tg (OR 4.09; p < 0.001) and LDL-c (OR 2.00; p = 0.005) as predictors for prediabetes.
High prevalence of early diagnosed PD in women with pGD was accompanied by advanced age and higher BMI at conception and after delivery. Moreover, age, HbA1c, Tg and LDL-c were predictors for PD.
既往有妊娠期糖尿病（pGD）的女性产后发生糖尿病前期（PD）的风险更高。本研究旨在确定pGD女性中PD的患病率及其预测因素。
本研究纳入了186例通过生活方式干预治疗的pGD女性。产后，根据产后4 - 12周2小时口服葡萄糖耐量试验结果，将这些女性分为A组（n = 80）患有PD和B组（n = 106）葡萄糖耐量正常（NGT）。我们记录了年龄、受孕时和产后的体重指数（BMI）、空腹血糖（FG）、糖化血红蛋白（HbA1c）、总胆固醇（TC）、甘油三酯（Tg）、低密度脂蛋白胆固醇（LDL - c）、高密度脂蛋白胆固醇（HDL - c）以及妊娠晚期测得的Tg/HDL - c比值。
在纳入本研究的186例pGD女性中，43%在产后4 - 12周表现为糖尿病前期，其中13.9%的女性表现为空腹血糖受损（IFG），12.9%表现为糖耐量受损（IGT），16.2%为IFG/IGT。两组在受孕时和产后的年龄及BMI方面存在差异。在妊娠晚期，A组女性的HbA1c高于B组（均值±标准差：5.6±0.4 vs. 5.2±0.3%；p < 0.001），而FG相当。与B组女性相比，A组女性的TC（7.1±0.8 vs. 6.6±1.0 mmol/L）、Tg（2.7±0.9 vs. 2.1±0.6 mmol/L）和LDL - c（4.7±0.8 vs. 4.3±1.0 mmol/L）更高（均p < 0.001），HDL - c更低（1.0±0.2 vs. 1.4±1.0；p < 0.001），中位数Tg/HDL - c更高（5.4 [范围4.6 - 14.3] vs. 4.9 [范围1.1 - 11.5]；p < 0.001）。单因素分析发现糖尿病前期与年龄、受孕时和产后的BMI、HbA1c、TC、LDL - c、HDL - c、Tg和Tg/HDL - c比值之间存在关联。在这些变量中，多因素分析显示年龄（比值比[OR] 1.19；p < 0.001）、HbA1c（OR 31.06；p < 0.001）、Tg（OR 4.09；p < 0.001）和LDL - c（OR 2.00；p = 0.005）是糖尿病前期的预测因素。
pGD女性中早期诊断的PD患病率较高，同时受孕时和产后年龄较大且BMI较高。此外，年龄、HbA1c、Tg和LDL - c是PD的预测因素。
