Risk of early progression to prediabetes or diabetes in women with recent gestational dysglycaemia but normal glucose tolerance at 3-month postpartum

P>Objective Both gestational diabetes mellitus (GDM) and milder glucose intolerance in pregnancy identify women who are at risk of developing type 2 diabetes. While some of these women will have prediabetes or diabetes in the early postpartum, most will have normal glucose tolerance (NGT), despite their future diabetic risk. In this context, we sought to evaluate the risk of early progression to dysglycaemia in women with NGT at 3-month postpartum and identify predictors thereof. Methods Three hundred and twenty-five women with varying degrees of gestational dysglycaemia but NGT on oral glucose tolerance test (OGTT) at 3-month postpartum underwent repeat OGTT at 12-month postpartum. Results By 12-month postpartum, 10% of the study population and 17 center dot 1% of those with recent GDM had progressed to dysglycaemia (primarily impaired glucose tolerance). At 3-month postpartum, compared to nonprogressors, the progressors had (i) higher BMI (P = 0 center dot 0023), LDL (P = 0 center dot 0017), triglycerides (P = 0 center dot 0002), leptin (P = 0 center dot 0021) and C-reactive protein (P = 0 center dot 043), and (ii) lower HDL (P = 0 center dot 0026) and adiponectin (P = 0 center dot 045). Notably, although all women had NGT at the time, each of the following glucose-related parameters from the OGTT at 3-month postpartum emerged as a significant independent predictor of progression on logistic regression analyses: area-under-the-glucose-curve (OR = 1 center dot 37, 95%CI: 1 center dot 13-1 center dot 65; P = 0 center dot 0012); sum of the glucose values (OR = 1 center dot 16, 95%CI: 1 center dot 05-1 center dot 29; P = 0 center dot 0042); and having a delayed blood glucose peak (occurring > 30 min postload) (OR = 2 center dot 89, 95%CI: 1 center dot 29-6 center dot 45; P = 0 center dot 0097). Conclusions A normal OGTT at 3-month postpartum does not necessarily provide assurance of a low risk of progression to prediabetes. Glucose-related measures during this OGTT may identify those women at highest risk for early progression.