4.4 Article

Prediction of recurrent gestational diabetes mellitus: a retrospective cohort study

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ARCHIVES OF GYNECOLOGY AND OBSTETRICS
卷 307, 期 3, 页码 689-697

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SPRINGER HEIDELBERG
DOI: 10.1007/s00404-022-06855-z

关键词

Gestational diabetes mellitus; Predictive model; Risk of recurrence; Family history; BMI; Obesity; Overweight; Insulin treatment

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Background: Women after gestational diabetes mellitus (GDM) are at increased risk for development of GDM recurrence. Objective: To evaluate factors for prediction of risk of recurrence. Methods: Retrospective cohort study including 159 women with GDM and a subsequent pregnancy. Logistic regression models were used to analyze putative risk factors for GDM recurrence. Results were compared to age-matched women without GDM. Results: The overall risk of GDM recurrence was 72.3%. Risk factors for recurrence included high pregravid BMI, positive family history, and insulin treatment during the index pregnancy. Cesarean section delivery (index pregnancy) showed borderline significance. Interpregnancy weight gain, excessive weight gain during the index pregnancy, and fetal outcome were not predictive. Neonates after GDM had a higher frequency of transfer to intensive care unit compared to controls. The best combined risk model for prediction of GDM recurrence included positive family history and high pregravid BMI. Conclusions: Positive family history of diabetes mellitus with overweight or obesity increases the risk of GDM recurrence. Normalization of pregravid BMI is an effective approach to reduce the risk of GDM recurrence.
Background Women after gestational diabetes mellitus (GDM) are at increased risk for development of GDM recurrence. It was the aim of our study to evaluate factors for prediction of risk of recurrence. Methods In this retrospective cohort study we included 159 women with GDM and a subsequent pregnancy. Putative risk factors for GDM recurrence were analyzed by logistic regression models. Results were compared to a cohort of age-matched women without GDM as controls (n = 318). Results The overall risk of GDM recurrence was 72.3% (115/159). Risk factors of recurrence were a body mass index (BMI) >= 30 kg/m(2) before the index pregnancy (odds ratio (OR) 2.8 [95% CI 1.3-6.2], p = 0,008), a BMI >= 25 kg/m(2) before the subsequent pregnancy (OR 2.7 [95% CI 1.3-5.8]. p = 0.008), a positive family history (OR 4.3 [95% CI 1.2-15.4], p = 0.016) and insulin treatment during the index pregnancy (OR 2.3 [95% CI 1.1-4.6], p = 0.023). Delivery by caesarean section (index pregnancy) was of borderline significance (OR 2.2 [95% CI 0.9-5.2], p = 0.069). Interpregnancy weight gain, excessive weight gain during the index pregnancy and fetal outcome where not predictive for GDM recurrence. Neonates after GDM revealed a higher frequency of transfer to intensive care unit compared to healthy controls (OR 2.3 [95% CI 1.1-4.6], p = 0.0225). The best combined risk model for prediction of GDM recurrence including positive family history and a BMI >= 25 kg/m(2) before the subsequent pregnancy revealed moderate test characteristics (positive likelihood ratio 7.8 [95% CI 1.1-54.7] and negative likelihood ratio 0.7 [95% CI 0.6-0.9]) with a positive predictive value of 96.6% in our cohort. Conclusions A positive family history of diabetes mellitus in combination with overweight or obesity were strongly associated with recurrence of a GDM in the subsequent pregnancy. Normalization of the pregravid BMI should be an effective approach for reducing the risk of GDM recurrence.

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