Prediction of Glucose Intolerance in Early Postpartum in Women with Gestational Diabetes Mellitus Based on the 2013 WHO Criteria

Abstract

Predictors for glucose intolerance postpartum were evaluated in women with gestational diabetes mellitus (GDM) based on the 2013 World Health Organization (WHO) criteria. 1841 women were tested for GDM in a prospective cohort study. A postpartum 75g oral glucose tolerance test (OGTT) was performed in women with GDM at 14 ± 4.1 weeks. Of all 231 mothers with GDM, 83.1% (192) had a postpartum OGTT of which 18.2% (35) had glucose intolerance. Women with glucose intolerance were more often of Asian origin [15.1% vs. 3.7%, OR 4.64 (1.26⁻17.12)], had more often a recurrent history of GDM [41.7% vs. 26.7%, OR 3.68 (1.37⁻9.87)], higher fasting glycaemia (FPG) [5.1 (4.5⁻5.3) vs. 4.6 (4.3⁻5.1) mmol/L, OR 1.05 (1.01⁻1.09)], higher HbA1c [33 (31⁻36) vs. 32 (30⁻33) mmol/mol, OR 4.89 (1.61⁻14.82)], and higher triglycerides [2.2 (1.9⁻2.8) vs. 2.0 (1.6⁻2.5) mmol/L, OR 1.00 (1.00⁻1.01)]. Sensitivity of glucose challenge test (GCT) ≥7.2 mmol/l for glucose intolerance postpartum was 80% (63.1%⁻91.6%). The area under the curve to predict glucose intolerance was 0.76 (0.65⁻0.87) for FPG, 0.54 (0.43⁻0.65) for HbA1c and 0.75 (0.64⁻0.86) for both combined. In conclusion, nearly one-fifth of women with GDM have glucose intolerance postpartum. A GCT ≥7.2 mmol/L identifies a high risk population for glucose intolerance postpartum.

Keywords: 2013 WHO criteria; gestational diabetes mellitus; glucose intolerance; postpartum; prediction; risk factors.

Figure 1

ROC curve for the glucose challenge test in pregnancy as a predictor for glucose intolerance postpartum. ROC: receiver operating curve; AUC: area under the curve.

Figure 2

ROC curve for fasting plasma glucose and HbA1c postpartum as a predictor for glucose intolerance. ROC: receiver operating curve; AUC: area under the curve; (A) ROC curve for fasting plasma glucose alone; (B) ROC curve for HbA1c alone; (C) ROC curve for fasting plasma glucose and HbA1c combined.