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. 2020 Jul;11(4):985-993.
doi: 10.1111/jdi.13209. Epub 2020 Feb 20.

Long-term maternal cardiometabolic outcomes 22 years after gestational diabetes mellitus

Greg E Tutino  1   2 , Claudia Ht Tam  1   2 , Riza Ozaki  1   2 , Lai Yuk Yuen  3 , Wing Yee So  1   2 , Michael Hm Chan  4 , Gary Tc Ko  1   2 , Xilin Yang  5 , Juliana Cn Chan  1   2   6 , Wing Hung Tam  3 , Ronald Cw Ma  1   2   6
Affiliations

Long-term maternal cardiometabolic outcomes 22 years after gestational diabetes mellitus

Greg E Tutino et al. J Diabetes Investig. 2020 Jul.

Abstract

Aims/introduction: Women with gestational diabetes mellitus are at increased risk for type 2 diabetes. We characterized the association between maternal glycemia during pregnancy with long-term outcomes.

Methods and methods: In this prospective nested case-cohort study, participants were recalled for follow up with detailed evaluation including oral glucose tolerance test at 8, 15 and 22 years. Logistic regression was used to estimate the risk of developing impaired glucose tolerance/type 2 diabetes and metabolic syndrome at follow up. The association between maternal glycemia at pregnancy and follow up was evaluated by linear regression. We also charted trajectory of β-cell function during follow up.

Results: The analysis included 121 women with a mean follow-up period of 22.5 years, and a mean age of 50.3 years. Gestational diabetes was associated with an adjusted odds ratio of 2.48 (95% confidence interval 1.03-5.99) for combined diabetes/impaired glucose tolerance at follow up (P = 0.04). Women with a pre-pregnancy body mass index ≥23 had an odds ratio of 5.43 (95% confidence interval 1.87-15.72) for metabolic syndrome at follow up, compared with those with body mass index <23 (P = 0.002). Both fasting and 2-h glucose during pregnancy were strongly associated with glycemic indices at follow up (P-value <0.001-0.016). Gestational diabetes was associated with impaired β-cell function that remained relatively stable after the index pregnancy.

Conclusions: Chinese women with a history of gestational diabetes have a high prevalence of impaired glucose tolerance/type 2 diabetes at 22-year follow up. Glucose levels during mid-pregnancy are strongly associated with those of middle age.

Keywords: Gestational diabetes mellitus; Obesity; Type 2 diabetes.

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Conflict of interest statement

JCNC is the Chief Executive Officer (on pro bono basis) of Asia Diabetes Foundation (ADF), a charitable foundation established under the Chinese University of Hong Kong (CUHK) Foundation for developing the Joint Asia Diabetes Evaluation (JADE) Technology. She has received honoraria and traveling support for consultancy or giving lectures, and her affiliated institutions have received research and educational grants from Amgen, Ascencia, AstraZeneca, Bayer, Bristol‐Myers Squibb, Boehringer Ingelheim, Daiichi‐Sankyo, Eli‐Lilly, GlaxoSmithKline, Medtronic, Merck Serono, Merck Sharp & Dohme, Novo Nordisk, Pfizer and Sanofi. RCWM has received honoraria and traveling support for consultancy or giving lectures. and his affiliated institutions have received research and educational grants from AstraZeneca, Bayer, Boehringer Ingelheim, Merck Sharp & Dohme, Pfizer and Worldwide Diabetes. Proceeds have been donated to support diabetes research and education at the Chinese University of Hong Kong. The other authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Patient disposition and study scheme for 22‐year follow up to the Screening Test for Gestational Impaired Glucose Tolerance and Gestational Diabetes Mellitus Study. Abnormal glucose tolerance (AGT) is gestational diabetes mellitus (GDM)/gestational impaired glucose tolerance (GIGT). FPG, fasting plasma glucose; NGT, normal glucose tolerance.
Figure 2
Figure 2
Conversion to combination of impaired glucose tolerance or diabetes at 8‐, 15‐ and 22‐year follow up.
Figure 3
Figure 3
Changes in fasting and 2‐h plasma glucose (mmol/L) at 8‐, 15‐ and 22‐year follow up. GDM, gestational diabetes mellitus; GIGT, gestational impaired glucose tolerance; NGT, normal glucose tolerance.
Figure 4
Figure 4
Changes in oral disposition index at 8‐ and 22‐year follow up. GDM, gestational diabetes mellitus.
See this image and copyright information in PMC

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