Recurrence of gestational diabetes: who is at risk?

Abstract

Objective: The object was to determine the recurrence rate of gestational diabetes mellitus and to find various risk factors that might increase this rate.

Study design: Seventy-eight patients with gestational diabetes mellitus in their index pregnancies were evaluated in subsequent pregnancies. Medical records for the index and subsequent pregnancies were abstracted for age, parity, body mass index, birth weight, gestational age of gestational diabetes mellitus diagnosis, insulin requirement, weight gain, and interval between pregnancies. These variables were then compared between patients with and without gestational diabetes mellitus in their subsequent pregnancies.

Results: Fifty-four of 78 patients (69%) had gestational diabetes mellitus in a subsequent pregnancy. The recurrence of gestational diabetes mellitus was more common when the following variables were present in the index pregnancy: parity > or = 1 (P < .004; odds ratio 3.0, 95% confidence interval 1.4-4.8), body mass index > or = 30 kg/m2 (P < .04; odds ratio 3.6, 95% confidence interval 1.1-25.9), gestational diabetes mellitus diagnosis at < or = 24 gestational weeks (P < .0003; odds ratio 20.4, 95% confidence interval 2.5-444), and insulin requirement (P < .0002; odds ratio 2.3, 95% confidence interval 1.3-3.4). A weight gain of > or = 15 pounds (P < .003; odds ratio 2.9, 95% confidence interval 1.0-5.3) and an interval between pregnancies < or = 24 months (P < .03; odds ratio 1.6, 95% confidence interval 1.1-2.2) were also associated with a recurrence of gestational diabetes mellitus. A multiple logistic regression analysis revealed that an interval of < or = 24 months and a weight gain of > or = 15 pounds between pregnancies were most strongly correlated with a recurrence of gestational diabetes mellitus.

Conclusions: Gestational diabetes mellitus is more likely to recur in parous, obese women who had an early gestational diabetes mellitus diagnosis and required insulin in the index pregnancy. In addition, a shorter interval (< or = 24 months) and a larger weight gain (> or = 15 pounds) between pregnancies appear to be the most significant risk factors for a recurrence of gestational diabetes mellitus.