Endocrine Abstracts

Background and aim :

To determine clinical and metabolic predictors of persistant abnormal glucose tolerance in post partum after gestational diabetes mellitus (GDM).

Methods:

This was a prospective study including 150 patients with GDM who underwent 75g oral glucose tolerance test (OGTT) at 4-12 weeks after delivery.

Results:

The prevalence of abnormal glucose tolerance in post partum after GDM was 32,8 % ,inclusive of 3.3% type 2 diabetes and 29.5% pre-diabetes.

After univariate analysis, persistent carbohydrate tolerance disorders in post partum were statistically associated with age (34,77± 4,02 vs 32,07±6,29 years ;p=0.015) and AB blood group (10.3% vs 0% ;p=0.012).

Family history of type 2 diabetes in a first degree relative, personal history of GDM, fetal macrosomia, pre-gestational Body Mass Index and parity did not statiscally differ between the two groups.

Thirty minutes of moderate physical activity five times per week was a protective factor (p=0.004) while sedentary lifestyle was associated with impaired carbohydrate tolerance in post partum (p=0.004).

Fasting blood glucose, glycemia at 2 hour in 75 g oral glucose tolerance test (OGTT) > 1.6 g / l and insulin use according to a full basal bolus regimen were significantly associated with the persistence of carbohydrate tolerance  disorders (respectively p=0.005, p=0.02, p =0.03).

After multivariate analysis, the independent factor associated with abnormal glucose tolerance in post partum was glycemia at 2 hour (OGTT) (OR 5.18, 95% CI 1.27- 21.16 ,p=0.02).

Conclusion:

Antenatal caracteristics may predict abnormal glucose tolerance in post partum after GDM. High prevalence of persistent carbohydrate tolerance disorders highlights the importance of ongoing screening for all women with previous GDM in order to delay the onset of type 2 diabetes in this high risk population.