Abstract

Introduction: Women with a history of gestational diabetes mellitus (GDM) have more risk for developing postpartum hyperglycemia. Identification of the potential predictors of future progression of prediabetes and/or diabetes in women with GDM will assist in more accurate risk stratification of patients during pregnancy. Therefore, this study aimed to identify the prevalence post-partum glucose intolerance and to develop a prediction model based on antenatal characteristics to predicted postpartum glucose intolerance.

Methods: A prospective cohort study was conducted on women with GDM diagnosed using the updated international diagnostic criteria. All women who had GDM were advised to undergo postpartum oral glucose tolerance test (ppOGTT) at 6-12 weeks of delivery. Predictors of post-partum glucose intolerance were identified using the multivariate analysis. The discriminative power of the predictable variables for postpartum glucose intolerance and the model accuracy were computed by the area under the receiver operating characteristic (ROC) curve and estimated by the area under the curve (AUC) with 95% confidence interval.

Results: Of all women with GDM, 112 (85.5%) attended and completed the ppOGTT. The prevalence of postpartum glucose intolerance was 21.4% (95% CI: 14.3–28.4) inclusive of 18.7% prediabetes and 2.7 % diabetes. Multivariate logistic regression analysis revealed that advanced maternal age, high FPG at diagnosis, overweight and/or obesity, and antenatal depression were significant predictive factors for post-partum glucose intolerance. The AUC of the final reduced model to predict post-partum glucose intolerance was 0.884 (95% CI: 0.821 to 0.939). The FPG at GDM diagnosis [AUC= 0.736 (95% CI: 0.616-0.845)] and overweight and/or obesity [AUC = 0.718 (95% CI:0.614- 0.814)] were better predictors of postpartum glucose intolerance. Moreover, the AUC for the combined predictors of FPG at diagnosis and MUAC was 0.822 (95% CI:0.722- 0.907), which was the best predictor.

Conclusion: Our finding confirmed the high prevalence of post-partum glucose intolerance among women with GDM. Antenatal factors were modestly predictive of post-partum glucose intolerance. The findings suggested the ongoing glucose screening is indicated for all women with GDM.

Keywords: gestational diabetes mellitus, post-partum glucose intolerance, oral glucose tolerance test, prediabetes, diabetes