Antepartum Predictors of Insulin Therapy and Type 2 Diabetes Development in Women with Gestational Diabetes Mellitus

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SAT 806-823-Gestational Diabetes
Saturday, June 15, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SAT-813
Thi Hoang Lan Nguyen*1, Lena Salgado1, Ji Wei Yang1, Elisabeth Codsi2, Patricia Lecca1, Catherine Adam1, Marie-Josée Bédard2 and Ariane Godbout1
1Centre de Recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada, 2Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
Background: Women diagnosed with gestational diabetes mellitus (GDM) represent a large spectrum of heterogeneous metabolic state. Necessity for antepartum insulin therapy (AIT) has been taken as a marker of GDM severity. Identification of predictors for AIT and postpartum Type 2 diabetes (T2D) development could optimize care for this high-risk population. Objective: To determine major predictors of GDM, AIT and postpartum development of impaired glucose tolerance (IGT) or T2D in our population. Methods: A retrospective study was carried out among women diagnosed with GDM between 2005 and 2011 and non diabetic women who delivered in 2011 at the CHUM. GDM was diagnosed if at least one of the two values on 75g oral glucose tolerance test (OGTT) was above local criteria. Following factors were analyzed: maternal age, parity, family history of diabetes mellitus (DM), pre-pregnancy body mass index (BMI), gestational weight gain (GWG), prior GDM or macrosomia, gestational age at GDM diagnosis, hypertension (HTN), OGTT and HbA1c values. Results: A total of 2436 women were included: 1653 with GDM (G1) and 783 without GDM (G2: control group). Compared to G2, G1 women were older, had higher pre-pregnancy BMI and proportions of primiparous and non-Caucasians were higher. Major risk factors identified for GDM were prior GDM or macrosomia and a family history of DM. AIT was required in 60.3% of women in G1. Predictors of AIT were early diagnosed GDM (<20 weeks:14.3 vs 2.8%), two values over limit at OGTT (35.9 vs 16.4%), pre-pregnancy BMI (27.4 vs 25.7 kg/m2), prior GDM (25.5 vs 13.0%), family history of DM (39.0 vs 31.9%), and, to a lesser extent, maternal age, fasting plasma glucose at screening (5.2 vs 4.8 mmol/L), HTN and prior macrosomia. GWG, ethnic groups distribution and HbA1c were similar in both groups. Prevalence of postpartum IGT was 11.6% and T2D 2.6% after OGTT done at a median of 20.9 weeks after delivery. Predictors of early postpartum IGT or T2D development were: maternal age (33.7 vs 32.8 years), non-caucasian origin, early GDM diagnosis, higher screening OGTT values, AIT (82.9 vs 68.7%), chronic HTN, past history of GDM or macrosomia and family history of DM. Conclusion: Probability of AIT, postpartum IGT or T2D can be estimated in GDM patients based upon similar predictors such as screening OGTT values, early GDM diagnosis, prior GDM and family history of DM, reflecting metabolic state of those women. Identifying these predictive parameters at GDM diagnosis would permit application of effective preventive strategies in this high-risk population.

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Nothing to Disclose: THLN, LS, JWY, EC, PL, CA, MJB, AG

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