Lack of postpartum reclassification test in gestational diabetes - factors conditioning loss of follow-up

BackgroundWomen with gestational diabetes (GDM) have an elevated risk of developing type 2 diabetes (T2DM). NICE Guidance recommends women who develop GDM are screened 6 weeks post-partum and annually thereafter.AimTo evaluate conformity to guidance of screening in women with GDM by 6-week post-partum fasting plasma glucose (FPG) and annual FPG and determine time between delivery and development of T2DM.MethodRecords at a tertiary referral centre were used to identify women (n = 54) diagnosed with GDM by antenatal oral glucose tolerance test between July 1999 and January 2007. Data from laboratory records were used to collect investigations of glycaemic status during the follow-up period (median follow-up 12.4 years, range 9.5–17.1 years).ResultsOf 252 women, 102 (40.2%) did not have a FPG at 6 weeks (+/−2 weeks). Of these, median time to first test was 1.2 years (range 0.04–10.8 years), with only 43.1% followed-up within 1 year. In those who had a 6-week FPG, 17 (11.3%) women had no further tests. A total of 84 (33% of those with gestational diabetes in the index pregnancy) women were diagnosed with T2DM; median time from delivery to diagnosis was 5.2 years (range 0.35–15.95). We found the only significant factor for a follow-up test at 1-year post-partum was the use of insulin.ConclusionOur data suggest an alternative approach is needed for monitoring women with a history of GDM. This needs to be appropriate for a generally healthy group in which traditional screening mechanisms may not be adequate or sufficient.

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Faculty Opinions recommendation of Metformin in gestational diabetes: the offspring follow-up (MiG TOFU): body composition at 2 years of age.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.13477960.14858061 ◽

2012 ◽

Author(s):

Jane Norman ◽

Rebecca Reynolds

Keyword(s):

Body Composition ◽

Gestational Diabetes

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Women's engagement, views and experiences of postnatal follow-up after Gestational Diabetes Mellitus in pregnancy

Midwifery ◽

10.1016/j.midw.2021.103043 ◽

2021 ◽

pp. 103043

Author(s):

Siân Pierce Roberts ◽

Sheila JS Brown ◽

Dr Seren Haf Roberts

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

In Pregnancy

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Correction to: Barriers to postpartum follow-up of mothers with gestational diabetes mellitus and its implications: a mixed method study

International Journal of Diabetes in Developing Countries ◽

10.1007/s13410-021-00982-0 ◽

2021 ◽

Author(s):

Ninu P. Mathew ◽

Arathi P. Rao ◽

Prakash Narayanan

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Mixed Method ◽

Mixed Method Study

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Metabolic signatures in the conversion from gestational diabetes mellitus to postpartum abnormal glucose metabolism: a pilot study in Asian women

Scientific Reports ◽

10.1038/s41598-021-95903-w ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Xi-Meng Wang ◽

Yan Gao ◽

Johan G. Eriksson ◽

Weiqing Chen ◽

Yap Seng Chong ◽

...

Keyword(s):

Diabetes Mellitus ◽

Glucose Metabolism ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Post Partum ◽

Diagnostic Biomarkers ◽

Serum Metabolites ◽

Abnormal Glucose Metabolism ◽

Metabolic Signatures

AbstractWe aimed to identify serum metabolites related to abnormal glucose metabolism (AGM) among women with gestational diabetes mellitus (GDM). The study recruited 50 women diagnosed with GDM during mid-late pregnancy and 50 non-GDM matchees in a Singapore birth cohort. At the 5-year post-partum follow-up, we applied an untargeted approach to investigate the profiles of serum metabolites among all participants. We first employed OPLS-DA and logistic regression to discriminate women with and without follow-up AGM, and then applied area under the curve (AUC) to assess the incremental indicative value of metabolic signatures on AGM. We identified 23 candidate metabolites that were associated with postpartum AGM among all participants. We then narrowed down to five metabolites [p-cresol sulfate, linoleic acid, glycocholic acid, lysoPC(16:1) and lysoPC(20:3)] specifically associating with both GDM and postpartum AGM. The combined metabolites in addition to traditional risks showed a higher indicative value in AUC (0.92–0.94 vs. 0.74 of traditional risks and 0.77 of baseline diagnostic biomarkers) and R2 (0.67–0.70 vs. 0.25 of traditional risks and 0.32 of baseline diagnostic biomarkers) in terms of AGM indication, compared with the traditional risks model and traditional risks and diagnostic biomarkers combined model. These metabolic signatures significantly increased the AUC value of AGM indication in addition to traditional risks, and might shed light on the pathophysiology underlying the transition from GDM to AGM.

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