1357-P: Gestational Diabetes Mellitus: Postpartum Metabolic Outcome and Risk Factors Involved

Abstract

Gestational diabetes mellitus (GDM) is a highly prevalent clinical entity that prospectively allows to identify a population of women with a high risk of developing type 2 diabetes mellitus (T2DM). The rate of persistent metabolic abnormalities after delivery and the evidence regarding risk factors related are limited and variable.

Objectives: 1) To describe the prevalence of carbohydrate metabolism (CHM) abnormalities after childbirth in Argentine women with GDM. 2) To categorize risk factors involved in such abnormalities.

Methods: During the last 5 years, 165 women with diagnosis of GDM (according to ADA criteria) were evaluated. Patients with diagnosed or suspected pregestational diabetes, clinical relevance comorbidities and those in treatment with hyperglycemic drugs were excluded. FPG and 2-hours plasma glucose during a 75-g OGTT were performed from 6 weeks postpartum.

Results: In the reassessment, 106 women (64.2%) had normal parameters (NP) and 59 (35.8%) showed impared glucemic metabolism (IGM): IGT in 18, IFG in 25, both abnormalities in 13 and 3 developed T2DM. In the IGM group, 74.6% were 30 yr or older while in the NP group only 52.8% (p=0.006). In women with pathologic reevaluation, 18.5% had a history of previous GDM compared to 4.8% in the other group (p=0.005). In patients with IGM, 62.5% showed pre-pregnancy BMI ≥ 27 vs. 44.3% in those with NP (p=0,039). A logistic regression analysis was performed to identify the pregnancy factors that independently predict IGM. As expected, age ≥ 30 yr (OR 4.05, 95%CI 1.01-15.08) and previous GDM (OR 11.35, 95%CI 1.22-104.86) were associated significantly (p=0.037).

Conclusions: In our population, the analysis showed a high prevalence of CHM abnormalities following GDM. We found a higher risk for IGM in patients who had a history of previous GDM, age ≥ 30 yr and BMI ≥ 27. We therefore believe it is important to categorize risk factors in order to establish preventive therapeutic actions, particularly in cases with greater vulnerability.