What is the risk for persistent metabolic dysfunction in women with a history of gestational diabetes mellitus (GDM)?

Updated: Apr 29, 2020
  • Author: Thomas R Moore, MD; Chief Editor: George T Griffing, MD  more...
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A study by Stuebe et al found that gestational diabetes mellitus and impaired glucose tolerance during pregnancy are associated with persistent metabolic dysfunction at 3 years after delivery, separate from other clinical risk factors. [3] A study by O’Reilly et al concluded that gestational insulin use, non-European ethnicity, a family history of type 2 diabetes mellitus, and an elevated body mass index (BMI) were factors associated with persistent dysglycemia in women who have had gestational diabetes mellitus. The study also concluded that breastfeeding may provide beneficial metabolic effects in women with gestational diabetes mellitus and should be recommended. [11]

A study by Benhalima et al indicated that in the early postpartum period, glucose intolerance is frequently present in women diagnosed (according to the 2013 World Health Organization criteria) with gestational diabetes mellitus. Of 135 women in the study diagnosed with gestational diabetes mellitus who underwent an OGTT, 42.2% had prediabetes, including 24.4% who had impaired glucose tolerance, 11.9% who had impaired fasting glucose, and 5.9% in whom both glucose tolerance and fasting glucose were impaired. Moreover, beta-cell function was lower in women with postpartum glucose intolerance than it was in women with a normal postpartum OGTT, although insulin sensitivity was similar between the two groups. [12]

A study by Wallace et al found that after age 40 years, the mean fasting glucose in women with a history of gestational diabetes mellitus was 27 mg/dL higher than that in nulligravid women. The investigators also observed racial heterogeneity in their results, noting a disproportionately elevated mean fasting glucose in black women with a history of gestational diabetes mellitus after age 40 years. [13]

A study by Franzago et al found in a cohort of women in their third trimester of pregnancy that the concentration of adipocyte-derived extracellular vesicles (aEVs) was lower in females with gestational diabetes mellitus than in controls. The report also indicated that the aEV concentration is significantly correlated with total cholesterol in third-trimester women with gestational diabetes mellitus. [14]

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