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Long term prognosis of women with gestational diabetes in a multiethnic population

¹ Department of Diabetes, Leicester General Hospital, Leicester, UK
² Department of Obstetrics and Gynaecology, Leicester General Hospital, Leicester, UK

Correspondence to:
Correspondence to:
Dr Matthew Oldfield
Department of Diabetes, Kingston Hospital, Galsworthy Road, Kingston Upon Thames, Surrey, KT2 7QB, UK; matthew.oldfield{at}kingstonhospital.nhs.uk

Aim: To assess the glucose tolerance of South Asian and Caucasian women with previous gestational diabetes mellitus (GDM).

Method: A retrospective follow-up study of 189 women diagnosed with GDM between 1995 and 2001. Glucose tolerance was reassessed by oral glucose tolerance test at a mean duration since pregnancy of 4.38 years.

Results: South Asian women comprised 65% of the GDM population. Diabetes developed in 36.9% of the population, affecting more South Asian (48.6%) than Caucasian women (25.0%). Women developing diabetes were older at follow-up (mean (SD) 38.8 (5.7) vs 35.9 (5.6) years; p<0.05) and had been heavier (body mass index 31.4 (6.3) vs 27.7 (6.7) kg/m²; p<0.05), more hyperglycaemic (Gl₀ 6.5 (1.7) vs 5.2 (1.1) mmol/l; p<0.01: G₁₂₀ 11.4 (3.3) vs 9.6 (1.8) mmol/l; p<0.01: HbA1c 6.4 (1.0) vs 5.6 (0.7); p<0.01) and more likely to require insulin during pregnancy (88.1% vs 34.0%; p<0.01). Future diabetes was associated with and predicted by HbA1c taken at GDM diagnosis in both South Asian (odds ratio 4.09, 95% confidence interval 1.35 to 12.40; p<0.05) and Caucasian women (OR 9.15, 95% CI 1.91 to 43.87; p<0.01) as well as by previously reported risk factors of increasing age at follow-up, pregnancy weight, increasing hyperglycaemia and insulin requirement during pregnancy.

Conclusion: GDM represents a significant risk factor for future DM development regardless of ethnicity. Glycated haemoglobin values at GDM diagnosis have value in predicting future diabetes mellitus.

Abbreviations: BMI, body mass index; GDM, gestational diabetes mellitus; HbA1c, glycated haemoglobin; IFG, impaired fasting glucose; IGT, impaired glucose tolerance; OGTT, oral glucose tolerance test; ROC, receiver operator characteristic

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