Risk factors for postpartum glycometabolism in patients with gestational diabetes mellitus: a prospective study / 中国基层医药

ABSTRACT

Objective:To investigate the risk factors for postpartum glycometabolism in patients with gestational diabetes mellitus (GDM), providing a new idea for clinical prevention of type 2 diabetes mellitus.Methods:Pregnant women who underwent regular prenatal examination in Cixi People's Hospital, China between February 2019 and January 2020 were included in this prospective cohort study. The clinical data before and during pregnancy were collected. These pregnant women were followed up for 6 weeks and 6 months postpartum. Oral glucose tolerance test (OGTT) with 75 g of glucose was performed. The clinical end point was abnormal glucose metabolism. Kaplan-Meier (KM) univariate analysis and multivariate Cox regression analyses were used to analyze the risk factors for abnormal glucose metabolism postpartum in patients with GDM.Results:A total of 252 eligible patients were included in this study. Among them, 212 patients finished 6-week follow-up, and 149 patients finished 6-month follow-up. Among the 212 patients who finished 6-week follow-up postpartum, 87 (41.04%) patients had abnormal glucose metabolism, 3 (1.42%) patients had impaired fasting glucose, 66 (31.13%) had impaired glucose tolerance, and 18 (8.49%) patients had type 2 diabetes mellitus. Among the 149 patients who finished 6-month follow-up postpartum, there were 2 new patients with impaired fasting glucose, 11 new patients with impaired glucose tolerance, and 3 new patients with type 2 diabetes mellitus. Overweight before pregnancy [body mass index (BMI) ≥ 24 kg/m 2] and1-hour OGTT (≥ 10.1 mmol/L) were the independent risk factors for abnormal glucose metabolism postpartum in pregnant patients with GDM ( OR = 2.273, 2.462; P = 0.039, 0.023; 95% CI = 1.495-3.051, 1.684-3.240). The Matsuda indexes and 60-minute insulinogenic index in the normal glucose metabolism group were significantly higher than in the abnormal glucose metabolism group ( t = 7.184 and 2.011, both P < 0.05). Conclusion:The incidence of abnormal glucose metabolism in patients with GDM at 6 months postpartum remains high. Overweight before pregnancy [body mass index ≥ 24 kg/m 2] and 1-hour OGTT (≥ 10.1 mmol/L) are the independent risk factors for abnormal glucose metabolism postpartum in pregnant patients with GDM.