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Weight gain after gestational diabetes elevates type 2 diabetes risk in obese women
Women with gestational diabetes who had obesity before pregnancy and continue to gain weight after are at increased risk for developing type 2 diabetes, according to research published in Diabetologia.
The risk for progression was 43 times greater among women with a BMI of at least 30 kg/m2 who gained 5 kg or more after delivery than women who maintained a healthy body weight before becoming pregnant and gained less than 5 kg after delivery, according to researchers.
“Before our study, the associations of BMI and weight change with risk of type 2 diabetes among women with a history of gestational diabetes — a population at high risk of type 2 diabetes — had not been comprehensively examined,” Cuilin Zhang, MD, PhD, of the Eunice Kennedy Shriver National Institute of Child Health and Human Development at the NIH, said in a news release.
Previous research has shown that up to one-third of women with type 2 diabetes have a history of gestational diabetes during pregnancy, according to the release.
Zhang, with Wei Bao, MD, PhD, also of the NIH, and colleagues from other institutions looked at data from 1,695 women with a history of gestational diabetes between 1991 and 2001 from the Nurses’ Health Study II (NHS II) to examine how adiposity and weight change affect long-term type 2 diabetes risk.
The investigation was part of the ongoing Diabetes & Women’s Health study, which aims to identify determinants of this type of diabetes progression among participants in both the NHS II and the Danish National Birth Cohort.
The investigators tracked the women until 2009. Body weight and incident cases of type 2 diabetes were reported biennially. The researchers defined baseline as the questionnaire period when women reported a pregnancy with incident gestational diabetes. Cox proportional hazards models were used to estimate HRs and 95% CIs.
During 18 years, there were 259 incident type 2 diabetes cases. The associated risk for type 2 diabetes increased similarly for each 1 kg/m2 increase in baseline BMI (HR = 1.16; 95% CI, 1.12-1.19) and most recent BMI (HR = 1.16; 95% CI, 1.13-1.2).
Further, for every 5-kg weight gain after developing gestational diabetes, the risk for developing type 2 diabetes was 27% higher (adjusted HR = 1.27; 95% CI, 1.04-1.54).
Women with a BMI of at least 30 kg/m2 at baseline and at least 5-kg weight gain after gestational diabetes had an adjusted HR of 43.19 (95% CI, 13.6-137.11) compared with women who had a BMI of less than 25 kg/m2 at baseline and gained less than 5 kg after gestational diabetes.
These associations between BMI and weight change and type 2 diabetes risk persisted across different categories of age, family history of diabetes, diet quality, physical activity, breast-feeding duration and time since gestational diabetes.
“Our findings provide evidence to support the recent call from [National Diabetes Education Program] and highlight the importance of achieving and maintaining a healthy weight in these high-risk women to prevent future development of type 2 diabetes,” the researchers wrote. – by Allegra Tiver
Disclosure: The researchers report no relevant financial disclosures.