Gestational diabetes greatly increases risk for developing future incident diabetes
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Key takeaways:
- Women diagnosed with gestational diabetes have 11.5 times higher risk for developing future incident diabetes.
- Gestational diabetes decreased the likelihood for achieving an HbA1c of less than 7%.
Women who have gestational diabetes during pregnancy have a more than 11 times higher risk for developing diabetes than women who did not have gestational diabetes, according to a study published in Diabetes Care.
“Our findings highlight the importance of regular diabetes screening following gestational diabetes, particularly in the first 12 months following delivery, which was marked by the highest incidence of diabetes and least likelihood of glycemic control, in order to facilitate early detection and appropriate diabetes management,” Katharine McCarthy, PhD, MPH, assistant professor at the Icahn School of Medicine at Mount Sinai, told Healio. “Other evidence has suggested that early diabetes control is associated with lower risk of future diabetes-related complications, even adjusting for glycemic control later in life, which underscores the clinical implications of these findings.”
McCarthy and colleagues analyzed data from A1C in Pregnancy and Postpartum Linkage for Equity (APPLE), a population-based cohort of postpartum women living in New York City. The study linked birth certificate data for New York City births from 2009 to 2011 with the city’s HbA1c registry data from 2009 to 2017. Observation began at 12 weeks postpartum. Only women without diabetes at baseline were included. Women had gestational diabetes if it was indicated on a hospital discharge record. Incident diabetes was defined as having two HbA1c records of 6.5% or higher. Glucose control was defined as an HbA1c less than 7% after a diabetes diagnosis. Women were divided by race and ethnicity into south/southeast Asian, east/central Asian, Black, Hispanic and white groups.
Gestational diabetes linked to higher risk
The study included 336,276 women, of whom 1.4% were diagnosed with diabetes during a 9-year follow-up. Gestational diabetes was prevalent in 6.7% of the cohort. The prevalence of gestational diabetes was highest among south/southeast Asian women (19.8%) and lowest among white women (4.2%). Incident diabetes was diagnosed in 11.8% of those with gestational diabetes and 0.6% without gestational diabetes.
The researchers noted that their algorithm did not distinguish between type 1 and type 2 diabetes, but they estimate that more than 95% of cases were type 2 diabetes.
Of women with incident diabetes, 70.4% achieved glycemic control with an HbA1c of less than 7% at follow-up. Achieving glycemic control was slightly more common among women without gestational diabetes compared with those with gestational diabetes (71.8% vs. 69.3%). Among racial-ethnic groups, east/central Asian women had the highest prevalence of women achieving glycemic control (81.9%) and Hispanic women had the lowest glycemic control rate (67.1%).
In adjusted analysis, women with gestational diabetes had a higher risk for developing diabetes than those without gestational diabetes (adjusted HR = 11.5; 95% CI, 10.8-12.3). The risk varied by racial-ethnic groups, with south/southeast Asian women with gestational diabetes having the lowest risk for developing diabetes (aHR = 7.7; 95% CI, 6.1-9.6). The increased risk for developing diabetes among women with gestational diabetes was higher for Black women (aHR = 10.3; 95% CI, 9.2-11.5), Hispanic women (aHR = 12.2; 95% CI, 10.9-13.5) and white women (aHR = 12.5; 95% CI, 10-15.6).
Glycemic control less common after gestational diabetes
Women with gestational diabetes were less likely to achieve glycemic control than those without gestational diabetes (aHR = 0.85; 95% CI, 0.81-0.93). Gestational diabetes was associated with a lower likelihood of having glycemic control in the first 12 weeks to 1 year postpartum (aHR = 0.88; 95% CI, 0.8-0.97), but no associations were observed in later postpartum periods. Black women with gestational diabetes (aHR = 0.77; 95% CI, 0.68-0.88) and Hispanic women with gestational diabetes (aHR = 0.84; 95% CI, 0.74-0.95) were less likely to achieve glycemic control than those without gestational diabetes.
“A history of gestational diabetes is a red flag for higher risk of diabetes among all racial-ethnic groups studied,” McCarthy said. “We also show that gestational diabetes is a warning sign for poorer glycemic control among those who develop diabetes after pregnancy, with Black and Hispanic women most affected. The good news is this red flag provides the opportunity for diabetes prevention, if we focus more intently on mom’s health in the first year postpartum.”
McCarthy said future studies are needed to examine the factors contributing to pathophysiological differences that led to the development of diabetes among women with gestational diabetes.
For more information:
Katharine McCarthy, PhD, MPH, can be reached at katharine.mccarthy@mountsinai.org.
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