Joon Ho Moon1, Soo Heon Kwak1, Hye Seung Jung1, Sung Hee Choi1, Soo Lim1, Young Min Cho1, Kyong Soo Park1, Hak C Jang1, Nam H Cho1. 1. Department of Internal Medicine (J.H.M., S.H.K., H.S.J., S.H.C., S.L., Y.M.C., K.S.P., H.C.J.), Seoul National University College of Medicine, Seoul 110-744, Korea; Department of Internal Medicine (J.H.M., S.H.K., H.S.J., Y.M.C., K.S.P.), Seoul National University Hospital, Seoul 110-799, Korea; and Department of Internal Medicine (S.H.C., S.L., H.C.J.), Seoul National University Bundang Hospital, Seongnam 463-707, Korea; and Department of Preventive Medicine (N.H.C.), Ajou University School of Medicine, Suwon 443-721, Korea.
Abstract
CONTEXT: The effect of weight gain on the development of type 2 diabetes after gestational diabetes mellitus (GDM) is not fully understood in Asian women who have a relatively low body mass index (BMI). OBJECTIVE: We investigated the effect of postpartum longitudinal BMI change on the development of diabetes in Korean women with a history of GDM. DESIGN AND SETTING: The study included a hospital-based, multicenter, prospective cohort with median follow-up of 4.0 years. PARTICIPANTS: A total of 418 women with previous GDM or gestational impaired glucose tolerance were recruited and underwent an oral glucose tolerance test at 6 weeks postpartum and annually thereafter. MAIN OUTCOME MEASURE: The risk of diabetes was analyzed according to the tertiles of BMI change. Changes in BMI were calculated between the initial postpartum visit and the last follow-up or at the onset of diabetes. RESULTS: The BMI change in each tertile was -1.8 ± 1.1, -0.2 ± 0.3, and 1.6 ± 1.2 kg/m(2), respectively. We observed an increased risk of incident diabetes as the tertile of BMI change increased (8.6%, 12.6%, and 16.9%, P = .039). Postpartum BMI change was an independent predictor of diabetes in a multivariate Cox analysis (hazard ratio 1.27, 95% confidence interval 1.04-1.56, P = .021), even after adjusting for BMI at the last follow-up. In the highest tertile group, there was a significant deterioration in cardiovascular risk factors including blood pressure, lipid profile, and insulin sensitivity. CONCLUSIONS: Postpartum increase in BMI is significantly associated with a risk of diabetes and deterioration of metabolic phenotypes in Korean GDM women.
CONTEXT: The effect of weight gain on the development of type 2 diabetes after gestational diabetes mellitus (GDM) is not fully understood in Asian women who have a relatively low body mass index (BMI). OBJECTIVE: We investigated the effect of postpartum longitudinal BMI change on the development of diabetes in Korean women with a history of GDM. DESIGN AND SETTING: The study included a hospital-based, multicenter, prospective cohort with median follow-up of 4.0 years. PARTICIPANTS: A total of 418 women with previous GDM or gestational impaired glucose tolerance were recruited and underwent an oral glucose tolerance test at 6 weeks postpartum and annually thereafter. MAIN OUTCOME MEASURE: The risk of diabetes was analyzed according to the tertiles of BMI change. Changes in BMI were calculated between the initial postpartum visit and the last follow-up or at the onset of diabetes. RESULTS: The BMI change in each tertile was -1.8 ± 1.1, -0.2 ± 0.3, and 1.6 ± 1.2 kg/m(2), respectively. We observed an increased risk of incident diabetes as the tertile of BMI change increased (8.6%, 12.6%, and 16.9%, P = .039). Postpartum BMI change was an independent predictor of diabetes in a multivariate Cox analysis (hazard ratio 1.27, 95% confidence interval 1.04-1.56, P = .021), even after adjusting for BMI at the last follow-up. In the highest tertile group, there was a significant deterioration in cardiovascular risk factors including blood pressure, lipid profile, and insulin sensitivity. CONCLUSIONS: Postpartum increase in BMI is significantly associated with a risk of diabetes and deterioration of metabolic phenotypes in Korean GDM women.
Authors: Dennis Schrijnders; Steven H Hendriks; Nanne Kleefstra; Pauline A J Vissers; Jeffrey A Johnson; Geertruida H de Bock; Henk J G Bilo; Gijs W D Landman Journal: PLoS One Date: 2018-01-25 Impact factor: 3.240