Angela Napoli1,2, Laura Sciacca3,4, Basilio Pintaudi3,5, Andrea Tumminia3,4, Maria Grazia Dalfrà6, Camilla Festa3, Gloria Formoso3,7, Raffaella Fresa3,8, Giusi Graziano9, Cristina Lencioni3,10, Antonio Nicolucci9, Maria Chiara Rossi9, Elena Succurro3,11, Maria Angela Sculli3,12, Marina Scavini3,13, Ester Vitacolonna3,14, Matteo Bonomo3,5, Elisabetta Torlone3,15. 1. AMD-SID Diabetes and Pregnancy Study Group, Rome, Italy. angela.napoli@uniroma1.it. 2. Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy. angela.napoli@uniroma1.it. 3. AMD-SID Diabetes and Pregnancy Study Group, Rome, Italy. 4. Department of Clinical and Experimental Medicine, Endocrinology Section, University of Catania Medical School, Catania, Italy. 5. SSD Diabetology, Ca'Granda Niguarda Hospital, Milan, Italy. 6. Department of Medicine, University of Padova, Padova, Italy. 7. Department of Medicine and Aging Sciences; Center for Advanced Studies and Technology (CAST, Ex CeSI-Met), G. D'Annunzio University, Chieti, Italy. 8. Endocrinology and Diabetes Unit, ASL Salerno, Salerno, Italy. 9. CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy. 10. Diabetes and Endocrinology Unit, Usl Nord Ovest Tuscany, Lucca, Italy. 11. Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy. 12. Endocrinology and Diabetes, Bianchi Melacrino Morelli Hospital, Reggio Calabria, Italy. 13. Division of Immunology, Transplantation and Infectious Diseases, Diabetes Research Institute (DRI), IRCCS San Raffaele Scientific Institute, Milan, Italy. 14. Department of Medicine and Aging, School of Medicine and Health Sciences, "G. D'Annunzio" University, Chieti-Pescara, Chieti, Italy. 15. Internal Medicine, Endocrinology and Metabolism, S. Maria Della Misericordia Hospital, Perugia, Italy.
Abstract
AIMS: To assess the proportion of women with gestational diabetes (GDM) by performing postpartum Oral Glucose Tolerance Test (OGTT) and to identify GDM phenotypes at high-risk of postpartum dysglycemia (PPD). METHODS: Observational, retrospective, multicenter study involving consecutive GDM women. Recursive partitioning (RECPAM) analysis was used to identify distinct and homogeneous subgroups of women at different PPD risk. RESULTS: From a sample of 2,736 women, OGTT was performed in 941 (34.4%) women, of whom 217 (23.0%) developed PPD. Insulin-treated women having family history of diabetes represented the subgroup with the highest PPD risk (OR 5.57, 95% CI 3.60-8.63) compared to the reference class (women on diet with pre-pregnancy BMI < = 28.1 kg/m2). Insulin-treated women without family diabetes history and women on diet with pre-pregnancy BMI > 28.1 kg/m2 showed a two-fold PPD risk. Previous GDM and socioeconomic status represent additional predictors. Fasting more than post-prandial glycemia plays a predictive role, with values of 81-87 mg/dl (4.5-4.8 mmol/l) (lower than the current diagnostic GDM threshold) being associated with PPD risk. CONCLUSIONS: Increasing compliance to postpartum OGTT to prevent/delay PPD is a priority. Easily available characteristics identify subgroups of women more likely to benefit from preventive strategies. Fasting BG values during pregnancy lower than those usually considered deserve attention.
AIMS: To assess the proportion of women with gestational diabetes (GDM) by performing postpartum Oral Glucose Tolerance Test (OGTT) and to identify GDM phenotypes at high-risk of postpartum dysglycemia (PPD). METHODS: Observational, retrospective, multicenter study involving consecutive GDM women. Recursive partitioning (RECPAM) analysis was used to identify distinct and homogeneous subgroups of women at different PPD risk. RESULTS: From a sample of 2,736 women, OGTT was performed in 941 (34.4%) women, of whom 217 (23.0%) developed PPD. Insulin-treated women having family history of diabetes represented the subgroup with the highest PPD risk (OR 5.57, 95% CI 3.60-8.63) compared to the reference class (women on diet with pre-pregnancy BMI < = 28.1 kg/m2). Insulin-treated women without family diabetes history and women on diet with pre-pregnancy BMI > 28.1 kg/m2 showed a two-fold PPD risk. Previous GDM and socioeconomic status represent additional predictors. Fasting more than post-prandial glycemia plays a predictive role, with values of 81-87 mg/dl (4.5-4.8 mmol/l) (lower than the current diagnostic GDM threshold) being associated with PPD risk. CONCLUSIONS: Increasing compliance to postpartum OGTT to prevent/delay PPD is a priority. Easily available characteristics identify subgroups of women more likely to benefit from preventive strategies. Fasting BG values during pregnancy lower than those usually considered deserve attention.
Authors: G de Gennaro; C Bianchi; M Aragona; L Battini; W Baronti; A Brocchi; S Del Prato; A Bertolotto Journal: Diabetes Res Clin Pract Date: 2020-07-07 Impact factor: 5.602