Published online Oct 15, 2021. doi: 10.4239/wjd.v12.i10.1778
Peer-review started: May 31, 2021
First decision: June 24, 2021
Revised: July 5, 2021
Accepted: August 30, 2021
Article in press: August 30, 2021
Published online: October 15, 2021
Processing time: 135 Days and 0.5 Hours
Gestational diabetes mellitus (GDM) is a common metabolic disorder of pregnancy. It has short- and long-term maternal, fetal, and neonatal complications. Women with GDM are at a seven-fold higher risk of developing type 2 diabetes (T2D) within 7-10 years after childbirth, compared with those with normoglycemic pregnancy.
There is emerging evidence that both GDM and T2D can be subtyped according to their pathophysiology. We attempted to examine the link between subtypes of GDM and the prediction of postnatal T2D.
To assess the utility of oral glucose tolerance test (OGTT) in the identification of distinct GDM pathophysiology and in the prediction of possible distinct postnatal T2D subtypes.
The glycemic status of a cohort of 4603 pregnant Emirati Arab women, who delivered in 2007 in Dubai United Arab Emirates, was assessed retrospectively, using OGTT according to the International Association of Diabetes and Pregnancy Study Groups criteria. Of the total, 1231 women were followed up and assessed in 2016. The receiver operating characteristic curve for the OGTT was plotted and sensitivity, specificity, and predictive values of fasting blood glucose (FBG) and 2hrBG for T2D were estimated.
The prevalence of GDM in pregnant Emirati women in 2007 was 1057/4603 (23%), while the prevalence of pre-pregnancy T2D based on ADA criteria, was 230/4603 (5%). In the subset of women (n = 1231) followed up in 2016, the prevalence of GDM in 2007 was 362/1231 (29.6%), while the prevalence of pre-pregnancy T2D, was 36/1231 (2.9%). Of the 362 pregnant women with GDM in 2007, 96/362 (26.5%) developed T2D, 142/362 (39.2%) developed impaired fasting glucose, 29/362 (8.0%) developed impaired glucose tolerance, and the remaining 95/362 (26.2%) had normal glycemia in 2016. The prevalence of T2D, based on ADA criteria, stemmed from the prevalence of 36/1231 (2.9%) in 2007 to 141/1231 (11.5%), in 2016. The positive predictive value (PPV) for FBG suggests that, if a woman is positive for GDM in 2007, then the probability of developing T2D in 2016 was about 24%. The opposite is being observed in the predictability of T2D in 2016 using the 2hrBG in diagnosis of GDM in 2007. The PPV value suggests that if a woman was positive for GDM in 2007 then the probability of developing T2D in 2016 was only 3%.
The results of this study revealed that both raised antenatal FBG and 2hrBG levels could predict postpartum T2D; however, it suggested that each parameter may indicate a distinct T2D pathophysiology. Women with predominant peripheral resistance to the action of insulin, who have raised FBG levels during pregnancy, were at a greater risk of developing T2D, compared with those with raised postprandial 2hrBG levels.
Our findings suggested that, for women who at a greater risk of developing T2D, postnatal management like frequent follow-ups, lifestyle modifications, and specific treatment protocols, should be applied to slow down the development of T2D and improve the quality of life for them and their newborns.