Predictors of Postpartum Diabetes in Women With Gestational Diabetes Mellitus

Predictors of Postpartum Diabetes in Women With Gestational Diabetes Mellitus Kristian Löbner 1 , Annette Knopff 1 , Andrea Baumgarten 1 , Ulrike Mollenhauer 1 , Sabine Marienfeld 1 , Marta Garrido-Franco 1 , Ezio Bonifacio 1 2 and Anette-G. Ziegler 1 1 Diabetes Research Institute and 3rd Medical Department, Krankenhaus München-Schwabing, Munich, Germany 2 Immunology of Diabetes Unit, San Raffaele Scientific Institute, Milan, Italy Address correspondence and reprint requests to Anette-G. Ziegler, Diabetes Research Institute, Koelner Platz 1, 80804 Munich, Germany. E-mail: anziegler{at}lrz.uni-muenchen.de Abstract The aim of this study was to stratify risk for postpartum diabetes in women who have gestational diabetes. Women with gestational diabetes were recruited between 1989 and 1999, and 302 were followed with oral glucose tolerance tests at 9 months and 2, 5, 8, and 11 years postpregnancy. The 8-year postpartum diabetes risk was 52.7% (130 diabetic cases). Risk was increased in women with autoantibodies to GAD and/or insulinoma antigen-2 (adjusted hazard ratio 4.1; P < 0.0001), women who required insulin during pregnancy (4.7; P < 0.0001), women with BMI >30 kg/m 2 (1.5; P = 0.04), and women with more than two prior pregnancies (2.5; P = 0.02). Women without these risk factors had a postpartum diabetes risk of 14% by 8 years, and risk rose incrementally to 96% by 8 years in autoantibody-positive women. Parity status, C-reactive protein concentration, a diabetes family history, maternal age, weeks of gestation, and the child’s birth weight did not significantly affect risk in multivariate analysis. Prospective diabetes assessment is indicated and intervention should be considered in women with gestational diabetes who are autoantibody positive, require insulin treatment during pregnancy, or are obese. CRP, C-reactive protein GDM, gestational diabetes mellitus IA-L, insulinoma antigen-2 IQR, interquartile range OGTT, oral glucose tolerance test Footnotes Accepted December 19, 2005. Received June 9, 2005. DIABETES