Endocrinol Metab.  2022 Feb;37(1):112-123. 10.3803/EnM.2021.1276.

Risk and Risk Factors for Postpartum Type 2 Diabetes Mellitus in Women with Gestational Diabetes: A Korean Nationwide Cohort Study

• Choi MJ
• Choi J
• Chung CW

• KMID: 2527142
• DOI: http://doi.org/10.3803/EnM.2021.1276

Abstract

Background
There are differences in risk and risk factor findings of postpartum type 2 diabetes mellitus (T2DM) after gestational diabetes depending on study design and subjects of previous studies. This study aimed to assess these risk and risk factors more accurately through a population-based study to provide basic data for prevention strategies.
Methods
This open retrospective cohort included data of 419,101 women with gestational diabetes and matched 1,228,802 control women who delivered between 2004 and 2016 from the South Korea National Health Information Database of the National Health Insurance Service. Following 14 (median 5.9) years of follow-up, the incidence and hazard ratio (HR) of postpartum T2DM were evaluated using Kaplan-Meier curves and Cox proportional regression models.
Results
The incidence and HR of postpartum T2DM in women with gestational diabetes (compared to women without gestational diabetes) after the 14-year follow-up was 21.3% and 2.78 (95% confidence interval [CI], 2.74 to 2.82), respectively. Comorbid obesity (body mass index [BMI] ≥25 kg/m²) increased postpartum T2DM risk 7.59 times (95% CI, 7.33 to 7.86). Significant risk factors for postpartum T2DM were fasting glucose level, BMI, age, family history of diabetes, hypertension, and insulin use during pregnancy.
Conclusion
This population-based study showed higher postpartum T2DM risk in women with gestational diabetes than in those without, which was further increased by comorbid obesity. BMI and fasting glucose level were important postpartum risk factors. The management of obesity and glycemic control may be important strategies to prevent the incidence of diabetes after delivery.

Keyword

Diabetes, gestational; Diabetes mellitus, type 2; Postpartum period; Body mass index; Glycemic control; Cohort studies

Figure

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  Fig. 1 Study subjects were identified for the analysis of risk of and risk factors for incident type 2 diabetes mellitus after delivery.

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  Fig. 2 Cumulative incidence rate of type 2 diabetes mellitus after delivery was evaluated by Kaplan-Meier curves according to gestational diabetes (A), gestational diabetes and obesity (B). CI, confidence interval.

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  Fig. 3 A forest plot showed significant risk factors for incident type 2 diabetes mellitus 1 year after delivery among women with gestational diabetes. CI, confidence interval; BMI, body mass index.

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