Long-term significance of gestational carbohydrate intolerance: a longitudinal study

Summary

Severe forms of GDM have been conclusively associated with significantly increased risk of developing DM later on in life. The long-term significance of GIGT has not yet been definitely elucidated. The study was set up to compare the present carbohydrate metabolism status and anthropomorphic characteristics of women diagnosed as suffering from abnormal carbohydrate tolerance during pregnancy eight years previously with those recorded as having normal glucose tolerance. The prevalence of present abnormal glucose tolerance was significantly higher in women who had been noted to have carbohydrate intolerance during their pregnancy, the prevalence depending on the gestational severity (10.0% in normal glucose tolerance, 36.4% in borderline GIGT; 66.7% in GIGT). Women whose overweight or obese status persists or develops after their pregnancy were statistically more likely to develop abnormal glucose tolerance later on in life (11.9-12.5% in normal-overweight BMI, 38.2% in obese BMI). A maternal and sibling, but not paternal, family history of diabetes was also a statistically significant risk factor. GIGT appears to be a definite risk factor for the development of carbohydrate metabolism problems later on in life, this being related to the severity during pregnancy and the presence or development of obesity. It is proposed that women diagnosed to suffer from GIGT should be regularly monitored after the pregnancy, particularly if other risk factors such as obesity are also present.

Diabetes mellitus - Pregnancy - Morbidity - Risk factors

References

• 1 Aerts L, Van Assche A. Is gestational diabetes an acquired condition?.  J Developmental Physiology. 1979;  1 219-225
• 2 Damm P. Gestational diabetes mellitus and subsequent development of overt diabetes mellitus.  Dan Med Bull. 45(5) 495-509 1998; 
• 3 Damm P, Kuhl C, Bertelsen A, Molsted-Pederson I. Predictive factors for the development of diabetes in women with previous gestational diabetes mellitus.  Am J Obstet Gynecol. 1992;  167 607-616
• 4 Katona G, Aganovic I, Vuscan V, Skrabalo Z. The National Diabetes Programme in Malta - Final Report Phases I & II. WHO.NCD/OND/DIAB/83.2. +115p Geneva; WHO 1983
• 5 Kerenyi Z, Tamas G. Diabetes and Pregnancy. In: Williams R, Papez L, Fuller J. (eds.) London; Diabetes in Europe INSERM 1994: 94-107
• 6 Mohamed N, Dooley J. Gestational diabetes and subsequent development of NIDDM in aboriginal women of northwestern Ontario.  Int J Circumpolar Health. 57 ((Suppl 1)) 1998;  355-8
• 7 O'Sullivan J B. Diabetes mellitus after gestational diabetes mellitus.  Diabetes. 29 ((Suppl 2)) 1991;  131-135
• 8 Persson B, Hanson V, Hartling S G, Binder C. Follow-up of women with previous gestational diabetes mellitus: insulin, C-peptide and proinsulin responses to oral glucose load.  Diabetes. 40 ((Suppl 2)) 1991;  136-141
• 9 Pettitt D J, Aleck K A, Baird H R, Carraher M J, Bennett P H. Congenital susceptibility to NIDDM. Role of intrauterine environment.  Diabetes. 1988;  37 622-628
• 10 Savona-Ventura C, Schranz A G. Metabolic effects of Infants born to mothers with G-IGT. A Pilot Study Inter J Risk Safety Med, submitted
• 11 Schranz A G. Abnormal glucose tolerance in the Maltese. A population-based longitudinal study of the natural history of NIDDM and IGT in Malta.  Diabetes Res Clin Pract. 1989;  7 7-16
• 12 WHO .Diabetes mellitus, report of a WHO study group. Technical report Series 727 Geneva; WHO 1985
• 13 Wein P, Beischer N, Harris C, Permezel M. A trial of simple versus intensified dietary modification for prevention of progression to diabetes mellitus in women with impaired glucose tolerance.  Aust N Z J Obstet Gynaecol. 39(2) 162-6 1999;