Vol 94, No 5 (2023)
Research paper
Published online: 2022-03-28

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Risk factors for recurrence of gestational diabetes mellitus in southern Chinese women: a retrospective study

Yingshi Liang1, Jingjin Gong1, Xiao Chen2, Guangqing Li1, Xiaobin Lin1, Jing He1, Yi Chen1, Ruixia Wu1
Pubmed: 35419789
Ginekol Pol 2023;94(5):350-357.


Objectives: Predictors of gestational diabetes mellitus (GDM) recurrence (GDMR) was determined in southern Chinese women.
Material and methods: A total of 376 women with GDM who had two consecutive singleton deliveries at our hospital between January 2014 and October 2020 were enrolled in the current study. We retrospectively compared the clinical characteristics, fasting plasma glucose level (FPG-1), and oral glucose tolerance test-1h-1 and -2h-1 (OGTT 1hr-1: 1-h post-load glucose level during the first pregnancy and OGTT 2hr-1: 2-h post-load glucose level during the first pregnancy) for the first pregnancy between patients in the GDMR group (n = 166) and the non-GDMR group (n = 210).
Results: The incidence of GDMR in the study population was 44.15%. During the first pregnancy, women in the GDMR group had significantly higher OGTT 1h-1, OGTT 2h-1, and FPG-1 + OGTT 1h + 2h-1 compared to the non-GDMR group. When the threshold of the FPG-1 + OGTT 1h + 2h-1 level in the first pregnancy was > 23.6 mmol/L, the specificity for predicting GDMR was 0.85, the sensitivity was 0.45, and the area under the receiver operating characteristic curve (ROC-AUC) was 0.70, indicating a 70% probability of predicting GDMR in the next pregnancy. Logistic regression analysis showed that patients with a combined abnormal FPG-1 + OGTT 1h + 2 h-1 level had a 10-fold increased risk for GDMR in subsequent pregnancies than patients with normal indicators (OR: 10.542, 95% CI: 3.097–35.881; p < 0.0001).
Conclusions: The OGTT 1h-1 and OGTT 2h-1 are independent risk factors for GDMR in southern Chinese women. Women with an FPG-1 + OGTT 1h + 2h-1 threshold level > 23.6 mmol/L in the first pregnancy had a 10-fold greater probability of developing GDMR in the second pregnancy than women in the non-GDMR group.

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  1. Gestational Diabetes Mellitus. Diabetes Care. 2004; 27(suppl_1): s88–s90.
  2. England LJ, Dietz PM, Njoroge T, et al. Preventing type 2 diabetes: public health implications for women with a history of gestational diabetes mellitus. Am J Obstet Gynecol. 2009; 200(4): 365.e1–365.e8.
  3. Hill JC, Krishnaveni GV, Annamma I, et al. Glucose tolerance in pregnancy in South India: relationships to neonatal anthropometry. Acta Obstet Gynecol Scand. 2005; 84(2): 159–165.
  4. Yang H, Wei Y, Gao X, et al. China National GDM Survey Working Group. Risk factors for gestational diabetes mellitus in Chinese women: a prospective study of 16,286 pregnant women in China. Diabet Med. 2009; 26(11): 1099–1104.
  5. Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 2011; 34(Supplement_1): S62–S69.
  6. American Diabetes Association. (2) Classification and diagnosis of diabetes. Diabetes Care. 2015; 38 Suppl: S8–SS16.
  7. Goyal A, Gupta Y, Kalaivani M, et al. Long term (>1 year) postpartum glucose tolerance status among Indian women with history of Gestational Diabetes Mellitus (GDM) diagnosed by IADPSG criteria. Diabetes Res Clin Pract. 2018; 142: 154–161.
  8. Serlin DC, Lash RW. Diagnosis and management of gestational diabetes mellitus. Am Fam Physician. 2009; 80(1): 57–62.
  9. Teng X, Shane McI, Pan S. The changing situation about maternal age, risk factors and pregnancy outcomes after the two-child policy: a retrospective cohort study. Ann Palliat Med. 2020; 9(3): 824–834.
  10. Guariguata L, Linnenkamp U, Beagley J, et al. Global estimates of the prevalence of hyperglycaemia in pregnancy. Diabetes Res Clin Pract. 2014; 103(2): 176–185.
  11. Metzger BE, Gabbe SG, Persson B, et al. International Association of Diabetes and Pregnancy Study Groups Consensus Panel. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010; 33(3): 676–682.
  12. Eyth E, Basit H, Smith CJ. Glucose Tolerance Test. [Updated 2020 Aug 11]. In: StatPearls [Internet]. StatPearls Publishing, Treasure Island (FL) 2915.
  13. Renz PB, Chume FC, Timm JRT, et al. Diagnostic accuracy of glycated hemoglobin for gestational diabetes mellitus: a systematic review and meta-analysis. Clin Chem Lab Med. 2019; 57(10): 1435–1449.
  14. Anna V, van der Ploeg HP, Cheung NW, et al. Sociodemographic correlates of the increasing trend in prevalence of gestational diabetes mellitus in a large population of women between 1995 and 2005. Diabetes Care. 2008; 31(12): 2288–2293.
  15. Bernstein J, Lee-Parritz A, Quinn E, et al. After Gestational Diabetes: Impact of Pregnancy Interval on Recurrence and Type 2 Diabetes. Biores Open Access. 2019; 8(1): 59–64.
  16. Dabelea D, Snell-Bergeon JK, Hartsfield CL, et al. Kaiser Permanente of Colorado GDM Screening Program. Increasing prevalence of gestational diabetes mellitus (GDM) over time and by birth cohort: Kaiser Permanente of Colorado GDM Screening Program. Diabetes Care. 2005; 28(3): 579–584.
  17. Rowaily MAAl, Abolfotouh MA. Predictors of gestational diabetes mellitus in a highparity community in Saudi Arabia. East Mediterr Health J. 2010; 16(06): 636–641.
  18. Aekplakorn W, Tantayotai V, Numsangkul S, et al. Detecting Prediabetes and Diabetes: Agreement between Fasting Plasma Glucose and Oral Glucose Tolerance Test in Thai Adults. J Diabetes Res. 2015; 2015: 396505.
  19. Kanat M, Mari A, Norton L, et al. Distinct β-cell defects in impaired fasting glucose and impaired glucose tolerance. Diabetes. 2012; 61(2): 447–453.
  20. Greenbaum CJ, Prigeon RL, D'Alessio DA. Impaired beta-cell function, incretin effect, and glucagon suppression in patients with type 1 diabetes who have normal fasting glucose. Diabetes. 2002; 51(4): 951–957.
  21. Schwartz N, Nachum Z, Green MS. Risk factors of gestational diabetes mellitus recurrence: a meta-analysis. Endocrine. 2016; 53(3): 662–671.
  22. Schwartz N, Nachum Z, Green MS. The prevalence of gestational diabetes mellitus recurrence--effect of ethnicity and parity: a metaanalysis. Am J Obstet Gynecol. 2015; 213(3): 310–317.
  23. Kwak SH, Kim HS, Choi SH, et al. Subsequent pregnancy after gestational diabetes mellitus: frequency and risk factors for recurrence in Korean women. Diabetes Care. 2008; 31(9): 1867–1871.
  24. Ryan EA. Diagnosing gestational diabetes. Diabetologia. 2011; 54(3): 480–486.
  25. Bergman M, Jagannathan R, Buysschaert M, et al. Lessons learned from the 1-hour post-load glucose level during OGTT: Current screening recommendations for dysglycaemia should be revised. Diabetes Metab Res Rev. 2018; 34(5): e2992.
  26. Kahn SE. The importance of the beta-cell in the pathogenesis of type 2 diabetes mellitus. Am J Med. 2000; 108 Suppl 6a: 2S–8S.
  27. Toft-Nielsen MB, Damholt MB, Madsbad S, et al. Determinants of the impaired secretion of glucagon-like peptide-1 in type 2 diabetic patients. J Clin Endocrinol Metab. 2001; 86(8): 3717–3723.
  28. Abdul-Ghani MA, Abdul-Ghani T, Stern MP, et al. Two-step approach for the prediction of future type 2 diabetes risk. Diabetes Care. 2011; 34(9): 2108–2112.
  29. Fiorentino TV, Marini MA, Andreozzi F, et al. One-Hour Postload Hyperglycemia Is a Stronger Predictor of Type 2 Diabetes Than Impaired Fasting Glucose. J Clin Endocrinol Metab. 2015; 100(10): 3744–3751.
  30. Lencioni C, Volpe L, Miccoli R, et al. Early impairment of beta-cell function and insulin sensitivity characterizes normotolerant Caucasian women with previous gestational diabetes. Nutr Metab Cardiovasc Dis. 2006; 16(7): 485–493.
  31. Retnakaran R, Qi Y, Sermer M, et al. The antepartum glucose values that predict neonatal macrosomia differ from those that predict postpartum prediabetes or diabetes: implications for the diagnostic criteria for gestational diabetes. J Clin Endocrinol Metab. 2009; 94(3): 840–845.
  32. Wang YY, Liu Ye, Li C, et al. Frequency and risk factors for recurrent gestational diabetes mellitus in primiparous women: a case control study. BMC Endocr Disord. 2019; 19(1): 22.
  33. Nathan DM, Davidson MB, DeFronzo RA, et al. American Diabetes Association. Impaired fasting glucose and impaired glucose tolerance: implications for care. Diabetes Care. 2007; 30(3): 753–759.
  34. Davies MJ, Raymond NT, Day JL, et al. Impaired glucose tolerance and fasting hyperglycaemia have different characteristics. Diabet Med. 2000; 17(6): 433–440.
  35. Meyer C, Pimenta W, Woerle HJ, et al. Different mechanisms for impaired fasting glucose and impaired postprandial glucose tolerance in humans. Diabetes Care. 2006; 29(8): 1909–1914.
  36. Festa A, D'Agostino R, Hanley AJG, et al. Differences in insulin resistance in nondiabetic subjects with isolated impaired glucose tolerance or isolated impaired fasting glucose. Diabetes. 2004; 53(6): 1549–1555.
  37. Golden SH, Bennett WL, Baptist-Roberts K, et al. Antepartum glucose tolerance test results as predictors of type 2 diabetes mellitus in women with a history of gestational diabetes mellitus: a systematic review. Gend Med. 2009; 6 Suppl 1: 109–122.
  38. Morrison MK, Lowe JM, Collins CE. Perceived risk of Type 2 diabetes in Australian women with a recent history of gestational diabetes mellitus. Diabet Med. 2010; 27(8): 882–886.