Postpartum dysglycaemia in overt diabetes in pregnancy   — ASN Events
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Postpartum dysglycaemia in overt diabetes in pregnancy   (#115)

Chih Ying (Maggie) Ko 1 2 , Ning Zhang 1 2 , Jenny Wright 1 , Stephanie Terry 1 , Cunjing Li 1 , Androulla Georgiou 1 , Mikey Xie 1 2 , Sarah Abdo 1 3 , Jeff Flack 1 3 , Tang Wong 1 2 3
  1. Bankstown-Lidcombe Hospital, Chippendale, NSW, Australia
  2. School of Clinical Medicine, Faculty of Medicine and Health , UNSW, Sydney, NSW, Australia
  3. School of Medicine, Western Sydney University, Sydney, NSW, Australia

Background:

Overt diabetes in pregnancy (ODM) is hyperglycaemia that is diagnosed during pregnancy but meets the diagnostic criteria of diabetes outside of pregnancy.  It is associated with increased risk of postpartum diabetes. 

 

Aim:

To compare the rate of postpartum dysglycaemia between ODM subgroups based on fasting plasma glucose (FPG) ≥ 7.0 mmol/L, 2-hr oral glucose tolerance test (OGTT) ≥11.1mmol/L, HbA1c ≥ 6.5%, or any combination of these.

 

Methods:

We analysed prospectively collected data from singleton pregnancies between 1991-2025 comprising ODM (n=660) and GDM (n=7658). Women with ODM were subcategorised into those that had FPG ≥ 7.0 mmol/L, 2-hr OGTT ≥11.1mmol/L, HbA1c ≥ 6.5%, or any combination of these.

Outcomes were rates of postpartum impaired fasting glucose (IFG) using WHO criteria of FPG 6.1-6.9 mmol/L, impaired glucose tolerance (IGT), using WHO criteria of 7.8-11.0 mmol/L, and type 2 diabetes (T2DM).

 

Results:

Overall, 39% of women with ODM completed a postpartum OGTT. 17 of the 79 women with FPG ≥ 7.0 mmol/L, 149 of 358 women with 2-hr OGTT ≥11.1mmol/L, 52 of 105 women with HbA1c ≥ 6.5%, and 41 of 118 women who met multiple criteria completed a postpartum OGTT.

Postpartum IFG or IGT was higher in ODM by 2h-OGTT vs GDM (34.9% vs 18.9%, p<0.001) and ODM by >1 criteria vs GDM (31.7% vs 18.9%, p<0.05). All subgroups of ODM had higher odds of progressing to T2DM, with odds ratio (OR) 9.5, 5.1, 12.5, and 13.8 for ODM by FPG, ODM by 2h-OGTT, ODM by HbA1C, and ODM by >1 criteria, respectively. Adjusting for age, BMI and non-European ethnicity did not significantly alter the OR.

 

Conclusions:

Only 39% of women with ODM completed OGTT postpartum. The women who did complete the OGTT showed increased odds of developing T2DM, regardless of ODM subgroup. Overall, the risk of IFG/IGT and T2DM were 30.1% and 22.0%, respectively. Consequently, the ODM group represents an important population to target when encouraging uptake of postpartum OGTT.