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Poster session II Clinical obstetrics, diabetes, labor, medical-surgical-disease, physiology/endocrinology, prematurity: Abstracts 237 - 386| Volume 208, ISSUE 1, SUPPLEMENT , S120, January 01, 2013

262: Risk factors associated with postpartum impaired glucose tolerance at the first postpartum screening in women with gestational diabetes

      Objective

      Gestational diabetes mellitus (GDM) is associated with much increased risk of developing diabetes later on in life. The purpose of this study was to identify risk factors associated with abnormal glucose tolerance (AGT) at the first postpartum 75g oral glucose tolerance test (OGTT) in women with GDM in their index pregnancies.

      Study Design

      We included women with GDM who had the first postpartum OGTT at 6-8 week postpartum. Women with overt diabetes in pregnancy were excluded. We investigated the association between abnormal OGTT results in the first glucose screening at 6-8 weeks postpartum and maternal risk factors including age, prepregnancy body mass index (BMI), insulin therapy in pregnancy, plasma glucose (PG) levels, HbA1c, fasting immunoreactive insulin (IRI), and insulinogenic index (II=ΔIRI[30-min]/ΔPG[30-min]) at the time of OGTT during pregnancy. We defined impaired glucose tolerance and diabetes by using WHO criteria as postpartum AGT. We tested the association between the risk factors and AGT by using logistic regression analysis.

      Results

      We included 168 women with GDM, to whom we examined OGTT at 6.9±1.5 weeks postpartum. Fifty-seven women (34%) showed postpartum AGT. In univariate analysis, 1-hour PG at OGTT (p<0.005), HbA1c (p<0.0005), II (p<0.02), and insulin therapy (p<0.001) were associated with postpartum AGT. Among them, II (p<0.05) and insulin therapy (p<0.0001) were independent risk factors of postpartum AGT after adjusting for maternal age, prepregnancy BMI, gestational age, and PG levels at OGTT during pregnancy. Adjusted odds ratios for postpartum AGT in women with II<0.4 and women with insulin therapy were 5.6 (95% confidence interval, 1.56-20.39) and 3.43 (1.03-12.6), respectively.

      Conclusion

      In women with GDM, lower II, as a marker of early phase of insulin secretion during OGTT, and insulin therapy during pregnancy are independent risk factors of AGT at 6-8 weeks postpartum.