Metabolic outcomes at 12 months postpartum among individuals with glucose intolerance in pregnancy.

Abstract

Gestational diabetes (GDM) is associated with long-term risk for type 2 diabetes (T2D). We evaluated metabolic characteristics and β-cell function during pregnancy and at 12 months postpartum among individuals with varying levels of gestational glucose intolerance. This was a planned 12-month postpartum follow-up to the Gestational Diabetes Diagnostic Methods (GDM2) trial, which randomized pregnant individuals to GDM testing using either the IADPSG or Carpenter-Coustan (CC) criteria. All GDM2 participants with treated GDM (diagnosed by either CC or IADPSG), those with untreated glucose intolerance in the CC arm, and half of the participants with normal glucose tolerance were invited for 12-month follow-up. Glucose values, Stumvoll and Matsuda Indices to evaluate insulin sensitivity and resistance, the Disposition Index (DI), lipids, leptin, and adiponectin were assessed at 12-months postpartum.  . Of the 407 individuals seen at 12 months, 49 (12%) had untreated glucose intolerance and 53 (13%) had treated GDM (CC and IADPSG). Both during pregnancy and at 12-months postpartum, there were significant differences in insulin sensitivity, beta cell function, dyslipidemia, and alterations in leptin and adiponectin among individuals with both untreated glucose tolerance and treated GDM when compared to those with normal glucose testing. Individuals with untreated glucose intolerance in pregnancy by the CC Criteria have impaired β-cell function and significant metabolic abnormalities at 12 months postpartum similar to individuals with treated GDM, highlighting the need for ongoing preventive attention in this population to prevent T2D later in life.