Changes Of Postpartum Glucose Metabolism In Women With Gestational Diabetes Mellitus

Objective: To investigate postpartum glucose metabolism and related risk factors in women with a history of gestational diabetes mellitus (GDM)Methods: Seventy women with GDM in 2000-2004 and a normal oral glucose tolerance (75-g OGTT) at 6～12weeks after delivery (the GDM group) and 30 control women with normal glucose metabolism(the control group) were performed at a 75-g OGTT and insulin release test within 1-5 years after delivery.The levels of postpartum glucose metabolism, pancreatic beta-cell function and insulin resistance were compared between the two groups. The risk factors related to postpartum abnormal glucose metabolism were analysed.Results: (1) In the GDM group,there are 20 (28.6%) subjects with AGM (GDM-AGM group),7 (10%) of diabetes,10(l4.3%)of IGT and 3 (4.3%) of IFG ,and 50 subjects with nomal glucose tolerance (The GDM-NGT group), DM was discovered at postpartum 1 year ,No women developed AGM in the control group (P< 0.001). (2) In the GDM group,there were more women with older maternal age and family history of diabetes than in the control group (P< 0.01) .In comparison to the control group ,women in the GDM group had higher the levels of postpartum body mass index(BMI), waist circumference(WC), total cholesterol(TC) and HOMA-IR, and the levels of high-density lipoprotein cholesterol (HDL-ch) and HOMA-6 was lower (P<0.05). (3) In delamination analysis of the GDM group, the glucose levels from OGTT (0',60',120!) during pregnancy were higher in the GDM- AGM subjects than in the GDM-NGT subjects,and more women had to use insulin therapy in the GDM-AGM subjects (P<0.05) . Compared with the GDM-NGT subjects ,women with AGM had greater WC and higher the levels of TG after delivery (P<0.05). Women in the GDM-NGT subjects had greater Wc and higher the levels of TG and more women had family history of diabetes compared with the control group (P< 0.05) .Level of HOMA-IR was gradually declined among the GDM-AGM subjects , the GDM-NGT subjects and the control group (P<0.0l) . Logistic regression analysis showed that age, WC and HOMA-IR postpartum contribute to postpartum AGM.Conclusion: (1) Women with previous GDM are prone to develop postpartum AGM. Risk factors of postpartum AGM include WC and insulin resistance postpartum.(2) DM was discovered at postpartum 1 year,so follow-up should start at postpartum 1 year.