Risk Factors Of Postpartum Hyperglycemia In Gestational Diabetes Patients

Objective:The present study was aim to provide a better understanding of postpartum hyperglycemia in women with gestational diabetes mellitus(GDM),to analyze the correlation between of islet function and postpartum hyperglycemia in GDM patients,to explore the risk factors for postpartum progression from GDM to type 2 diabetes(T2DM)using the multivariate non conditional logistic regression analysis,and to provide the clinical and theoretical basis for the prevention of postpartum progression from GDM to impaired fasting glucose/impaired glucose tolerance(prediabetes)or type 2 diabetes.Methods:The participants were pregnant women who enrolled in our hospital outpatient between December 2015 and December 2016.These women underwent 75g glucose tolerance test(OGTT)between 24-28 weeks of pregnancy and 435 women were diagnosed with GDM.300 cases were included in the present study and were followed-up to one year(January 2017 to December 2017).254 cases were eligible to be included to the present study.The metabolic markers of the participants were collected during pregnancy,including body mass index,blood glucose,blood lipid and other related markers.During the follow-up period,the following information were collected one year after giving birth:body weight,blood pressure,body composition,breastfeeding,physical activity,serum insulin,fasting blood glucose,two hours postprandial blood glucose,glycated hemoglobin,triglyceride and total bile acids,alcohol,high-density lipoprotein,low-density lipoprotein,leptin,C-reactive protein,adiponectin and interleukin-6 levels.OGTT was reexamined 6 weeks after postpartum and grouped according to the OGTT index one year after one,the use of t test to analyze the difference between the different groups in pregnancy indicators,the risk factors for postpartum progression from GDM to type 2 diabetes(T2DM)were analyzed using the multivariate non conditional logistic regression analysis.The method of repeated sequence analysis of variance was used to analyze the islet function index of GDM women at different periods to explore the relationship between the islet function of GDM women and the incidence of postpartum hyperglycemia and type 2 diabetes.Results:In this study,there was no statistically significant difference in age and height between the control group(the group with normal blood glucose return)and the study group(P>0.05).The mean BMI before pregnancy in the study group 1 year after delivery was 22.34+4.35,higher than the mean BMI of 21.23+3.12 in the control group,and the difference between the two groups was statistically significant(P<0.05).The cumulative incidence of postpartum abnormal glucose metabolism(i.e.,abnormal OGTT rate)of GDM pregnant women was 22.83%(58/254),and the incidence of abnormal glucose metabolism was increased with the extension of follow-up time,but the onset peak was within 42 days after delivery.The differences in prenatal and postpartum lipids between the study group and the control group were statistically significant at 42 days postpartum,six months postpartum,and one year postpartum(all P<0.05).There was no significant difference in prenatal and postpartum serum lipid levels in the abnormal glucose metabolism group at 42 days postpartum,six months postpartum,and one year postpartum(all P>0.05).Stepwise Logistic regression analysis of multiple factors and non-conditional variables was performed step by step with age of pregnancy,number of births,family history of DM,BMI before pregnancy,weight growth rate during pregnancy,postpartum weight difference,fasting blood glucose during pregnancy,insulin use during pregnancy,abnormal OGTT,dyslipidemia and OGTT as dependent variables.Regression analysis showed that family history of DM,BMI before pregnancy,fasting blood glucose during pregnancy,increased islet function during pregnancy and abnormal OGTT test during pregnancy were risk factors for abnormal glucose metabolism in GDM pregnant women postpartum(OR=9.222,95%CI:3.503?24.282).OR=1.176,95%CI:1.014?1.364;OR=1.246,95%CI:1.142?1.360;OR=1.740,OR=3.559,95%CI:1.549?1.364;OR=3.069,95%CI:1.520?6.179).There was no significant difference in prenatal and postpartum serum lipid levels in the abnormal glucose metabolism group at 1 year,3 years and 5 years after delivery(all P were>0.05).Conclusion:(1)GDM patients had a higher risk of hyperglycemia,which contributes in the development of T2DM.Thus,long-term follow-up(after giving birth to approximately five years after giving birth)among GDM patients is necessary;it is particularly important for GDM patients to have OGTT within 42 days after giving birth.(2)Family history of DM,pre-pregnancy BMI,fasting blood glucose during pregnancy,islet function during pregnancy,and abnormal OGTT during pregnancy were all risk factors for postpartum hyperglycemia in GDM patients.The presence of abnormal islet function during pregnancy may be an independent risk factor for T2DM in GDM patients.