High rates of diabetes and pre-diabetes in postpartum period in Indian GDM women

Abstract

AbstractAimTo investigate postpartum glucose intolerance in South Asian Indian GDM women within 1 year of delivery.MethodsBetween 2001-2005, 220 women were treated for GDM at the Diabetes Unit, King Edward Memorial Hospital, Pune. GDM was diagnosed by 75g OGTT [WHO 1999 pregnancy criteria]. OGTT was repeated 3 months to 1 year postpartum. One hundred and nineteen non-GDM women were also studied.ResultsOf 220 GDM women [30years, BMI 26.0kg/m2] 9 women continued to be diabetic after delivery and a further 111 attended OGTT within one year of delivery. Two had IFG, 16 IGT and 23 diabetes [WHO 1999], thus 50[42%] women were glucose intolerant. Of the non-GDM, 1 had IFG, 8 IGT and 3 diabetes (10% glucose intolerant). Those who were hyperglycemic at follow up had stronger family history of diabetes [64% vs. 58%], were shorter [154.6 vs. 156.5cm], had higher FPG concentrations during pregnancy [5.27 vs. 4.99 mmol/L], and higher BMI [26.3 vs.25.0kg/m2] and waist circumference [88.0 vs. 82.3cm] at follow up compared to normoglycemic women. Hyperglycemia was not associated with GAD antibody positivity (4 vs 3 in normoglycemic).ConclusionWe describe one of the highest rates of postpartum hyperglycemia within a short time after delivery in young urban GDM women from India. Majority of risk factors for GDM were present from before pregnancy, and we propose that metabolic disturbances were also likely present. This has implications for peri-conceptional epigenetic programming of diabetes in the offspring. Pre-pregnancy screening and treatment of glucose intolerance and its risk factors in the high-risk populations could be an important measure for primordial prevention of diabetes.Key messagesWe describe one of the highest rates of postpartum hyperglycemia in young urban GDM women from India within a short time after delivery.Our results invite further research and policy discussion for screening and treatment of glucose intolerance before pregnancy in high-risk populations.